Itching without a rash may not be an allergy

Itching is a common symptom seen often in the allergist/immunologist’s office. However, if the patient is itching without a preceding rash, there are a list of numerous possible causes and include non-allergic conditions. We first need to determine whether the cause of itching is derived from the skin or another organ system. Itching that is not caused by a skin condition usually does not have a rash, although some patients can develop a secondary rash.

Several circumstances can cause itching without a rash and can be due to systemic, neurologic, or psychiatric conditions. A few examples of systemic conditions include kidney disease, liver disease, hyperthyroidism, lymphoma, polycythemia vera, and HIV infection. Narcotic medications can have itching as a side effect, as well as nerve injury from shingles or spine disease, as they can cause localized itching at the affected area. Lastly, psychiatric conditions such as substance abuse or obsessive-compulsive disorder can also lead to itching.

The management of itching without rash should start with evaluating for and treating the underlying cause. There are a variety of remedies available for symptomatic relief; moisturizing the skin, keeping nails short, wearing loose clothing and taking antihistamines. While antihistamines are often used for itching, studies suggest that first generation antihistamines only help itching by causing sedation.

There are more successful, prescribed oral medications available which can be slowly increased to minimize side effects.

If you have questions regarding an allergic condition, I invite you to come in for a consultation.

For more on allergy triggers, visit my website NYC Allergy Doctor.

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Tips for Managing Food Allergies

Managing food allergies may seem overwhelming at first, but it does get easier over time.

Start with these basic measures to safeguard yourself from adverse reactions and prepare yourself for the challenges you will face.

  • Emergency medication – Due to the nature of food allergies, it is important to be prepared against anaphylaxis, always carry your Epi-pen.
  • Outline an emergency care plan and inform family and friends of the plan. This will alert those around you to recognize signs and symptoms of your allergies so that they know when and how to use your emergency medication.
  • Wear medical identification at all times to make responders aware of your allergy.
  • Plan in advance how to handle certain situations; prepare yourself for variety of environments you may find yourself in. Keep a food diary to assist in learning what foods to avoid and get tested if symptoms persist.

To successfully manage food allergies, you have to monitor your diet and lifestyle.

Accidents can happen and you should always be prepared. If you have any questions, you can read more about Food Allergies on my website at Or if you feel the need to be tested for allergies and live in the NYC area, please call our office to arrange for a consultation, 212-247-7447.

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Summer Vacations And Asthma

Summer is the time of year when most of us relax and take vacations.   My patients often ask me, other than taking their asthma medication with them when traveling, what other tips can I recommend to avoid asthma attacks.
If one is staying in the city or heading out to the country, I tell them to be cognizant of the weather reports each day.  The EPA recommends checking the Air Quality Index.  Most simply, this is done by checking televised weather reports or by logging on the EPA’s website,  The AQI measures the amount of air mixed with pollutants as well as pollens.
In an interesting article by the American Lung Association (ALA),  when flying, it  recommends taking a carry-on bag packed with the following: copies of your asthma action plan; extra written prescriptions; insurance cards; medicines such as  quick-relief and controller medications; a spacer; and a peak flow meter.
The ALA also has a free app, the State of the Air, for your smartphone which is free.  You punch in the zip code your are traveling to or use the geo-location  function.
Also when flying, the TSA allows you to bring a nebulizer on board or as checked baggage.
Before you arrive at your destination, you should have in mind the following to reduce the chances of an asthma attack:  request a hotel or  an inn with a smoke free room; wood floors instead of carpeting if available; ask for fragrance free toiletries; even bring your own bedding to reduce dust mite exposure.
Remember, each vacation environment poses its own challenges for asthmatics.  For beach-goers, bring fragrance-free sunscreen, pack plenty of water and pain relievers that won’t exacerbate your asthma–consult your physician.  When traveling to countryside, avoid animal hair and bird feathers which produce dander, and are asthma triggers.  When swimming in pools, make sure these areas do not have a strong smell of  chlorine and that the pools are well ventilated, to prevent an allergic reaction.
Following these tips should make your vacation more enjoyable.


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School Asthma Management Plan Act

School Asthma Management Plan Act

The most common chronic disorder in children, ASTHMA affects nearly seven million children. Over half of these children suffered with an asthma attack or episode in 2014 to their poorly controlled condition. As well as the health risk involved, these asthma attacks resulted in 10.5 million missed school days and U.S. $56 billion in healthcare expenditures. A good number of these costs are preventable when a prescribed Asthma Plan is implemented correctly.

