Shake off the winter blues!

Winter blues setting in? Dreaming of springtime? Well, the wait is almost over! March is a week away, and that means Spring is on its way! Longer days, long walks in the garden, and rain showers and rainbows are on the horizon. The meteorological calendar says spring begins March 1st, but the astronomical calendar says spring begins on the vernal equinox, which this year is March 20th! Regardless of which calendar you follow, tree pollen, the main culprit of the sniffles and sneezes during spring allergy season, is already starting to make an appearance!

Trees typically start producing pollen as early as January in the Southern U.S., and the Northern and Central areas follow with pollen production sometime in February. However, one outlier, the Ashe Juniper Tree (commonly referred to as Mountain Cedar) wreaks havoc in Oklahoma and Texas as early as December. Many trees keep producing pollen through June. The milder the winter season, the earlier the trees will begin producing pollen. Even late winter or early spring snowfall leads to pollen production by producing copious amounts of moisture when it melts which allows a greater volume of pollen production.

Pollen is a small powdery substance made up of small spores that come from male trees and flowers. There are two primary types of pollen, the first is “Sticky Pollen”. This pollen is produced by plants and trees that have bright and attractive flowers. This kind of pollen is the type that sticks to bees and is transported during flight, fertilizing other plants. These bright flowers are commonly thought to be spring allergy offender, however because they do not release much pollen into the air they are not as likely the culprit of allergy symptoms. The other type of pollen, however, is “Wind-Blown Pollen”. This pollen comes from larger trees like pine and oak. The pollen is released in large quantities into the air, fertilizing other trees of the same species. The tree pollen that typically causes the well-known nasal congestion, runny nose, and itchy eyes is typically the wind-blown pollen. This pollen is very small and light, and easily spread by the wind for miles and miles.

Those that suffer from allergies, can benefit from checking their local pollen counts, to determine the density of pollen in the air on any given day. Pollen counts are determined collecting pollen on special rods. The pollen is then counted under a microscope. The pollen count is then calculated in grains per cubic meter of air. Pollen counts tend to be the highest early in the day, or often when the wind picks up just before a large rainstorm. If you like dancing in the rain, or jumping in rain puddles, however, you are in luck because during a rainstorm and immediately following, pollen becomes still and dormant due to the rain making it damp and heavy. As the air becomes warm and dry following the storm, the pollen count will become potent again.

Those with tree pollen allergies should try to avoid heavily dense wooded areas, especially in early spring when pollen is the most dense and abundant. Also, those with tree pollen allergies should give careful thought into which trees they are planting this year in their yards. Major tree offenders that should be skipped over at the nursery are oak, birch, maple, cedar, juniper, and eucalyptus (unless you can guarantee they are female trees). Instead, look for friendlier species such as dogwood, pear, plum, redbud, or crape myrtle.

Pollen counts are never zero, nor will an allergy sufferer truly be able to avoid tree pollen in the spring. However, some practices like utilizing the air conditioner and keeping the windows and doors of their home and car closed and utilizing the dryer rather than the fresh breeze to dry clothing will help to decrease pollen exposures. Also, wearing of some masks will help to minimize the amount of pollen reaching the nasal passages if being worn in outdoor settings. Tree pollen allergy suffers should also make a habit of changing their clothes after coming in from being outdoors, and bathing prior to getting into bed/laying on upholstered furniture.

If someone is unsure whether tree pollen is a trigger for their spring nasal congestion, runny nose, post nasal drip, sneezing, and itchy watery eyes, seeing their provider for an allergy test may provide the clarity they are looking for. And you do not need to wait until spring! Now is the perfect time for allergy testing, BEFORE spring season is in full force.
If you are currently experiencing itching eyes, coughing, sneezing, runny nose, or congestion, your provider won’t leave you out in the cold! There is no better way to beat the winter blues by planning ahead for a great spring! A spring free of the burden of allergies! Whether you are currently suffering from winter allergies, or wanting to get a jump on spring allergy symptom prevention, typically this time of year providers can get you in quickly. If you are unsure if allergies are the cause of your symptoms, needleless allergy testing an offer an accurate diagnosis within minutes in the office. There are certain medications that should be temporarily avoided so that the results of the allergy test will be accurate. Make sure to talk to your provider prior to scheduling your allergy test visit to learn about which medications you may need to hold. Many symptom controlling allergy medications typically need avoided prior to allergy skin testing and so getting tested now before spring allergy symptoms are in full swing is helpful! Consider getting tested now, before symptoms are in full force and the thought of withholding medications that get you temporarily through the day seems impossible.
And whether an allergy diagnosis is brand new, or you are a long time suffering allergy veteran, your provider can also develop an individualized treatment plan, such as immunotherapy. Allergen immunotherapy can reduce or eliminate your need for medications.

Allergy is a chronic or long-term condition. Many allergy patients forget what it feels like to be well or symptom free. Allergen immunotherapy unlike medications is a natural long-term way to both treat and prevent allergies. This benefits you in symptom control and feeling better, but even more importantly in preventing the development of other allergies or asthma. Medications on the other hand are used for short-term symptom reduction rather than prevention or long term treatment. Many people, including children, also suffer side effects, some life threatening from these medications.


