Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis (EoE) is a recognized diagnosis that produces symptoms related to dysfunction of the esophagus. In EoE, large amounts of white blood cells, specifically eosinophils, collect in the inner lining of the esophagus resulting in inflammation. Typically, the esophagus is free from eosinophils and resulting inflammation, and so in EoE, a patient will begin to notice a difference in the way they can eat and swallow food. This condition can be difficult to diagnose as other conditions can present with eosinophils in the esophagus, and historically EoE has not been a common or well-known disease. Awareness has significantly improved however in the last decade, and patients are being recognized and diagnosed much earlier. This week, the FDA has approved the first ever treatment for EoE.

Symptoms of EoE

Many EoE patients also have symptoms of one or more allergic disorders like asthma, allergic rhinitis, atopic dermatitis (eczema) and food allergy. It is important for EoE patients to be properly assessed and tested for potential allergens as well as properly diagnosed for their atopic conditions. Similar to proper diagnosis, it is crucial that any and all allergic aspects of EoE can be properly treated in conjunction with management of the EoE. Patients benefit from a team of providers working together such as a primary care provider, allergy specialist, and gastroenterology specialist.

Early diagnosis of this chronic condition is important so patients can be educated and properly managed, sparing them from discomfort, malnutrition, and even life-threatening situations. An emergent situation can arise if inflammation becomes too great and causes narrowing in the esophagus, trapping swallowed food. In younger children, EoE typically presents with poor feeding, failure to grow properly, vomiting, reflux symptoms, and abdominal pain, whereas in adolescents and adults EoE most often presents with dysphagia (trouble or painful swallowing) and emergent esophageal food impactions.

Allergy Correlation

Allergic symptoms are similar to those of EoE
Allergic symptoms are similar to those of EoE

Airborne allergies can play a role, however adverse immune responses to food are the main cause of EoE in many patients. It can be more difficult to properly diagnose food allergies in EoE patients because many do not present with the typical symptoms associated with IgE mediated food allergy. Instead of immediate itching, flushing, hives and vomiting after ingestion of the offending food, the reactions can be delayed over hours or days. Milk, egg, soy and wheat are recognized as the most common triggers for EoE, however, conventional allergy tests often fail to detect sensitivity to the foods causing EoE. This is because most food allergy reactions in EoE are delayed and caused primarily by immune mechanisms other than classical IgE-mediated food allergy.

Diagnosis

Other than proper identification and diagnosis of atopic conditions, EoE must also be properly diagnosed itself as a disease. If EoE is suspected, a specialist performs an upper endoscopy, where a small tube with embedded camera is passed down the esophagus. The tube not only has a camera and light for inspection, but a small device to take samples, or biopsies of the esophagus. The biopsies of the esophagus are examined under a microscope for eosinophils and inflammation and are necessary to diagnose EoE. A provider looks for appropriate symptoms that were described above, visual inspection of the esophagus, and examination of tissue biopsies to make the final diagnosis of EoE.

Managing EoE

There are many viable options to managing EoE effectively. Food sensitivities or allergies can be managed by removing those offending foods from a person’s diet, but only under the direct guidance and supervision of a provider. A provider can advise eliminating a specific food, or a food group based on individual history, examination, and diagnosis.  This elimination approach can be helpful to some, but it is important to only remove what is advised, and a medical provider will closely monitor a person and regularly discuss nutrition and intake. Many times, a dietician is added to the medical care team to make sure a person is still receiving all the necessary nutrients. A provider’s goal is to carefully add back any foods that can in fact be tolerated and are proven not to incite eosinophils in the esophagus.

Aside from adjustments to a person’s diet, there are some medications providers use to help provide symptom relief and management of the EoE. It is important to note that aside from the first medication being approved by the U.S. Food and Drug Administration (FDA) to treat EoE, typical options for treatment include proton pump inhibitors and steroids. Proton pump inhibitors (PPIs) reduce acid production in the stomach and have also been found to be able to reduce esophageal inflammation in some patients with EoE. PPIs are very commonly used as a frontline therapeutic for EoE patients. If PPIs do not work for a patient, another option may be swallowed topical corticosteroids. Swallowing small prescribed doses of corticosteroids so they come in direct contact with and treat the inner lining of the esophagus is the most common treatment.