On April 22, 2015 Senator Kirsten Gillibrand (D-NY) introduced the Asthma Management Plan Act with Senators Mazie Hirono (D-HI) and Bob Casey (D-PA).


The School Asthma Management Plan Act allows schools to apply for grants that help them: 1) develop asthma management plans, and 2) purchase medication and equipment necessary to treat students affected by asthma.

Bill Summary
• Develop and implement school asthma management plan—Schools shall use grant money to develop asthma management plans based on national guidelines that include, among other provisions, methods for identifying all students with asthma diagnoses, implementing asthma education for all staff, providing access to medication and methods to administer medication for all affected students, and developing medication and emergency policies specific to each school.

• Purchase asthma medications and devices—Schools shall also use grant funds to purchase asthma inhalers, spacers, air purifiers, asthma education materials, and other supplies necessary for the relief and treatment of affected students.

• Improve communication and coordination—Schools receiving grants shall find ways to encourage bidirectional communication between schools and physicians, and improve adherence to asthma treatment my students. Schools shall also utilize existing systems and resources when possible.

The AAAAI is on the record as a supporter of the bill, having submitted an official letter of support to Senator Gillibrand. In it, AAAAI President Robert F. Lemanske, Jr., MD, FAAAAI, states: “As the current president of the AAAAI, this bill is of great interest to me personally since my major presidential initiative focuses on the creation of the Office of School-based Management of Asthma and Allergic/Immunologic Diseases within the AAAAI to serve as a resource for the creation of programs to establish optimal clinician-school nurse-family communications to better care for children with asthma in the school setting.”

If you have questions about Asthma or how to control asthma with an Asthma Treatment Plan, please contact an allergist. Live in NYC or tri-state area, please feel free to contact my office for a consultation. The first step to Asthma control, is adhering to your prescribed Asthma Treatment Plan.

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Is it a Food Allergy?

Food allergy awareness has boomed over the past decades, and rightfully so. Many people suffer from some sort of food allergy, whether a minor irritation or life-threatening situation. Let’s talk about the symptoms, the causes, and what you can do if you suffer from food allergies.

Some common allergies include nuts, shellfish, gluten, egg and dairy. Allergic reactions to foods typically begin with minutes to a few hours after eating the food. How often and how severe one experiences symptoms varies widely from one person to another. Mildly allergic persons may only suffer from a runny nose or sneezing, while highly allergic persons may experience severe and potentially life-threatening rations.

The most common symptoms of a food allergy involve the intestines or the skin. Symptoms presenting on the skin can include rashes or hives. Intestinal symptoms often include nausea, vomiting, stomach cramps, indigestion, and diarrhea. Other symptoms can include swelling of the tongue, lips, or throat; asthma, with coughing or wheezing; itchy or runny nose and sneezing; loss of blood pressure; and, in rare cases, anaphylaxis, a very severe allergic reaction.

While it’s possible that a patient experiencing these symptoms is having an allergic reaction to food, there may be other causes in the works. We can run a skin test to be sure that these symptoms are caused by a food allergy before a treatment plan can be discussed. In the skin test, we look for particular allergies by scratching the patient’s skin with a toothpick like tool containing a tiny sample of the potential allergen. The skin’s reaction to the test will help us to determine if you are in fact allergic to the food in question or if their symptoms may be caused by something else.

If you do have a food allergy, it is the result of their body’s immune system over-reacting to food proteins. Normally the immune system protects the body against allergic reactions; however, in the individual with a food allergy, the immune system produces increased amounts of the allergic antibody called immunoglobulin E (IgE). When these antibodies combine with food proteins, histamine and other chemicals are released as part of the body’s immune reaction. The release of these chemicals can result in the symptoms mentioned earlier.

Avoidance is key in the treatment of food allergies. However, avoiding trigger foods isn’t always a guarantee. Accidents happen and it’s always smart to have a backup plan. For those with mild allergies, oral antihistamines can be quite helpful. For those with severe reactions, keep an EpiPen handy at all times. If you have any questions or want to be tested for allergies, please give our office a call!