Six More Weeks of Winter

The first official Groundhog Day celebration took place on February 2, 1887, in Punxsutawney, Pennsylvania, and was the brainchild of local newspaper editor Clymer Freas. He sold a group of businessmen and groundhog hunters on the idea of gathering around the inaugural famous groundhog to see whether he saw his own shadow or not. Similar to this Groundhog’s Day just last week on February 2, 2022, the inaugural groundhog saw his shadow.

Punxsutawney Phil, as the groundhog is lovingly named, has promised all six more weeks of winter. Studies by National Climatic Data Center and the Canadian weather service have yielded a dismal success rate of around 50 percent accuracy for Punxsutawney Phil however, we are optimistic in Phil’s accuracy and hope to prepare everyone for additional exposures to winter allergens.

Winter weather and freezing temperatures do bring an end to seasonal pollen allergies, but millions of people are still living with winter allergies. Winter allergens, like indoor molds, dust mites, cockroach dander, and animal dander tend to increase in the home this time of year. Furnaces help to circulate airborne dust that is shaken loose from those much-anticipated holiday decorations coming out of the basement or attic. And indoor gatherings will continue to keep people warm but also exposed to the high concentration of these indoor winter allergens.

  • Dander It’s the dander (dead skin flakes), or saliva, not the hair of household pets such as cats and dogs, that can cause allergic reactions
  • Dust Mites These microscopic bugs might be the most common cause of year-round indoor allergies, notes the Allergy and Asthma Foundation of America. Dust mites thrive in bedding, carpeting, and the upholstered furniture inside your home.
  • Indoor Mold We all breathe in mold spores, but for those with an allergy, exposure can trigger sneezing, congestion, and itchiness. Mold and mildew favor damp areas, like basements and bathrooms.
  • Cockroach Droppings These persistent pests can live anywhere, and while they’re not a sign of an unhygienic or unsanitary household, it’s important to keep food well-contained and be vigilant about cleaning up crumbs. Fixing leaky faucets and pipes and sealing up cracks and crevices in your home can help keep cockroaches away

If you are currently experiencing itching eyes, coughing, sneezing, runny nose, or congestion, your provider won’t leave you out in the cold! Whether you are currently suffering or wanting to get a jump on spring allergy symptom prevention, typically this time of year providers can get you in quickly. If you are unsure if allergies are the cause of your symptoms, needleless allergy testing an offer an accurate diagnosis within minutes in the office. And whether an allergy diagnosis is brand new or you are a long time suffering allergy veteran, your provider can also develop an individualized treatment plan. Allergen immunotherapy can reduce or eliminate your need for medications.

Allergy is a chronic or long-term condition. Many allergy patients forget what it feels like to be well or symptom free. Allergen immunotherapy unlike medications is a natural long-term way to both treat and prevent allergies. This benefits you in symptom control and feeling better, but even more importantly in preventing the development of other allergies or asthma. Medications on the other hand are used for short-term symptom reduction rather than prevention or long term treatment. Many people, including children, also suffer side effects, some life threatening from these medications.

Allergy sufferers who also have asthma should be aware asthma symptoms can also become worse in the winter! Asthma symptoms can worsen due to cold and flu season, cold air outside, warm fires in fireplaces inside, and increased indoor allergens like we discussed previously.

Winter allergy sufferers can use a humidifier to reduce dryness in the air, but don't turn your home into a rain forest. Dust mites can thrive in humidity over 60 percent and temperatures of 60 to 85 degrees Fahrenheit. Mold also grows faster in high humidity. Rank recommends a maximum humidity of 50 percent. Is possible avoid wall-to-wall carpeting, which provides a favorable environment for dust mites. Use area rugs instead or hard wood/cement floors instead. Clean regularly, using a vacuum with a high-efficiency particulate air (HEPA) filter. Wash sheets weekly in hot water — at least 130 degrees Fahrenheit — to kill dust mites and use hypoallergenic cases for mattresses and pillows to keep dust mites trapped. Finally, minimize dander by bathing pets once a and try keep animals out of the bedroom or on the bed of anyone in the house who has allergies.


The BIG 9: Food Allergens

For the last 17 years, the official list of major food allergens, or “The Big 8” has consisted of milk, egg, fish, shellfish, peanut, tree nut, wheat, and soy. The Big 8 were part of legislation that was signed into law in 2004 requiring manufacturers to indicate on labels when a product was made using any of those eight ingredients, describing them as “major food allergens” because they collectively accounted for “90 percent of food allergies.” Now, sesame will take the coveted ninth spot nationally, as well as soon join the UAS panel of food allergens offered to providers for testing.

On April 23, 2021, the Food Allergy Safety, Treatment, Education, and Research (FASTER) Act was signed into law, declaring sesame as the 9th major food allergen recognized by the United States. Effective on January 1, 2023, clear and regulated labeling of sesame as an allergen will be required whereas previously sesame could be labeled as “spices”, “natural flavor”, or “artificial flavor”. This understandably makes it challenging to identify sesame in food products.