 

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.


Allergies, Asthma, and Air Quality

As we move into the summer months, it is important to understand the connection between allergies, asthma, and air quality. While air pollution does not directly cause allergy or asthma, it can increase the risk of developing atopic disease. Air pollution can also trigger allergy or asthma symptoms or an asthma attack for persons with existing conditions. Air pollution usually increases during summer months. This pollution leads to an increase in related symptoms, urgent office visits, and emergency room visits.

Air Quality Components

Allergy and asthma symptoms can be triggered by two key air pollutants, ozone (found in smog) and particle pollution (found in haze, smoke, and dust).

The link between Allergies, Asthma, and Air Quality
Allergies, Asthma, and Air Quality
  • Ozone, a gas, is one of the most common air pollutants, contributes to smog, and is more common in cities where there are a lot of cars. In the summer months ozone can increase when intense sunlight and heat convert a mixture of tailpipe and power plant emissions with other chemicals resulting in unhealthy air. Allergy and asthma symptoms may trigger more easily because ozone is irritating to the lungs and can reduce lung function.
  • Particle pollution is present and stable throughout the year but is typically worse near busy roads, during rush hour and around factories. It is also high when there is smoke in the air from wood stoves, fireplaces, or burning vegetation. These small particles can irritate the nose, throat, and especially the lungs, and also reduce lung function and cause asthma exacerbations.

Air Quality Reports

The United States Environmental Protection Agency (EPA) reports air pollution levels using the Air Quality Index (AQI). AQI reports the level of ozone and other air pollutants. When the AQI is 101 or higher, it is dangerous for people with allergies and especially asthma. Sometimes asthmatics can experience increased symptoms even when ozone levels are moderate (AQI 51-100). Many local news stations and weather forecasters report local air quality to advise the public about moderate or high pollution days.

Another resource, The American Lung Association has just released their annual State of the Air report. One interesting finding in the report is, “The addition of 2020 data to the 2022 “State of the Air” report gives a first look at air quality trends during the COVID-19 pandemic. Regardless of the shutdowns in early 2020, there was no obvious improvement.”

Combatting Air Quality Conditions

When air quality may be dangerous to people with allergies or especially asthma, they are deemed as “Action Days”. During Action Days, people with asthma should limit their time outdoors, especially in the afternoon or rush hour periods, stay in a well-ventilated, preferably air-conditioned, building, and most of all, do not intensely exercise outdoors. Also try to keep windows closed in your home and car, and instead utilize the air conditioning on the recycled setting.

There is also a risk that you could have poor indoor air quality within your home. Irritants can exacerbate allergy and asthma symptoms. These and allergy and asthma triggers are common items such as:

  • household cleaners
  • hair products
  • perfumes
  • air freshening sprays or plug ins
  • scented candles/diffusers
  • smoke produced from
    • tobacco
    • fireplaces
    • candles
    • cooking
    • wood burning stoves

Not smoking or permitting smoking in the home is one of the easiest ways to protect the home from indoor air pollution. Finally, be mindful of high humidity and mold growth. These two factors can greatly impact indoor air quality. Installing exhaust fans in kitchens, bathrooms, and laundry rooms can help lower humidity. The use of a dehumidifier helps significantly as well.

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.


Earth Day

Earth Day and Climate Change Effects

Earth Day is this Friday, April 22nd. Earth Day is truly a mainstay in American culture, created by Past-President Richard Nixon. This year the Earth Day theme is “Invest in Our Planet”. We are called upon to have “unstoppable courage to preserve and protect our health, our families, our livelihoods…” One of the continued focal points of interest is trying to put a dent in rising global temperatures, with an average increase of 2.4 degrees Fahrenheit in the last 50 years. It doesn’t sound like a lot, but each degree brings bigger changes than many realize. The rising temperatures have a directly negative impact on allergy sufferers and those offering optimal allergy care to their patients.

