Food Allergy, Anaphylaxis and Epinephrine

Over the recent decades, food-related anaphylaxis is continually increasing, particularly in young children.

Data shows that food allergies and related anaphylaxis are on the rise, especially in young children, and the resulting deaths prove to be an ever-growing problem in the United States. Common triggers for food allergies are milk, eggs and peanuts. Symptoms of anaphylaxis may general present with coughing, wheezing, and/or vomiting. Children too young to verbalize a reaction may show signs such as crying, drooling or regurgitation.

One of the most commonly used therapies for food-related anaphylaxis is epinephrine.

In the event of an allergic emergency, treatment with epinephrine by injection should be given quickly. Clinical guidelines recommend that corticosteroids and antihistamines, other available therapies, should only be used as supplementary to epinephrine – not in replacement of. Corticosteroids given after epinephrine can help reduce the chances of recurrent reactions. Antihistamines given after epinephrine can help control symptoms such as itching and flushing. However, research shows that nearly half of all patients experiencing anaphylaxis are inappropriately administered other treatments before receiving epinephrine.

It is important to note that, although rare, deaths from anaphylaxis do happen. The average time to cardiac or respiratory arrest from ingestion of reaction-inducing food is around 30 minutes. Fatal reactions are most likely to happen to those who have previously had mild reactions. Recognizing the symptoms and being quick to act are necessary for anyone with (or around) children with food-related allergies. It is a community-wide effort: parents, teachers, nurses, babysitters. Everyone must be at the ready to recognize symptoms and deliver treatment. Staying educated and alert are ways that everyone can help prevent future anaphylaxis fatalities.

Food Allergy, Anaphylaxis and Epinephrine

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Sublingual Immunotherapy


What is Sublingual Immunotherapy?

Sublingual immunotherapy (SLIT) is an alternative way to treat allergies without injections. SLIT treats the cause of allergies by giving small doses of what a person is allergic to, which increases “immunity” to the allergen and reduces the allergic symptoms. Unlike injection immunotherapy, which is given as shots, sublingual immunotherapy is given as drops under the tongue. The safety and efficacy of allergy drops is still being established by the FDA, and they are only used off-label in the United States.

When symptoms present, an allergist must first use standard allergy testing to confirm the patient’s sensitivities. Once the allergen is determined, an extract in drop or tablet is prescribed.  In office, the patient is directed to keep the extract under the tongue for one to two minutes and then swallow it. The process is repeated at home anywhere from three days a week to daily. During the first four months, called the escalation phase, the dosage of the extract is gradually increased. After the initial appointment, patients should see their allergists once or twice each year for a check-up.  It is recommended that sublingual immunotherapy is continued for three to five years to ensure developing a lasting immunity.

Allergy Causes

Suitable for both children and adults, sublingual immunotherapy is relatively safe and effective form of treatment for rhinitis and asthma caused by allergies to dust mites, grass, ragweed, cat dander, and tree pollens. Evidence suggests that sublingual immunotherapy may be effective for treating bothersome eyes caused by pollen during hay fever season. Additionally, it might prove an effective therapy for children with mild eczema and is currently being studied for its potential in treating food allergies.

Treatment Details

Generally, sublingual immunotherapy risks relate to the nature of the treatment: it is administered at home and without direct medical supervision. Patients should heed the treatment plan provided to them. This will help with identifying and managing adverse reactions and side effects. Side effects among both children and adults are usually local and mild and include itching in the mouth or stomach problems. These can usually be managed by dose adjustments. Adhering to the prescription set by the medical care provider is best.
Request an appointment with an allergist to see if sublingual immunotherapy is right for you. Vials will take one to two weeks to mix before treatment can start. Patients take the drops in the convenience of their own homes and visit their doctor only once or twice per year. It is recommended that patients keep using the drops for three to five years in order for the body to build up a lasting immunity.
Give us  a call to arrange a consultation. Together, we can determine if allergy drops are a good fit for you.

Allergy drops

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Allergic to Valentine’s Day?

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Anaphylaxis, the Life-Threatening Allergic Reaction

Anaphylaxis is a life-threatening allergic reaction to specific triggers such as foods, medications, insect venom, or latex. Recognizing and treating anaphylaxis early is crucial since an allergic reaction can become an anaphylactic reaction in only a few minutes.

In a severe allergic reaction or anaphylaxis, the body is overwhelmed by its own immune response. Intravenous medications and chemicals are often the cause of severe anaphylaxis, as well as wasps, bees, and ants stings. This is because the allergen usually reaches the bloodstream very quickly, and circulates widely throughout the body.

If the reaction worsens, multiple body systems are affected, including the cardiovascular, respiratory, GI and skin. Patients can develop hives or urticaria, which can be very itchy as fluid shifts into the sublayers of the skin. As in other disease processes, the faster anaphylaxis sets in, the less likely the body can compensate and the more likely it will be fatal. Treatment must occur quickly in the form of a rapid, aggressive support of the airway, breathing and circulatory status of the patient, and administering epinephrine as early as possible.

It’s important to note that the beneficial effects of epinephrine, while quick, are short lived. Epinephrine is rapidly broken down by the body, therefore EMS providers may need to administer a second dose of epinephrine while waiting for the longer-lasting effects of diphenhydramine or corticosteroids to begin.

In very severe cases of anaphylaxis, massive swelling of the airway’s soft tissue may require immediate transport by EMS providers to the closest receiving facility for surgical intervention. Paramedics may perform a needle or surgical cricothyrotomy to preserve the airway if pharmacologic interventions are not successful.

If you have any questions regarding severe allergy symptoms and/or treatment, feel free to give my office a call, 866-632-5537.

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It May Not Be a Cold

Sinusitis and the common cold are often confused as they have similar symptoms including congestion, post-nasal drip, fever, and coughing. However, the common cold usually only lasts a couple of weeks, at most, and a serious case of sinusitis can last for months.

Sinusitis can also develop after a bout of the common cold and that may be a reason people confuse it. It may start as a cold but then the inflammation of the sinuses leads to an infection that will persist after the virus itself has been cleared from the patient’s system. With winter on the way, colds are soon to start interrupting our daily lives again with some regularity. If your cold seems to be persisting and is coupled with headaches that seem to be located behind the eyes and facial pain, you may be suffering from a sinus infection. If you are concerned you may have a sinus infection, particularly if symptoms have persisted for 8 weeks or more, see a doctor. Live in the NYC area? Feel free to contact my office for a consultation.

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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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