Why sesame? Currently, more than 1 million people in America are allergic to sesame, according to a 2019 study published in the journal JAMA (the Journal of American Medical Association). Like other food allergens, sesame allergy can produce mild symptoms like itching or hives, however it also has the potential to trigger anaphylaxis, and pose a life-threatening risk to those allergic to it. A sesame allergy is caused by a protein found in the edible seeds of the sesame plan, and therefore also in products made from the seeds such as sesame oil. People allergic to sesame must also watch for ingredients such as tahini, sesamol and gomasio, and foods such as falafel, sushi, hummus, and certain rice. The allergen can also be found in chips, cereals, snack bars and a variety of other foods.

Please see below for a more comprehensive list of sesame containing ingredients and sesame containing foods put together and published by the Food Allergy Research and Education organization (FARE):

Ingredients:

  • Benne, benne seed, benniseed
  • Gingelly, gingelly oil
  • Gomasio (sesame salt)
  • Halvah
  • Sesame flour
  • Sesame oil
  • Sesame paste
  • Sesame salt
  • Sesame seed
  • Sesamol
  • Sesamum indicum
  • Sesemolina
  • Sim sim
  • Tahini, Tahina, Tehina
  • Til

 

Food Products:

  • Baked goods (such as bagels, bread, breadsticks, buns, and rolls)
  • Bread crumbs
  • Cereals (such as granola and muesli)
  • Chips (such as bagel chips, pita chips and tortilla chips)
  • Crackers (such as melba toast and sesame snap bars)
  • Dipping sauces (such as baba ghanoush, hummus and tahini sauce)
  • Dressings, gravies, marinades and sauces
  • Falafel
  • Hummus
  • Flavored rice, noodles, risotto, shish kebabs, stews and stir fry
  • Goma-dofu (Japanese dessert)
  • Herbs and herbal drinks
  • Margarine
  • Pasteli (Greek dessert)
  • Processed meats and sausages
  • Protein and energy bars
  • Snack foods (such as pretzels, candy, Halvah, Japanese snack mix and rice cakes)
  • Soups
  • Sushi
  • Tempeh
  • Turkish cake
  • Vegetarian burgers

 


Prepare for Spring Allergy Season

Spring is fast approaching, and if you are a seasonal allergy sufferer, you likely associate this time of year with chronic sneezing, sniffling, and coughing. Your immune system is armed and ready to defend against harmless pollens, sending histamine soaring in your body triggering sneezing, runny nose, stuffy nose, watery eyes, and itching. Identifying the cause of your allergy symptoms before you start sniffling and sneezing can make them more manageable. Allergy testing can determine the specific allergens that trigger your reactions, and the results can help you try to avoid triggers and prepare ways to treat your symptoms before they occur.

Although many allergy sufferers turn their attention toward allergy care in the spring months, the winter months can be a great time to plan ahead and do allergy testing. A clinical evaluation, with allergy skin prick testing now can prepare you for the tougher months ahead in the spring, summer, and fall, and can potentially lessen the burden you will carry. Another key reason to have testing in the winter is that people may not be taking antihistamine medications in the off season. There are fewer potential pollen allergens outside during cold months, so many people are less likely to need their allergy medicine. First and second generation oral antihistamines, as well as nasal antihistamines and ocular antihistamines are typically recommended to be held for one week or 5-7 days to allergy testing (although some could as short as 3 days and some as long as 11 days). This can be particularly challenging for people during the peak of their worst allergy symptoms in the spring. Winter can provide a stable window for allergy testing prior to someone starting their medication or while symptoms are mild enough to discontinue without major episode or discomfort.

When preparing for an allergy skin prick test, it is important to share any and all medications you are taking with your provider. As discussed above, certain medications like antihistamines, can interfere with the development of a wheal and/or flare and negatively affect the accuracy of the allergy test. Many people understand the importance of temporarily withholding allergy medication or specifically oral antihistamines prior to testing, however antihistamines can be found in unsuspecting cases.  Antihistamines are found in many over the counter medications, including Tylenol Allergy, Actifed Cold and Allergy, Alka-Seltzer Plus Cold with Cough Formula, and many others. Make sure you read and check the ingredients carefully. Other medications your doctor may recommend temporarily stopping include tricyclic antidepressants, atypical antidepressants, benzodiazepines, and sedatives. Tricyclic antidepressants have the longest recommended wash out period ranging from 10-14 days. Benzodiazepines are recommended to hold for roughly 7 days, and most sedative and atypical antidepressants can be held for as little as 5 days. It is crucial to have direct guidance from your provider regarding temporarily withholding your medication and for how long. Never discontinue a medication without first discussing with your provider.

There are also few natural supplements worth withholding to ensure the accuracy of the allergy test results. Licorice, green tea, saw palmetto, St. John’s wart, turmeric, and feverfew can falsely reduce or eliminate positive results. Alternatively, astragalus and milk thistle can falsely increase or create positive results.

In preparation for an allergy test, it is equally important to know what medications should not be discontinued as it is to know which ones should. Intra nasal steroids such as Flonase, Nasonex, Veramyst, Nasacort, Rhinocort, and QNasal can be continued as directed prior to and during an allergy test. A nasal decongestant spray, Afrin, can also continue to be utilized. Although some stomach acid reducers such as Pepcid or Zantac do need to be discontinued due to their antihistamine properties, proton pump inhibitors such as Nexium, Prevacid, Prilosec, and Protonix can continue to be used. Similarly, although tricyclic antidepressants and atypical antidepressants can negatively affect the accuracy of allergy skin test results, other medication used for the treatment of depression such as selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are fine to continue taking as directed and do not impact the accuracy of skin test results. Singulair and all asthma medications can continue to be taken regardless of an upcoming allergy skin prick test, as well as common medications like Mucinex or Sudafed. Always make sure to discuss any and all medications (over the counter or prescribed) with your provider at least 1-2 weeks ahead of your scheduled test.