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Skin Test

Walking into our office for the first time, some people might not know what to expect.

One of the first things that needs to be done is to identify what allergies you suffer from. This is where the skin test comes in. A skin test is a simple procedure that allows us to assess what you may be allergic to and then create a treatment plan that is tailored specifically for you. Because everyone has specific allergy triggers, knowing what you are allergic to as early as possible is important to determine an effective treatment plan.

You may be asked to stop taking antihistamines or other decongestant drugs prior to your visit. Some drugs may interfere with the results of the skin test and prevent us from getting the most accurate (and helpful) assessment for you.

A skin test takes approximately two to three hours from start to finish. A series of tiny scratches are made on the surface of the back. The scratches are conducted with a small instrument similar to a plastic toothpick, which contains trace amounts of a single allergen, such pollen or mold. If you are indeed allergic to any of the allergens, a small mosquito bite-like bump will appear.

But are there any side effects? It is highly unlikely that you will experience any side effect beyond the small bump to the tests that you are allergic to. The size and redness of the bump will depend on the severity of your allergy. Some mild itching may occur, but a topical cream can be applied to reduce any discomfort. This type of reaction is normal and typically clears up in about 20 minutes.

Following the skin test, we will review the results with you and determine the treatment plan that is best for your profile. The skin test is just the first step in seeking relief from allergies. Further care includes trigger avoidance, medications and check-ups. Schedule an appointment with us today and take the first step towards diminished allergy symptoms.

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Asthma Triggers

It is estimated that 25 million people in the United States are currently living with asthma. That equals out to one in every 12 people or about 8% of the population. That’s a lot of people. But for a disease that is so common, symptoms and triggers can be confusing. Let’s shed some light on asthma.

Asthma Symptoms

inhalerThe symptoms of asthma can be vast and varied but typically include shortness of breath, wheezing while breathing, tightness in the chest and excessive or painful coughing. If you experience any of these symptoms, be sure to visit your allergist to determine causes and triggers. Left untreated, allergies can also develop into asthma. Be safe and consult your allergist early on.

Symptoms of an asthma attack are caused by constriction (tightening of the muscles) and inflammation (swelling and irritation) of the airways. During an attack the muscles around the airways spasm,  the mucosal membrane lining the airways gets inflamed, and excessive amounts of mucus flow in the airways all contributing to the narrowing of the airway. This increases constriction and makes breathing very difficult.

Types of Asthma and Causes

Depending on each person, asthma attacks can be caused by either internal and/or external triggers. Asthma is commonly categorized by symptom triggers. These categories include:

Allergic Asthma triggered by allergic reactions to allergens such as pet dander, dust or dust mites, mold or pollen.

Seasonal Asthma triggered by seasonal allergic reactions to allergens such as trees, grasses, or weeds.

Non-Allergic Asthma triggered by irritants in the air that you breathe such as tobacco smoke, wood smoke, room deodorizers, fresh paint, and perfume.

Exercise-Induced Asthma triggered by exercise or physical activity.

Nocturnal Asthma can occur in a patient with any of the aforementioned types of asthma, though the asthma symptoms will increase or worsen at night.

Asthma is the most common chronic illness among children. If a child’s asthma is left untreated, it can result in loss of sleep, exercise limitations, absenteeism, emergency room visits and, in a few cases, death. Asthma in both adults and children can be effectively managed with medications and “trigger” avoidance.

Receiving medical help for asthma is essential. If you’re concerned that you or a loved one is showing signs of asthma, please consult your allergist.  Live in the NYC area, call my office to arrange a consultation,  (212) 247-7447

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Hygiene Hypothesis & Dishwashing

The Hygiene Hypothesis is raised again, this time in regard to sanitized dinnerware.

If you remember, the Hygiene Hypothesis determines that children exposed to innocuous bacteria are less likely to develop allergies; children raised on farms, children who eat foods purchased directly from farms, or eat fermented foods.

handwashing dishes to reduce allergiesA study released in February now adds dishwashing practices to that list.  Parents who wash their dishes by hand, rather than in dishwasher, may also be lowering their children’s chances of developing allergies.

Following 1,000 young Swedish children, researchers monitored certain parental behaviors like; fed their children foods from farms, such as eggs, meat,  unpasteurized milk,  fed children fermented foods (probiotic bacteria) and lastly if they washed their dishes by hand or used a dishwasher.

