Fish Allergies

In recent years, the conventional wisdom is that the Americans consume too much meat in their diet. Public health officials have said that we should diversify our diet with dairy, vegetables and fish. Yet some Americans are allergic to fish and may be allergic to products that contain fish.

WebMD states that food products containing fish ingredients are: “Worcestershire sauce, barbecue sauces made with Worcestershire; Caesar salad and Caesar dressing, caponata (Sicilian eggplant relish), caviar and fish roe; artificial fish like imitation crabmeat, and fish sauce, oils, and gelatin.”

I tell my patients that those who are allergic to fish, may only be allergic to only a certain type of fish. Some allergists feel that a fish allergic person should avoid fish altogether, but that person may feel that he or she should be allowed to eat other types of fish in their diet. They can ask their allergist to test them for their specific fish allergy.

The American College of Allergy, Asthma and Immunology (ACAAI) website states that after your allergist tests you for your particular fish allergy “take extra precautions to avoid cross-contact (when two foods come into contact with each other and their proteins mix) when purchasing fish from a market or when dining out.”

Typical symptoms of fish allergies, like other food allergies, may include: nausea, stomach cramps, indigestion, vomiting, diarrhea, stuffy/runny nose, sneezing, headaches, and asthma. Yet some people are so sensitive to fish allergies, that merely touching fish or being in an area where it is being cooked can provoke a severe anaphylactic response. People that are so allergic adverse are advised to carry an epien (epinephrine injector) with them and to avoid fish contaminated areas.

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Are Your Allergic To Your iPad?

In my practice, I see a lot of pediatric rashes: heat rashes, medicine rashes, ringworm and even swimmer’s itch, among others. But now there’s a rash that’s connected to our web obsessed culture–the iPad rash.

It appears that the Apple’s i Pad has been cast as the culprit in reports of unexplained allergic rashes in children, according to an interesting story I recently saw in the Washington Post. The paper reported the iPad allergy outbreak from a study in the medical journal, Pediatrics.

The study profiled an 11- year old boy who had an itchy body rash which wouldn’t go away, who was treated at a San Diego hospital. The Daily Mail, a London-based newspaper stated “the boy had a common skin condition that causes scaly patches, but he developed a different rash all over his body that didn’t respond to usual treatment. Skin testing showed he had a nickel allergy, and doctors traced it to his iPad, which he had used daily.”

The boy improved after he put his iPad in a protective case.

However, the 11-year old isn’t an isolated case when it comes to nickel allergies. At the beginning of this year, people who brought the fitness tracker, Force- a wearable band– reported developing contact dermatitis from wearing this device. The manufacturer, Fitbit recalled the band after it was revealed that nickel was involved in the production of this product. Some wearers tried to cover the nickel port with tape, but it didn’t stop rash.

Dr. Sharon Jacob, a dermatologist at the San Diego hospital where the 11-year old was treated stated that “nickel allergies are becoming more common, or increasingly recognized.” And said that “national data showing that about 25 percent of children who get skin tests for allergies have nickel allergies, versus about 17 percent a decade ago.”

If you or your child have developed a rash that won’t go away or won’t respond to over-the-counter treatments, see your allergist.

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Allergies Keeping You From Dining Out? Allergic Girl Can Help

A lot of my patients have food allergies and many are afraid of dining out. I tell them there are a number of blogs and books they can consult to allay their fears of an allergic attack when eating out. But one of the most interesting allergy consults is New York-based one, Allergic Girl Resources. Her website is
Founded by Sloane Miller, Allergic Girl Resources offers a wide range of services for the allergy prone such as one-on-one counseling with families, a consultant with restaurants and other food establishments as well as working with governmental agencies about food allergies. She also written a well – received book on being allergic– Allergic Girl: Adventures in Living Well with Food Allergies–and received the Samter Journalism Award by the American Academy of Allergy, Asthma and Immunology.

One of the most informative aspects of the Allergic Girl website is the restaurant ratings. The website rates these eating establishments by the following criteria:

“Chef/ Owner/Menu change- This restaurant has had a change which may result in a change of allergy-friendly status.

“(Year). The year the restaurant was visited.