Contraindications for Immunotherapy

Allergies are not always clear cut and simple to understand. A person may assume that a certain food or substance is the cause of their symptoms and relate it to allergies, or they may not see the complete picture. We know allergy testing is extremely beneficial in allowing a provider to determine precisely what is or is not causing troublesome symptoms. Accurate diagnosis of the allergy, along with insights into any current medications that have failed to improve or control symptoms, avoidance measures taken, and impact on daily life enables your provider to determine the best treatment program which often includes immunotherapy.

When a provider is considering allergy testing and immunotherapy, it is important to take into consideration potential contraindications that may warrant a different approach including potentially refraining to utilize United Allergy protocol in a particular patient. A contraindication in our instance is a particular condition which makes allergy testing or allergen immunotherapy potentially inadvisable. A contraindication may be absolute meaning that is any situation that this condition is present it is definitely not advised allergy testing or immunotherapy is utilized. The majority of contraindications applicable to allergy testing and immunotherapy, however, are relative. A relative contraindication means a certain condition can drive concern and could increase risks making it possibly inadvisable. Risk vs benefit assessment needs to take place.

Patients that present with one or more of the following contraindications should be screened thoroughly by the provider and the benefits for testing and treating patients with immunotherapy must be weighed against the risks associated. This important assessment and determination on how to proceed will always rest with the ordering provider directly supervising the care of the patient.

  • Beta Blockers: We highly recommend providers that have patients on beta-blockers consider switching them to another medication if appropriate prior to initiating immunotherapy. A beta-blocker may mask cardiac signs or symptoms related to anaphylaxis. Also, if a patient has an adverse event, they may not respond to the epinephrine needed to counteract the life-threatening reaction. There is currently limited data available to support holding beta blockers for a short time period such as 24 hours prior to an allergy test or immunotherapy dose to increase a patient’s safety.
  • ACE Inhibitors: ACE inhibitors have been another cardiac medication thought to pose a risk if utilized with immunotherapy. ACE Inhibitors are considered due to their mechanism of action although whether they pose a significant risk as always been a major topic in academia. During an adverse reaction, it is thought that an ACE inhibitor can block the endogenous compensatory response manifested by the increased secretion of angiotensin-converting enzymes and prevent the destruction of kinins produced during the anaphylactic episode. The evidence regarding a true increased risk has not been clearly proven with environmental allergen immunotherapy and so is not currently included on our list of potential contraindications. Currently, data supports increased risk in venom allergen immunotherapy which is not offered under UAS protocol.
  • Cardiac conditions: Patients with historic and current cardiac issues such as congestive heart failure, myocardial infarction, labile arrhythmias, uncontrolled hypertension, or other significant cardiac problems could be negatively challenged clinically if they experience anaphylaxis due to allergy testing or immunotherapy. Furthermore, many of these patients may not successfully tolerate the consequences of epinephrine injections if required to treat anaphylaxis.
  • Previous history of anaphylaxis to aero allergens: Patients that have a history of previous reactions are much more likely to have a repeat reaction, oftentimes more severe than the initial reaction.
  • Pregnancy: Pregnant patients must remain at the same concentration level of immunotherapy throughout the pregnancy and should not increase the dosage volume or concentration. This is because repeating the same positively tolerated dose, protects the expectant mother and developing fetus from potential harmful effects of epinephrine should a significant systemic reaction occur. It is beneficial for patients that become pregnant or plan to become pregnant at prior to testing, or at low dosage/concentration, delay allergy testing and immunotherapy until the pregnancy has concluded.
  • HIV positive/ AIDS patients: AIDS or AIDS associated disorders are absolute contraindications to immunotherapy, however HIV+ status only is not always contraindicated according to literature. UAS currently recommends providers with patients with a positive HIV + status consider seeking an alternative protocol with an opportunity for closer and more consistent in office monitoring. However, despite this advisement, it is important to share there is no current absolute contraindication for a patient with a positive HIV status to begin allergen immunotherapy. There also are no large, controlled studies that can provide validity to the risks or to the benefits of allergen immunotherapy in HIV positive patients. There have been citations in recent literature to demonstrate both a negative response to initiation of immunotherapy (in which T-cell proliferation and RNA viral load increase occurred) and a positive response (a 3.5-year course of immunotherapy reduced symptoms and medication use, as well as provided well controlled symptoms 3 years port IT, without significant impact to HIV disease).  Each patient must be closely assessed on an individual basis.
  • Immunocompromised patients/ chemotherapy patients (including AIDS patients as mentioned above): Immunocompromised patients have not been shown in the literature to receive benefit from immunotherapy. Immunotherapy works by changing the T-cell repertoire. In immunocompromised patients T-cells are often altered. Thus, patients with an immunocompromised state are not recommended as candidates for immunotherapy.
  • Patients with autoimmune diseases or utilizing immunosuppressant medications: As quoted from the AAAAI “Although concern about the safety of allergen immunotherapy in patients with autoimmune disorders has been raised in the past, there is no substantive evidence that such treatment is harmful in patients with these diseases.” Due to the variation in these different disease states and individual patient situations, it is recommended the benefits and risks are assessed on an individual basis. When a patient is utilizing an immunosuppressant medication there are theoretical concerns that immunotherapy's benefit could be lessened, however there is no overarching body of evidence in literature that provides clear evidence of this regard. The best guidance I can provide for the ordering provider is to have full transparency with the patient regarding the theoretical concern of decreased efficacy of IT and considering holding immunotherapy during active exacerbations of autoimmune diseases.
  • Uncontrolled asthma/severe asthma/severe COPD: The group of patients with the highest risk of severe reactions to allergy testing or allergen immunotherapy are asthmatics, particularly those that have uncontrolled or severe asthma. This can apply to anyone with impairment, obstruction, or restriction of their airways. To protect against a negative outcome of a severe systemic reaction it is strongly recommended providers do not test, initiate immunotherapy, or continue immunotherapy while a patient is in a compromised respiratory state.
  • Eosinophilic Esophagitis (EoE) or Gastroenteritis: This is a concern that applies to sublingual immunotherapy ONLY and does not pertain to subcutaneous immunotherapy.  In sublingual immunotherapy, the allergen is swallowed and has direct contact with the esophagus. Swallowed food, and an allergic response to the food or allergen is presumed to be important in the development or worsening of EoE. Therefore, it is thought that exposure of an aeroallergen with the esophagus can produce the same effects. Package inserts for the FDA approved SLIT tablets indicate that eosinophilic esophagitis is a contraindication for use.
  • Inability to communicate: Patients undergoing allergy testing or allergen immunotherapy need to possess the ability to both mentally and physically participate in their diagnostic and/or treatment plan. The ability to clearly express and communicate active symptoms is crucial should an adverse reaction occur. Patients also need to possess the mental ability to understand the procedure or treatment ordered for them, be cooperative during the process, and understand the importance of their compliance.