Effects on the Planet

Earth Day
Climate change and growing pattern effects

Warming temperatures results in longer growing seasons. Although people tend to enjoy nature’s natural beauty a bit longer, and famers have additional time to harvest crops, the increase in temperatures prolong and worsen the suffering of those with pollen allergies and can cause an imbalance in the optimal growth range for crops and cause foods shortages.

Different plants require different conditions to grow, and when the climate continually changes, so do the arrangements and floristic zones of the world’s plants. As the planet warms, we continue to see the planting zones where these plants grow will continue shifting north. Shifting planting zones threaten things like accurate allergy testing panels, cocoa beans for chocolate producers, coffee beans, and maple syrup. Plant species, being entirely mobile beings, will be forced to move upslope or downslope, or species with arrange themselves in new combinations entirely. Finally, the rising temperatures also negatively impact plants by impacting the pollinators that assist with their growth. Warmer temperatures and changing climates have negative effects on pollinator species like butterflies and honeybees. This further shift growing and blooming seasons and further weakens the plant populations.

Allergy Amplification

As the planet warms, allergy season tends to begin earlier and last longer each year. Talk to your primary care provider about allergy testing and treatment options if you notice that your allergies are worsening. You may be a great candidate for immunotherapy, a solution to change the source of your allergy misery rather than treating just the symptoms.

 

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.


Easter and Passover food allergy tips and suggestions

Easter and Passover Allergy Concerns

The Easter and Passover holidays are here! Holidays mean family centered fun, festive meals, and usually sweet treats to enjoy. For allergy suffers, however, holidays like Easter and Passover can be challenging to navigate with traditional holiday foods containing hidden allergies, and the high tree pollen counts over most of the country by this time. Aside from the usual pollen and food allergies, brightly dyed eggs, household pets, and sweet baby chicks and bunnies can also wreak havoc on the nose and chest. Here are some tips to navigate the upcoming holidays and ensure that you and your family have a safe and happy holiday.

Allergy friendly meal options
Easter and Passover

Traditional holiday meals are at the cornerstone of Easter and Passover. Plan the meals out in advance and be mindful of any guests that may have a food allergy. Be flexible and try to switch ingredients for allergy-friendly alternatives, eliminate a recipe from the menu altogether, or take care to prepare allergy-friendly dishes separately from the other meals. If you are not sure whether guests have a food allergy, consider printing recipes out for each of the dishes and allow people to determine if it’s a safe food for them to indulge in. Also consider avoiding a buffet style offering, or separating allergen safe foods from allergen containing foods in two different areas or tables.

These spring holidays typically mean chocolate and sweet treats to younger members of the family, or those young at heart. Try to again consider those guest and family members that may have allergies to things like chocolate, so they are not left sitting on the sidelines. Allergy to chocolate itself, or the cacao bean, is incredibly rare, however more commonly the offenders are milk, peanuts, tree nuts, soy, and corn. A little research will provide an array of options of dairy free or peanut/tree nut free brands of treats. Always check labels to see if the offending food in contained in the ingredients list, or mentions it was produced in a facility that also processes other allergen containing foods putting your loved one at risk of cross contamination. Keep in mind most chocolate does contain soy in the form of soy lecithin to keep it solid at room temperature, and white chocolate commonly contains corn in the form of corn syrup. If the treats offered are of the homemade variety, it can be even more challenging for a food allergy sufferer due to lack of label to research ingredients. If you suffer from food allergies, a good rule to follow if “If you can’t read it, don’t eat it”. Plan to bring some of your own safe snack or goodies, unless you can make sure your host prepared foods allergen free, safely away from other allergen containing food, and on a separate and thoroughly cleaned surface. In lieu of store bought or homemade edible treats, consider offering nonfood items for younger guests such as books, sporting goods, stickers, novelty items, or toys.