The researchers then recorded if the children had allergies including asthma, eczema and hay fever.

Children in households where dishes were always washed by hand had half the rate of allergies, that rate diminished even more if the children ate fermented foods and foods purchased directly from local farms.

These findings, interesting to discuss are associative, not cause and effect. It is not clear that washing dishes by hand leads to fewer allergies. The Hygiene Hypothesis has been bantered around for a number of years, and the research to identify cause and effect has yet to be established.

The sanitizing effect of dishwashers serves well to reduce germs and bacteria found on dishware.  And while this is an interesting finding, it has yet to be confirmed.

If you have questions regarding an allergic condition, I invite you to come in for a consultation. For more on allergy triggers, visit my website and click on Common Allergies.

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Childhood Stress Linked to the Development of Allergies

A study recently published in Pediatric Allergy and Immunology showed correlated link between childhood stress and an increased risk of developing allergies later on in life by a research group in Germany who had conducted long-term research.

Over 3,000 newborn children were recruited between 1997 and 1999. Parents were interviewed about lifestyle-related factors. Blood tests were drawn. A total of 565 children were examined up to the age of six, and for 234 participants, blood analyses of stress and immune parameters were carried out.

Blood samples drawn from 234 6yo showed that children who experienced stressful situations like moving or being separated from parents had  higher levels neuropeptide vasoactive intestinal polypeptide (VIP) in their blood suggesting that the neuropeptide could be influencing the regulation of immune responses.

Stressful events occurring during childhood are increasingly suspected of playing a crucial role in the later development of asthma and allergic skin disorders. For children, stressful situations can include the serious illness of a family member to seemingly harmless situations such as moving house.

Stress has been known to exhibit influence over the development of allergies. Unknown is the mechanism behind the phenomenon. This investigation during early childhood can play a large role in understanding the correlation between immune and stress markers.

Keep in mind, that the even though there were a comparatively small number of children affected, the results can still provide valuable insight into what exactly happens to the body through stress. More studies are required and are currently in process.

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Allergy Season Survival Tips

If the weatherman holds true, spring will be coming to NYC this week.

With the rain and warmer temperatures in the forecast, trees and grasses will begin their seasonal production of pollen.  Once that pollen catches a breeze, allergy season opens.

How were your allergies last year? If you find yourself already dreading spring, you aren’t alone.  I am constantly asked “How can I stay ahead of my allergies?”

To answer that question, I’ve compiled a list of suggestions that may help you avoid your allergy trigger.  If these actions don’t satisfactorily ease your symptoms, give me a call – there are many new treatments and medications available. You may find relief is possible without a battery of allergy shots.

The first – Know what triggers your symptoms.  Early spring symptoms can be triggered by tree pollen, grasses, mold and even dust mites (stirred up from spring cleaning). If you aren’t certain what’s causing your discomfort, get a skin test.  A skin test can assist in proper diagnosis and treatment. Allergy drops and tablets (called sublingual allergy treatment) are great solutions for grasses and even some pet allergies.

Next – avoid being outside when pollen level are at their peak.  The best times for outdoor activities are before dawn, late afternoon and early evening.

Something else to consider, the material making up your clothing, synthetic fabrics coupled with movement (fabric rubbing against itself) can create a small electric charge. This charge can actually work as a magnet, drawing pollen to the “charged” fabric. Consider natural fibers during allergy season.

If you are heading out, gardening or doing some yard work, take an antihistamine ½ hour before going outside.  An antihistamine can offer some support by blocking your body’s allergy response, suppressing your allergy symptoms. A mask can also help. Use a mask rated 95 by the National Institute for Occupational Safety and Health (NIOSH) for the best protection.  Do not touch your eyes.  Again, if you find the antihistamine makes you drowsy, there are alternatives available to you without the OTC antihistamine side effects.

When you come in from the outdoors, leave your shoes at the door and shower, making certain to wash your hair. Wash your clothes.  Vacuum often and use machine washable furniture and floor coverings.

We’ve had a long winter, and springtime in New York is not to be missed – or observed from afar.  If these tips don’t ease your symptoms, or if you find your allergies are affecting your quality of life, see an allergist (I welcome you to contact me for a consultation). There are a number of good treatment options that are unobtrusive yet effective that can get you back outside.

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