United Allergy Services believes in appropriate patient selection (taking into consideration relative and absolute contraindications), doses building in a low, slow deliberate manner, and treatment in compliance with the relevant standards of practice guidelines. The proven safety results and efficacy of the self-administered subcutaneous immunotherapy protocol developed by United Allergy Services is based on a pre-selection of low-risk patients.  If there are additional questions or any additional information requested, please contact the Clinical Support Team. We are here to support providers and provide guidance as they provide excellent allergy care to their patients.

 

Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA. After spending 8 years in clinical practice, she joined United Allergy Services where she is currently the Vice President of Clinical. Amanda is also the past president of the Association of PAs in Allergy, Asthma, and Immunology. 

United Allergy Services is also on FacebookLinkedInor TwitterSee other interesting and related articles on the UAS Blog.


2022 - New Year, New You!

Happy New Year, and welcome 2022! The start of a new year arrives for many with guilt-laden resolutions to improve things like personal health goals. Resolutions to improve health can seem overwhelming and cause anxiety if they are unrealistic in the end goal or timeframe. Allergy and asthma sufferers do not have to overhaul an entire health plan to see some solid results. A few simple tweaks could make a big difference in easing sniffling, sneezing, and wheezing.

⦁ Adding Exercise – Is it even a New Year’s resolution if it doesn’t involve adding exercise or physical activity – and it’s an especially good goal for those with asthma! It is a common misconception, and one that can be detrimental to overall health, that those with asthma should not exercise. It is true that when asthmatics exercise in certain places or conditions, such as  in cold weather, it can make asthma symptoms worse, so avoid exercising outside if it’s cold and windy (or hot and humid). Air pollution – both indoor and outdoor – as well as high pollen counts, can also cause symptoms during exercise. Consider sports that typically require shorter bursts of exertion or activity like volleyball, gymnastics, baseball, wrestling, golf, and swimming. Using an inhaler before exercising and as needed during exercise can further help. If asthma limits your ability to exercise, talk to your provider to discuss a possible adjustment to your asthma medication routine, or better control of your allergies through testing and allergen immunotherapy.

⦁ Decrease stress – Numerous studies have shown that stress can cause negative health effects, including increased or worse symptoms for allergy and asthma sufferers. Consider downloading a meditation or relaxation app to use at night before bed. Soothing music can also be beneficial, as can doing activities you enjoy that lift your spirit.

⦁ Stop smoking or ban it from your surroundings – Quitting smoking and making your house a smoke-free environment could easily be the single best resolution to make as an asthma and allergy sufferer. This resolution should be on the top of your list. Direct smoke and secondhand smoke is extremely damaging and harmful to many parts of the body, but particularly the lungs. Studies have shown children with asthma who are exposed to secondhand smoke at home have nearly double the risk of being hospitalized than children with asthma who aren’t exposed. If you or your kids have asthma you should also try to avoid fireplace fires and campfires.

⦁ Protect yourself - It's important to do all you can to protect yourself against respiratory viruses like influenza, RSV, and COVID-19 because people with asthma and allergies can be at an increased risk for severe illness. For viruses like the flu and COVID-19, get vaccinated, or get a booster shot, wear a mask when appropriate and social distance.