Although most food allergens are most offensive if ingested, it is important to consider that some people do have reactions or develop irritations from contact exposure to egg or the dyes used to make them bold and bright. If colorful dyed egg hunts are part of your spring holiday tradition, there are alternative ways to include everyone on the fun.  Instead of coloring eggs with traditional eggs and traditional dye, consider eggs made of wood, ceramic, or plastic, and consider natural dye alternatives. Other options include making gelatin eggs, egg sugar cookies for decorating, or decorating marshmallows in place of eggs. Also, consider replacing the hard-boiled egg on the Passover Seder plate with a ceramic or plastic egg to keep guest anxiety free.

If the above-mentioned allergies are life threatening for you or a loved one, always make sure to carry a minimum of two epinephrine auto injectors if it is prescribed. Make sure the epinephrine autoinjector is carried in a way it can be accessed and administered within 60 seconds of a need arising. If you or a loved one does have life threatening allergies, it is always a good idea to check with your health insurance and ensure you know where to seek medical care should the need arise if celebrating the Spring holidays out of town.

Food allergens typically are the easiest to keep front of mind during the Easter and Passover holidays, however equally as difficult for allergy suffers and arguably more difficult to avoid are the tree pollens and mold spores blowing in the air. These unwanted guests can ruin any picnic or outdoor gathering with nasal, sinus, eye, and chest symptoms. If there is both indoor and outdoor venues at the celebration location, try to minimize the time spent outdoors. If you are hosting the celebration, try to offer an indoor haven if planning to spend time outdoors, as well as keep windows and doors closed at the indoor space. Also, minimize the exposure to outdoor allergens while traveling to the destination by keeping windows up in the car and instead using the air conditioning.

It is a good habit to always check pollen counts for the area where you will be celebrating, and if planning the celebration try to plan for it to start mid-day or later due to peak pollen times typically occurring in the first half of the day (specifically 5am 10am). Also, it would be beneficial to plan the event outside of heavily grassy areas or those densely populated with trees. This may help to decrease the concentration of allergens in the air.  If the celebration will be entirely outdoors with no indoor refuge, it is a good idea to make sure you are on top of your allergy medication or immunotherapy regimen before going, and make

Easter and Passover allergy friendly meal options
Easter and Passover

sure to pack a few changes of clothing as well as wet wipes for the ability to remove pollen from your immediate environment every few hours. Once you return home from the festivities, plan to shower or bathe before prioritizing any other activities. It is especially important to bathe before crawling into bed, to remove any allergens that have adhered themselves to your skin or hair. 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.

Many people choose to show their appreciation to their host or show their love to their family by bringing beautiful spring flowers or plants to the Easter or Passover celebration. Unfortunately, people can have severe symptoms such as sneezing, along with nose and eye itching and watering related to the pollen, or just the smell of particular flowers. Even an asthma attack can be triggered from them. According to the American College of Allergy, Asthma and Immunology, there are many flowers you can get at a florist that produce little pollen. Look for tulipsroses, begonia, columbine, crocus, daffodil, and geraniums if you want to be safe.

We cannot forget about the cherished furry family members that may be in attendance for the spring holiday celebration, as well as the propensity to give the give of baby chicks or bunnies this time of year. Dander, saliva, sweat, and urine from adorable dogs, cats, and even bunnies can trigger an allergic response in some people. If possible, try to keep pets confirmed to only a certain area of the celebration so that those that wish to enjoy them can, while those that are unable can find refuge elsewhere. Make sure to thoroughly wash your hands before returning to an animal free area of the celebration, before partaking in shared food items, or before touching your face, mouth, or eyes. Also, make sure the recipient of a new spring pet is not triggered by them. Although recent literature has shown us a true allergy to bird feathers is rare, there are substantial amounts of dust mites found in feathers that can trigger unwanted allergy symptoms.

If you or a loved are unsure whether tree pollen, grass pollen, mold spores, dust mites, or animal dander are potential allergy triggers and the cause of the nasal congestion, runny nose, post nasal drip, sneezing, and itchy watery eyes you have been suffering with, seeing your provider for an allergy test may provide the clarity they are looking for! Some providers may have the ability to access food concerns as well! And if you are already aware of true allergy triggers, but the spring allergy medication and avoidance measures are just not cutting it, there is still time to see your provider and discuss starting allergen immunotherapy.

 

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.


Botanical sexism

Botanical Sexism: Does it impact allergy sufferers?