“*Means that the restaurant is consistently good and is allergy-friendly consistently.

“Provisional- Ms. Miller was once there but has not been back.

“Menu- This restaurant has a special menu for various dietary restrictions.

“Book- This restaurant has an ingredient book at the manager’s station.

“Price-$ to $$$$. All price ranges.

“Child friendly. This restaurant has a children’s menu.”

Concerning allergy friendly restaurants, she explains on her website that even if it appears that the restaurant is not specifically allergy friendly on its menus, she had occasions in which was at one eating establishment and told the wait staff her dietary restrictions and asked if they could come up with a meal for her. The chef, she said, was delighted to come up with a meal that met her allergy needs. Sometimes, she says, all you have to do is ask.

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The Great Outdoors And Summer Allergies

Many of my patients and their children are ready to beat the heat of the city and head towards parks and other open spaces this summer. But even in these temperate climates, a variety of allergies are caused by flora and fauna.

An interesting article in Consumer Reports describes what to watch out for outdoor when hiking or camping in the great outdoors.

When traveling in heavily tree-laden areas, like parks and forests, watch out for poisonous plants. Poison ivy, oak and sumac are the most common cause of an itchy, skin rashes in these wooden areas. To relieve symptoms, take cool showers or apply cool compresses, If symptoms persist, contact a doctor about the use of a prescription corticosteroid.

A variety of bugs are common occurrence in the outdoors during the summer. A particular concern is the tick that triggers Lyme disease and the mosquito that triggers West Nile virus. The areas that tick predominate are in the Northeast or upper Midwest, while the mosquito predominates in hot climates and areas of high rainfall. The tick bite triggers a bull’s-eye rash and expands over a few days. Symptoms include fever, fatigue, headaches and aching muscles or joints. The mosquitoe bite triggers symptoms that include an unexplained fever, headache, muscle pain, or weakness and vomiting.

To prevent symptoms of both types of bugs, you should apply an insect repellant before going outdoors as well as wear protective clothing such as long pants, long-sleeved shirts, socks and closed toe shoes when walking in insect-prone areas. At the onset of long-lasting symptoms for both insects, immediately contact a physician.

Another insect to watch out for are bees. I’ve seen a number of bee stings on patients in my waiting room. The sting triggers a widespread rash of itchy, red skin bumps that could trigger a serious allergic reaction. As Consumer Reports states “when stung, try to scrape away the stinger with a straight-edge object, such as a credit card. While over the counter remedies include cold compresses and steroid creams can help ease most bites, along with oral antihistamines, if you’ve had a severe reaction to insect stings, ask your doctor to prescribe an epinephrine injection kit.”

Finally, be aware of fungal infections. Again, Consumer Reports states “such infections as brownish-red rash on your feet–otherwise known as athlete’s foot, groin (jock itch), armpits, and under the breasts in women. If left untreated, a lot of times they will go away on their own.” If you bothered by symptoms “wash the affected area daily with soap and water, then dry well. Apply Lotrimin AF creme or miconazole powder or spray for at least two weeks. If symptoms worsen, see your doctor.”

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Dirty Kids, Allergies And The Amish

Many of my female patients who have kids feel that dirt is the ultimate “evil” that their little ones can bring home. Those mothers are real “germaphobes.” They think dirt and kids don’t mix and are obsessed with their children’s cleanliness.

Yet according to various studies, a little dirt may be a good thing for kids.

In an interesting 2012 study, Dr. Mark Holbreich, an allergist with Allergy and Asthma Consultants found that children growing up in the Amish culture in Switzerland have significantly less asthma and allergies than Swiss children who didn’t grow upon a farm.

In an article on the website Health Day, the results of this study stated “Amish children had about the half the prevalence of asthma compared to their non-farm-dwelling counterparts (about 5 percent vs 11 percent). Swiss farm children had a rate of asthma of nearly 7 percent. The rate of allergic sensitization followed similar patterns. Non-farm children had the highest rates, at about 44 percent, compared with 25 percent in the Swiss farm children and just above 7 percent among the Amish children.”