⦁ Watch what you eat – but wait, this has nothing to do with dreaded dieting! -  For those with food allergies, remain diligent in avoiding the foods you are allergic to. This year, double down on making sure those you love, especially teens or college students, are being vigilant. Older kids sometimes believe not mentioning food allergies helps them not stick out among their peers. Encourage them to courageously educate their friends and enlist their help in the battle to stay allergen-free. Help them take control of their food allergies by urging them to be aware of what’s on the menu wherever they eat. Also, resolve to make sure epinephrine auto injectors are current and up to date, and that two separate doses or injections are always available to be utilized within 60 seconds of need.

⦁ Proactively see your provider – Each year people wait to discuss their allergies and asthma with their provider and be evaluated when pollen season and allergy symptoms are at their worst. Avoid reaching that level of suffering, the allergy season rush, and the inability to be allergy tested due to need for allergy medications by proactively seeing your provider now. Your provider can help you determine what is causing symptoms and show you how to avoid triggers.

 

Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA. After spending 8 years in clinical practice, she joined United Allergy Services where she is currently the Vice President of Clinical. Amanda is also the past president of the Association of PAs in Allergy, Asthma, and Immunology. 

United Allergy Services is also on FacebookLinkedInor TwitterSee other interesting and related articles on the UAS Blog.


Eczema and Atopic Dermatitis

We have made it to the highly anticipated holiday season! We ate more than our share of turkey, taken down the last of the fall décor, have started trimming the tree, and are double down on the holiday gift lists. With winter weather upon us or in the near future, and personal care products a favorite stocking stuffer, this is a perfect opportunity to think about proper skin care, especially if eczema or atopic dermatitis is present.

It is common for patients and even healthcare providers to use the terms ‘eczema’ and ‘atopic dermatitis’ interchangeably. All atopic dermatitis is a form of eczema, however not all eczema is atopic dermatitis. Atopic dermatitis is the most common form of eczema and typically begins in childhood. Someone suffering from atopic dermatitis typically has dry, itchy skin, as well as potential rashes that range from red/purple to brown/gray. The skin becomes so dry, itchy, and inflamed due to the immune systems hyperactivity, and loss of or lack of a protective protein called filaggrin that allow our skin to produce and maintain a strong skin barrier. Without a strong skin barrier, it is easy for moisture to quickly escape and bacteria carried by fingernails scratching the skin’s surface to get in.

Atopic dermatitis can be triggered by allergen exposure, stress, infection, or commonly weather changes. Atopic dermatitis can unfortunately worsen drastically in the winter, with this month being the start of the season in the US. The cold, dry air outside as well as the dry indoor heat cause the moisture to escape from the skins surface leading to dry skin. Issues with dry skin are further compounded by the tendency to layer up clothing and blankets, or taking lengthy and hot baths or showers.

If the itching keeps on giving this holiday and winter season, here are some helpful hints on how to help the skin survive and get some much-needed relief:

  • Dress in soft, breathable clothing and avoid itchy fabrics like wool that can further irritate the skin.
  • Despite the persistent itch, try not to scratch or rub the skin. This will cause additional damage and irritation as well as cause more heat on the surface of the skin which innately leads to more intense itching. By refusing to scratch, the itching cycle is broken and the skin is protected from virus and bacteria carried by fingernails.
  • For relentless itching sensations, apply cool, damp cloths to affected areas to cool the skin down. Also useful are cold compresses, ice packs, or even that bag of frozen peas in the back of the freezer. Just make sure to always place a towel or barrier between very cold or frozen items and bare skin.
  • Although hot showers and baths go hand in hand with winter weather, aim for lukewarm water bathing lasting for no more than 10 minutes.
  • When bathing, skip the harsh washcloths and loofahs. Instead use your hands to lather up with a good cleanser. (A cleanser is different than soap or body washes. Soaps and body washes typically contain sodium lauryl sulfate which is a skin irritant, and are not as moisturizing or hydrating as a cleanser)
  • Make sure cleansers, moisturizers, detergents, and skin hygiene products are fragrance free and dye free. (Look for the National Eczema Association Seal of Acceptance on products to guarantee they are free of fragrance, dyes and other common allergens.)
  • When done bathing, pat the skin dry rather than harshly rubbing.
  • Replace moisture in the skin by applying a moisturizer immediately after taking a bath or shower. Try to aim for moisturizing to occur within the first 3 minutes.
  • Moisturizers can be classified as an ointment, cream, or lotion based on the amount of oil and water they contain. The more oil in a moisturizer, the better it usually is at providing relief and even treating atopic dermatitis. Ointments have the highest oil content and are the best line of defense for atopic dermatitis.
  • Try using a humidifier.  Make sure to change the water in the humidifier and clean the machine every three days. Consider using distilled or demineralized water.

The National Eczema Association is a great resource for learning more about eczema, atopic dermatitis, causes, symptoms, and treatment options. There is a wealth of information on their website: https://nationaleczema.org/


Dust Mite Allergy

Halloween may be over, but there are certain creepy creatures that diligently remain year-round and commonly trigger allergy and asthma symptoms. Dust mites are eight-legged relatives ticks and spiders, have no eyes, have translucent bodies, and are microscopic, or too small to see with the unaided eye. These tiny creatures love to make their home on human and pet bedding, mattresses, carpets, curtains, toys and upholstered furniture. They love to choose these locations for their homes because of the plentiful food supply. Dust mites regularly feed on the dead flakes of skin that people and pets shed daily and gain their water from moisture found in their environment (think humidity and sweat!). They live somewhere between 60 and 100 days.