What is Botanical Sexism? Tom Ogren, horticulturist and allergy researcher, has done extensive research on ways to reduce pollen counts and pollen potency. His theory centers around the unbalanced planting of male vs female plants. This unbalance can impact pollen counts and the resulting escalation of pollen allergies. He wrote and published an article in Scientific American, coining “botanical sexism” to explain his theory. Ogren believes a better mix or “gender balance” of male and female trees, especially in urban settings, would lower pollen counts.

Ogren’s article focuses on the foundation set in the 1949 USDA Yearbook of Agriculture which reads, “When used for street plantings, only male trees should be selected, to avoid the nuisance from the cottony seed.” This idea comes from the fact that male trees produce pollen, and female trees receive that pollen and produce fruit and seeds. It was recommended to plants primarily or all male tress to avoid messy sidewalks and parks from the flowering female trees that would drop their seeds and fruits.

Tree System Selection

Is botanical sexism a natural selection? Trees have four primary sexual systems: cosexual, monoecious, dioecious and polygamous. A tree that produces single flowers with combined fully functional male and female parts

Male and female trees play a role in pollen count
Are your trees male or female?

is called cosexual. Monoecious trees similarly have both male and female parts within the same tree, however they separate the male and female parts into different flowers or cones on the same tree. Dioecious trees separate male and female parts on completely different trees where one tree is strictly female and one strictly male. These trees were Ogren’s primary focus. And for completeness we will define polygamous trees as the most complex and as cosexual, with male and female flowers on the same tree but also with separate male and female parts in different combinations on completely different trees.

Ogren’s work focuses on dioecious males planted independently of dioecious females. This is often the case in urban areas due to the cleanliness concern described above. When this occurs however, their pollen is unchecked by any capture by female flowers and causing copious amount of pollen to be distributed in the air to cause coughing, sneezing, and respiratory issues. Tree pollen is one of the greatest offenders of not only allergic rhinitis, but also allergic conjunctivitis and allergic asthma as well.

Pollen Count Impact

Botanical sexism referenced higher pollen counts due to failed tree “gender balance”,  and is further exacerbated by higher pollen potency. Studies have shown that air pollution (which tends to be higher in urban settings) attaches to pollen grains and causes the powdery substance to shatter into still tinier pieces. “When that happens the inside of the pollen grain is exposed and that’s 10 times more allergenic than the outside,” explained Ogren. This is again exacerbated by increasing CO2 levels which causes plants to bloom at a faster rate and at a higher content which means even higher pollen counts where predominantly male trees reside.

Purpose of Defining Botanical Sexism

Prime allergy season is usually defined as mid-March to early June in most of the United States. Frequency of allergic rhinitis (AR) diagnosis increase greatly during this season. AR affects more than 400 million people worldwide, and is expected to rise by another 100 million by 2025. Ogren collected extensive data, and by 2000 was able to develop a scale called OPALS (Ogren Plant Allergy Scale) that ranks more than 3,000 plants from 1 to 10 based on how allergenic they are. This was the first numerical ranking system in existence for plant allergies and is used to develop allergy rankings in large US cities.

Ogren’s work is meant to encourage city planners, plant distributors, and homeowners to think carefully about their plant choices. He feels we all are all responsible for the rising numbers of allergy sufferers, and we, by making the correct plant choices, can at least reduce the amount of allergenic pollen in the air. Examples of plants that are allergy friendly include pansies, impatiens and snapdragons.

 

 

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.


Tree Pollen and Pollen Counts Explained

March is here, and so is Spring! Spring has officially started which brings longer days, refreshing rain showers, bright colorful flowers, and of course…tree pollen!

The majority of trees typically produce pollen as early as January in the Southern United States. The Northern and Central areas follow suit with pollen production kicking off in February and continuing through June. The milder the winter season, the earlier the trees 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. However, there is an outlier. The Ashe Juniper Tree (commonly referred to as Mountain Cedar) wreaks havoc in Oklahoma and Texas as early as late November or December.