Dr. Hobreich said in the American Academy of Allergy, Asthma and Immunology (AAAAI) annual meeting that the study ” supports the hygiene hypothesis …that early life farm exposures are protective against developing allergies and asthma.” He went on to say that “our next goal is figuring out of the farm life factors that are protecting the children we studied…Early exposure to farm animals and drinking milk directly from the farm, which is neither pasteurized nor homogenized, may be key factors.”

Coming on the heels of the Amish study, prior research indicates that exposure to ordinary dirt activates the neurons that produce serotonin–a key chemical in many bodily functions, as well as being a natural anit-depressant. Also, dirt is a boom to the immune system. Early exposure to naturally occurring microbes can help building stronger, more disease-resistant children.

Parents should encourage their children to spend more times outdoors and expose them to soil rich environments. Creating an outdoor garden for your child to tend, or even taking them in the woods for hikes or nature collection–such as studying insects or plants– can create an allergy-resistant and happier child.

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Allergies, Asthma and Pregnancy

Allergy season is in full swing, so the question that I am often asked by my female patients who are pregnant is “Dr. Lubitz, what type of medications can I take for my allergies that are safe for my unborn child.” Well, there are a variety of modalities I can recommend.

An interesting article on the Mayo Clinic website recommends an approach that is the least invasive for pregnant mothers. It states:

“*Avoid triggers. Limit your exposure to anything that triggers your allergy symptoms.

“*Try saline nasal. Over-the-counter saline nasal spray can help ease nasal dryness, bleeding and congestion. It can be used as often as needed.

“*Rinse your nasal cavity with a neti pot. Once or twice a day, fill the neti pot with an over-the-counter saline nasal solution. Then tilt your head over the sink, place the spout of the neti pot in your upper nostril and gently pour in the saline solution.

“*Include physical activity in your daily routine. Exercise helps reduce nasal inflammation.

“*Use nasal strips at night. Over-the-counter adhesive nasal strips–such as Breathe Right–can help keep our nasal passages open while you sleep.”

Now if these approaches do not alleviate allergy symptoms, there are prescription medications available. To know which medications are suitable, a physician gives his patient a Immunocap blood test. This test can diagnose pollen an food allergies during pregnancy. It’s considered safer than a regular allergy skin prick test for pregnant women which may effect the fetus.

The FDA classifies drugs that are safe for pregnant women with allergies and asthma on a scale of A, B, C, D and X. Category A is the safest shown through studies on pregnant women in the first trimester but for which there are relatively few drugs available at present. Category X which is the least desirable category shows clear evidence of birth defects in animals/and or human studies, and should not be used in cases of pregnancy.

Many doctors recommend the use of Category B medications for their allergic pregnant patients. This means that medications have been used in studies in pregnant animals and are considered relatively safe in humans, but no human studies are available.

The website lists medications classified in three categories. They include: “antihistamines, such as Chlor-Trimeton, Benadryl, Claritin and Zyrtec (generic forms) are considered Class B; decongestants, including Pseudoephedrine (Sudafed) are considered Class C and should be avoided by female patients during the entire first trimester; medicated nasal sprays such as NasalCrom and Rhinocort Aqua are used in treating allergic rhinitis and are classified as Class B. Other medicated nasal sprays such as Flonase are considered Class C.

Concerning the use of asthma drugs in pregnant women, Pulmicort is a Class B drug most often prescribed to treat asthma in pregnancy. It is estimated that 1% of all pregnant women are asthmatic and controlling their asthma symptoms is a priority. To do this, doctors often use a variety of asthma drugs that may be from other FDA classifications of medications that are not in the B class. Their use depends on what types of symptoms their female pregnant patients manifest.

When contemplating the use of any medication for your allergies or asthma, a qualified allergist should be consulted.

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No Quick Fix For Asthma Treatment

One of the things my mother taught me growing up in Brooklyn was to be disciplined. Whether it be my homework, career goals or life in general. And that’s my view in treating diseases like allergies and asthma, especially asthma. You have approach it in a disciplined way; have a plan and take logical steps to deal with it. Really, there are no quick fixes for treating asthma.