Dust mites are well adapted, and currently inhabit every continent except Antarctica. There are two main species of dust mites, the American house dust mite (Dermatophagoides farinae) and the European House dust mite (Dermatophagoides pteronyssinus). Providers utilizing United Allergy Services for their patients’ allergy needs can safely test and treat their patients to both species of mite. Dust mites, as opposed to bed bugs or other parasites, will not and cannot bite you. Dust mites are extremely lightweight and cannot be felt crawling on the skin. They can cause allergic or asthma symptoms in some when those sensitive to them inhale the microscopic fecal matter and shed skins of the mite.

As with any allergen, the goal is to first identify the allergen as troublesome to the individual person and develop a treatment plan. A treatment plan should always include how to reduce the exposures to the offending allergen. However, if your home has humans or pets living in it, there are dust mites present, and it is impossible to avoid them completely. There are several things that can help diminish their food supply and create less of a welcoming environment. The best approach with dust mites is trying to convince them that their current environment will be too much work to maintain their existence. Trying to kill them is almost impossible, there is no spray or pesticide currently labeled in the United States for the destruction of dust mites, and dead dust mites still shed the problem causing protein that triggers allergy and asthma symptoms.

Hard surfaces such as vinyl, wood, or tile, and other hard surface blinds instead of curtains or draperies are helpful in decreasing the dust mite colonization in a home. It is also beneficial to select leather furniture as opposed to upholstered and remove things like books, lamps, knick-knacks, and dust catching items from a room. These steps, although beneficial to a home, can be challenging if home renovations are not in the budget. And who plans to live in a home without any type of lamp, picture frames, or other décor? There are other steps to reduce the dust mite colonization of a home.

First and foremost, a regular and thorough cleaning of the surfaces and regions that dust mites are most likely to dwell is an easy front-line approach to sending dust mites searching for another place to call home. It is especially important to focus on where someone will sleep as this is when a person can spend upwards of 8 hours a day breathing in potential allergens. Cleaning and washing all bedding such as sheets, blankets, and pillowcases in a hot, sanitary cycle is recommended once weekly. Sleeping quarters can further be protected from dust mites by using special covers and encasements to keep out these unwanted visitors. An encasement should be placed on each mattress and sleeping pillow in the home. As well as cleaning and covering areas in which sleeping occurs, it can be beneficial to keep pets and copious amounts of dust collecting stuffed toys out of sleeping areas and off beds as well.

Dust mite body casings are lightweight and can easily become airborne and travel through the air. Ceiling fan blades can harbor dust and dust mites and allow dust to become easily airborne. It is imperative to regularly dust fans, especially before turning on.  Air quality can also be improved by using a high-energy particulate absorption (HEPA) air purifiers on the air conditioning and heating units, as well as the vacuum to remove many allergens, especially dust mites, from the air. A dehumidifier can also be helpful as it helps to create a less favorable environment for the dust mites to survive. Remember, dust mites get their water supply from the humidity in the air as well as human and pet moisture, aka sweat, left behind! Just make sure to regularly clean the dehumidifier unit to prevent mold growth. And finally, wearing a mask can be beneficial to allergy and asthma sufferers when cleaning the home, removing bedding or drapery for washing, or taking out and putting away things from storage spaces like holiday decorations.


Respiratory Care Week, October 24-30

As we settle into this final week of October and prepare for some frightful fun at the end of the week, let’s all take a big deep breath in before the end of the year holiday season is upon us! Speaking of that big deep breath, October is Healthy Lung Month and this week, October 24-30 is Respiratory Care Week. This week we focus on the importance of protecting our lungs against infections like bronchitis, allergens such as mold, air pollution and smoking because if we take care of our lungs, our lungs will take care of us.

One of the more impactful allergens on the lungs specifically, is mold. Mold is a type of fungi, and the seeds or spores of the mold travel easily through the air to reproduce and grow. There are many different types of molds, and some spores thrive in dry, windy weather while other spores need damp, humid environments. Although there are many different types of molds, not all mold is responsible for allergic reactions. The most common allergy-causing molds include Alternaria, Aspergillus, Cladosporium and Penicillium.

Mold is unfortunately everywhere, indoors, and outdoors, and is a year-round allergen, although is typically at its highest from July through October or November. Some of the most favorable places for mold growth are on rotting logs or plants, piles of fallen leaves, compost piles, and on grasses or grains. Mold also tends to grow in cool, damp environments indoors such as basements, kitchens, and bathrooms. Tracking symptoms along with exactly where someone has been, can be extremely helpful to a provider trying to determine if mold is an allergen for their patient and the culprit for the troublesome symptoms the patient might be experiencing. Everyone breathes in mold spores on a regular basis, however, those that have an allergy to mold can experience itchy nose, mouth and lips, sneezing, itchy, watery eyes, and nasal symptoms. Those allergic to mold with underlying allergic asthma are especially susceptible to increased wheezing, coughing, chest tightness, or shortness of breath.