Tree Pollen

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 is the type of pollen that sticks to bees and is transported during flight, fertilizing other plants. These bright flowers are commonly thought to be spring allergy offenders, however, because they do not release much pollen into the air they are not 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 well-known nasal congestion, runny nose, and itchy eyes is typically the wind-blown pollen. This pollen is very small, light, and easily spread by the wind for miles and miles.

Those that suffer from allergies can greatly benefit from checking their local pollen counts to determine the density of pollen in the air on any given day. Pollen counts go up and down by the season and even fluctuate within a single day. Pollen count is a measure of the average number of pollen grains per cubic meter2, and is usually determined by collecting pollen on special greased silicone rods. The pollen is collected for a certain period, usually about 24 hours, and then counted under a microscope. The pollen count is then calculated in grains per cubic meter of air. These findings are then published in user friendly terms such as: low, moderate, or high counts so the general public can decide how to plan their day.

Pollen Counts

Pollen counts tend to rise early in the day and peak around midday.  Often there is an increase in pollen 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! 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 in their yard this year. 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 will help to decrease pollen exposures, such as: utilizing the air conditioner, keeping the windows and doors of the home and car closed, and utilizing the dryer rather than the fresh breeze to dry clothing. Also, one benefit COVID-19 may bring allergy sufferers is the regular use of a face mask. Most face 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 or 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 them with more clarity!


Green beer and wheat allergy

St. Patrick's Day, Green Beer, and Wheat Allergy

St. Patrick's Day is fast approaching! Are you wondering if your wheat allergy will get in the way?

History of the Holiday

In Ireland, the holiday was created as a way to honor the country's patron saint and a time to cut loose during the Catholic Lent season. Today, the holiday is honored in myriad of ways around the world to celebrate all things Irish. From preparing classic Irish food to setting leprechaun traps, young and old alike look for the luck o'the Irish on March 17. Many adults may even enjoy a clover green colored beer as they celebrate. While I assumed this was a modern tradition, during my research I discovered that green beer is over a century old!

Wheat Allergy and Green Beer explained
Can your wheat allergy wreak havoc during St. Patty's Day?

According to IrishCentral, an Irish American New York City coroner named Dr. Thomas Hayes Curtin gets credit for this discovery. He unveiled his invention of a beer the color of shamrocks at a Bronx social club in 1914. The doctor used “wash blue” in a light ale to liven up the celebration. Unlucky for his family, friends, and colleagues, however, the “wash blue” was also, in fact, poison. This substance is an iron powder solution used to whiten clothes. Thankfully, more than a century later, green beer prevails, and this Irish American’s invention continues. Now a few drops of green food coloring give the beer that glorious emerald hue instead of wash blue.

Wheat Allergy and Beer

I recently was asked whether those with a wheat allergy could partake in the green beer tradition. According to the AAAAI, there are a variety of reasons someone may experience a reaction while consuming beer:

The most frequent causes of reactions to beer are either IgE-mediated reactions to barley/hops or a reaction to the alcohol itself. This alcohol reaction is quite often due to acetaldehyde dehydrogenase 2 deficiency. Acetaldehyde dehydrogenase 2 is the enzyme that metabolizes the first metabolic product of alcohol digestion, acetaldehyde. When acetaldehyde accumulates, it produces mast cell degranulation, and therefore its symptoms mimic an allergic response. Although not as prevalent, there can be reactions to rye, wheat, yeast, or molds. In addition, some beers may contain additives such as sulphites, sodium benzoate, or tartrazine that can cause sensitivities. Some craft beers also contain, fruit and nut extracts or dairy. Any of these ingredients can cause discomfort or reactions in someone with a food allergy or sensitivity to one of them.

If someone has a wheat allergy specifically however, there are several wheat free beers available. You can find a great list allergy-insight.com with additional insight to ingredients such as oats, brown rice, corn, or sweet potatoes. You may consider hosting a St. Patrick’s Day party at your home, purchasing a wheat free pale beer, and adding as much green food coloring as you wish. If out and about for the holiday, make sure to talk with the brew master about your selection. Better yet, order a beer in a bottle to view the ingredient list yourself!

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.


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