Let me tell you a story. Recently, a young, 24-year old very bright woman, walked into my office. She complained of having asthma and after I asked her a few questions, she told me “all I want is a new inhaler with refills. That’s all I want.” I tried to explain to her that having asthma is complicated and requires a plan to successfully deal with the symptoms in order to lead a normal life. She responded, “I don’t need to hear all that! All I want is an inhaler with a few refills! I’ll be back in a year.”

So her response is like a number of patients who are in a hurry to get a quick fix for their problem. Sometimes a physician can’t give patients what they want. I told her, “Listen. Obviously you think you’re the doctor and telling me what I should do! When in reality I have 30 years experience treating asthma patients and you should listen to me!” With that statement she got angry and walked out.

I am very concerned about the well-being of all my patients. I tell them using an inhaler for sudden asthma attacks is no panacea for long- term asthma treatment. You need a well, thought-out, asthma action plan in writing, with your healthcare provider.

Here are some steps I advise my patients to note in their action plan when treating their asthma:

Step 1. General information: Include your name, emergency contact information, your asthma classification number and a list of triggers that my cause an asthma attack.

Step 2. An asthma action plan is divided up into three color-coded zones. 1) The green zone is the optimal zone where you want to be on a daily basis. That means you have no asthma symptoms so you continue taking long-term medications even if you are feeling well; 2 ) the yellow zone is defined as one who is experiencing symptoms and need the use of quick-relief medications to prevent the worsening of asthma symptoms; and 3) the red zone is when you experience severe asthma symptoms and should get immediate medical treatment if your symptoms do not improve.

Step 3. Use a peak flow meter. This is a device that monitors your peak flow rate–whether your asthma is getting worse, even before symptoms occur. Your best peak flow rate is the highest peak flow number you have maintained in a two to three week period. Your physician can help you to calculate it.

Step 4. Symptoms – Monitoring your symptoms is another way to use your asthma plan. They may vary during day and nighttime hours. They include: daytime symptoms (cough, wheeze or chest tightness); movement or activity level (working, exercising or playing); and nighttime symptoms (like dayttime symptoms).

Step 5. Medications. Discuss with your doctor what short-term and long-term medications are right for you depending on your symptoms.

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Buteyko Breathing Method May Help Asthmatics

Patients of mine who are asthmatics take a variety of medications and inhalers to help cope with their asthma. But many of them have asked me, “Dr. Lubitz, is there anything else that I can do to help me with my symptoms?”
I tell them there are a number of exercise techniques that may help them during an asthma attack or even help them reduce their reliance on medication.

I know of one such method that is called Buteyko Breathing Therapy (BBT). It was developed by a Ukranian physiologist, Konstantin Buteyko in 1952. Basically, he observed that when sufferers of asthma have an asthma attack, they hyperventilate thus triggering a response of gasping for air. Adds Jane E. Brody in an interesting article in the New York Times that asthmatics “breathe too fast and too deeply and through the mouth and this lowers the level of carbon dioxide in the blood and that the airways constrict to conserve it. They don’t realize that too much air can be harmful to health and trigger a bronco spasm.”

The Buteyko method takes a different approach. Jane E. Body explains that the method trains people –especially during asthma attack–”to breathe shallowly and slowly through the nose, breaking the vicious cycle of rapid, gasping breaths, airway constriction and increased wheezing.”

A study in the UK, published in December in 2003 for the British journal Thorax, tested 384 asthmatic adults who practiced the Buteyko method. The findings stated that these patients reduced their reliance on rescue inhalers and halved their need for steroids within six months. The British Thoracic Society has given the Buteyko method a “B” rating, meaning that positive results of the trials are likely due to the breathing method itself.

Other support for Buteyko–albeit qualified– comes from the National Asthma Council’s Asthma Management Handbook, an Australian publication from that country’s asthma association. It states that “controlled studies have found that Bueyko breathing can help improve symptoms and reduce the use of reliever medicines in some people. However, these studies did not show that Buteyko breathing altered carbon dioxide levels or measures of airway inflammation or lung function.”

It is recommended by many medical associations and physicians that people should not start practicing the Buteyko technique on their own, but train under the supervision of a trained professional.