With molds living indoors, outdoors, and year-round it might seem overwhelming to figure out how to avoid this troublesome allergen. Similar to pollen counts, mold spore levels in the air are regularly tracked and reported so it is important to check the allergen forecasts and try to limit time outdoors when counts are high. Planning for indoor exposures can be a bit more challenging, however, some spots like greenhouses, farms, flower shops, construction sites, and antique shops are bound to have higher mold spore counts. Plan to take additional allergy medication, avoid during symptom exacerbations or bring a mask to help lower exposures.

Large fields of grains and grasses, and piles of dead, damp leaves are prime places for mold. Avoiding those places is beneficial, and if planning for the young or young at heart to jump in their fall leaf piles, try to plan for a day with low outdoor mold counts if possible. It is important to try to immediately shower after outdoor activities like mowing, or jumping in leaves, especially before crawling into bed. This will help to wash away any allergens that have adhered themselves to your skin or hair and are hoping to enjoy your comfortable accommodations right alongside you. This is especially important before allowing them to have access to your pillow or sheets and being in the immediate space and air you breath in all night.

Finally, and possibly the most important, let’s focus on how to minimize mold existence and exposure in the home environment. As discussed previously, indoor mold tends to prefer damp, humid environments, and areas with high levels of moisture in the air. Consider using a dehumidifier and air conditioners/heating units fitted with high-efficiency particulate air (HEPA) filters. It is best to try to keep humidity below 60%, ideally between 35% and 50%, and that can be easily tracked with a humidity meter available at a low cost at most hardware stores. Mold can thrive in warm, damp bathrooms and humid kitchens. If the kitchen or bathroom has an exhaust fan, use it, especially when taking a shower or bath. This will help to further reduce humidity in these rooms.

Clean surfaces do not provide a conducive environment for mold spore attachment and reproduction however soap scum in the bathroom or grease in the kitchen do provide an inviting area for mold growth. Aside from regular cleaning, it helps to closely monitor counters, and more importantly refrigerators, drip pans, door seals, showers/baths, AC drain lines, dryer vents and garbage pails. If the kitchen and bathroom have proven to be difficult areas to control mold growth, consider removing carpeting from kitchens, bathrooms, and basements, and replacing with linoleum or concrete flooring to inhibit floor mold growth as these surfaces do not hold moisture. Finally store things like old schoolwork, projects, paper, and clothing in plastic, airtight containers as opposed to plastic bags.


football, food, and fall allergies

Football, Food, and Fall Allergies

Fall has arrived and so have shorter days, cooler weather, and football season! Unfortunately for some, football, food and fall allergies go hand in hand. This is especially true in the southern and western regions of the US where some weed allergens peak in the fall. The idea of sneezing and wheezing with itchy, watery eyes while watching a game or practice can be dreadful. Perhaps more concerning is visiting major sports venues if you or a loved one have food allergies.

Outdoor Allergies

It is common to check the weather forecast to plan for warm or cool temperatures when attending sporting events. . A good habit may be to also check the local pollen counts in the area. Keep in mind that peak pollen times are typically in the first half of the day (specifically 5am 10am). Attending practices or games midday, in the afternoon, or in the evening may help to reduce exposures.

Avoidance for Fall Allergies

If you have a future MVP of your own, packing some wet wipes could be helpful. Wiping down their hands, face and neck can combat those distracting allergy symptoms when out on the field. Also, verify any allergy medication they take will not make them drowsy during their practice or game. Non-sedating medication options or allergen immunotherapy may be worth discussing with their provider.

After practices or games, changing out of the clothing worn while participating or spectating can help alleviate allergy symptoms. Also helpful is an immediate shower, particularly before crawling into bed. Showering will help to wash away any allergens that have adhered themselves to your skin or hair. This is especially important to keep them out of the immediate space and air you breath in all night.

Food Allergies

If food allergies are a concern, planning ahead can alleviate a lot of anxiety and allow for a smooth trip. Always make sure to carry a minimum of two epinephrine auto injectors if one is prescribed to you or a loved one. Make sure the epinephrine autoinjector is carried in a way it can be accessed and administered within 60 seconds of a need arising. The Food Allergy Research and Education (FARE) organization recommends “to reach out directly to the venue to learn more about their efforts” in regard to additional steps they may be taking to ensure your family’s safety at the game.

Food Allergy TipsFootball and Food Allergies

Some suggested topics to cover when you contact the venues are:

  • Availability of allergy friendly games, sections, or suites
  • Is power washing utilized for seating, and traffic pathways at the stadium?
  • Are ingredient lists available upon request at the concessions?
  • Policy for bringing in safe meals and snacks
  • Locations for emergency responders

Planning and communication make it possible to avoid fall allergies and enjoy football season. Communicate with family, friends, coaches, players, and venues, and create a plan that is right for your family. However, missing out on football season does not have to be part of that plan. If you or your loved ones are not quite sure if allergies are playing a roll, or if the allergy medication is just is not cutting it, consider contacting your provider and discussing allergy testing and starting allergen immunotherapy.

 

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Amanda Hofmann, MPAS, PA-C, is a graduate of Duquesne University, in Pittsburgh, PA. After spending 8 years in clinical practice, she joined United Allergy Services where she is currently the Vice President of Clinical. Amanda is also the past president of the Association of PAs in Allergy, Asthma, and Immunology. 

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