There are Buteyko centers and practitioners around the world. Buteyko Center USA is the North American representative of the Buteyko Clinic in Moscow and is headquartered in Woodstock, NY.

People suffering from asthma, however, are advised that any new treatment or exercise should be cleared after consulting a qualified allergist who will determine its efficacy based on the patient’s symptoms.

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Late Allergy Season Expected To Be Intense

Was it just six weeks ago that we experienced driving rain, snow and unrelenting cold temperatures? Dubbed the “polar vortex,” we didn’t know when it would end.”

Now spring has arrived and according to most experts, we’re headed for another vortex–”the pollen vortex”. I’m telling my patients to be prepared for the onslaught of a bad allergy season. According to the Washington Post this pollen vortex will consist of “a tidal wave of pent-up pollen could be coming our way as the area heads towards the height of allergy season this month.”

I know, I know. What’s a New Yorker to do? Well, for starters whether you’re staying in the city or going cross-country, know what pollens to watch out for. Here’s a sample of the 10 top pollens to recognize and the regions they predominate according to Warren V. Filley, MD a spokesperson for the American Academy of Allergy, Asthma and Immunology:

Hayfever–comes from beautiful plants and trees growing in your neighborhood. It’s an allergy, that is unfortunately, widespread in many regions of the country. It’s hard to avoid, but try to stay away from it mid-day.

Ragweed– about 75% of Americans who are allergic have this allergy. You’ll see it in the fields, riverbanks, roadsides of the Midwest and Mississippi River basin. You see it around the fall and summer months.

Mountain cedar–it’s in the mountainous areas of Arkansas, Missouri, parts of New Mexico, Oklahoma, and Texas. Appears in the spring.

Ryegrass–you find it in dry, cool lawns, meadows and pastures. Predominates in the northern parts of the United States in spring and summer.

Maple–it’s found in areas along streams and woods. Found all over the eastern United States and Canada. It peaks in the early spring. There’s a lot of it in New York.

Elm–found in cultivated and wetland habitats. It is widespread in the eastern and midwestern regions. Also found in New York, especially in city parks and along streets. In the spring it is known as American Dutch Elm. In the fall, lace bark elm.

Mulberry–you see it in woods and river valleys. All over the eastern US. The season stretches from winter to summer. The pollens are from cherry and crabapple tree blossoms and contributes to hayfever.

Oak–found in wooded areas. The states that predominate are the Coastal Plan from Texas to Virginia, and Florida. It’s season is spring time and oak trees produce the most pollen for the season.

Tumbleweed–found all over the western and northern US. It’s season is spring to fall.

Arizona cypress–wherever you’ll go in the southwestern US, you’ll find this. It appears during the spring although the pollens can last for six or seven months throughout the year in some yearly cycles.

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Air Purifier? – There’s An App For That

Now that spring is in full swing, tree pollens are predominating in the New York area. Although we can’t do too much to avoid pollen outdoors, I tell my patients we have more control over our environment outdoors.

Air purifiers are a way to eliminate many indoor allergens such as pollens, dust and mold, that get trapped in our home. Although there are many different types that target on a variety of allergens as well as unwanted odors, I recently came across an interesting article about a high-tech air purifier.

I read recently, in the Wall Street Journal that the Honeywell Company has introduced the first Bluetooth-enabled air purifier, one that’s controlled by a smartphone app.

While quite pricey–at $250.00–it does what other air purifiers do–filters dust, mold and other allergens. But the difference is that a smartphone app is the remote control that makes it work (with a 30-foot range) and can schedule on and off times.

What’s more interesting is a feature offered by the smartphone–an allergy tracker. The Journal reports “that it takes advantage of the phone’s internet connection to gather pollen counts and other allergen information by zip code. Armed with this knowledge, the app can tell the purifier to dial up the power or to lie low.” a potential savings on electric bills.

The article continues and states “the purifier has a proximity sensor that works in conjunction with the app to turn off the device when you are not around. Also, there is an indicator to show how dirty your filters are getting, filter-change alerts and of course, direct links to purchase replacement filters.”

The Honeywell air purifier covers rooms up to 310 square and can be purchased at Best Buy. Its app is compatible with iOS and Android devices.

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