Archive for Immunology

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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Itching?

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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The Dangers Of Raw Milk

As a doctor, I am interesting in preventing disease as well as treating it. So I try to encourage my patients that having a healthy lifestyle is key is lessening their frequency of having allergies and asthma.

What concerns me is that in the public’s quest to eat healthy, some may have gone overboard. Many people who promote organic food–because it has less additives and pesticides, which is a good thing– are now promoting a food that has potential dangers in its so-call pure state: that is raw milk.

Under the mistaken belief that raw milk is better for your health, the American Academy of Pediatrics issued a statement that “substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections.”

Pasteurization is the term in which heating milk to a high enough temperature for a long time period to kill disease-causing bacteria has been used safely for over 100 years. And states the New York State Department of health that “pasteurization is the only way to ensure that milk products do not contain harmful bacteria such as salmonella, E. coli, Campylobacter, Staphylococcus aureus, Yersinia, Brucella, Coxiella and Listeria.”

In an interesting article by the FDA, it stated that CDC reported between 1993 and 2006 more than 1500 people in the US became ill due to drinking raw milk or eating cheese made from raw milk. Also the CDC stated that “unpasteurized milk is 150 times more likely to cause food borne illness and results in 13 times more hospitalizations. It is especially dangerous to people with weakened immune systems, children, older adults and pregnant women.”

Symptoms of people becoming ill from raw milk include: vomiting, diarrhea (sometimes bloody), abdominal pain, fever headaches and body aches. More serious reactions such as blood-stream inflections, kidney failure and inflammation of the nervous system can occur. Consult a physician in you or your children exhibit these systems.

When shopping for milk or milk products, make sure to check the package to see it its states pasteurized.

For more information go to: http://www.nycallergydoctor.com/allergy

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Measles Outbreak Reported In NYC

Parents are very concerned about the health of their children–what they eat, are they getting enough exercise, etc. A lot of my patients who are parents remind me of my mother who still lives in Brooklyn. Even now, at 93, my mother still comments on my weight. Well, that’s mothers for you.

Yet some parents are very lax in getting their children vaccinated against childhood diseases such as mumps and measles. They figure that those diseases are a thing of the past, that they don’t exist anymore. Well I’ve got news for them. Those childhood illnesses are making a comeback.

Just a few weeks ago, the Health Department of the City of New York reported an outbreak of measles in the city. The initial cases started in the Bronx and spread to the Lower East Side. The 25 cases reported then included 12 children and 13 adults. Today it is 28 cases.

The Health Department defines “measles as a virus that is highly contagious whose symptoms included a generalized rash and high fever, accompanied by a cough, red eyes, and runny nose, lasting five to six days. The rash begins on the face and spreads down the body, and may include the palms of the hands and soles of their feet.”

Most of the New York cases of the measles occurred after individuals or immigrants visited countries that had measles outbreaks. Other cases occurred by random exposure to sick individuals. So it is important when traveling abroad to pay attention to US Consular health advisories concerning foreign travel.

I cannot say enough that the vaccines are very safe and that any side effects are minimal and may include soreness where the shot was given.

Those who should be inoculated are babies at 12 months of age. Two doses are measles vaccine are required for full protection. Children usually get the second dose at 4 to 6 years of age before going to school. Also older children and adults should get the vaccine if not already done so. It’s never too late to be vaccinated.

 

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How To Cope With Allergic Induced Asthma

A lot of my patients are asthmatics. And a lot of them have allergies. Some of them have allergic asthma.

Like regular asthma, allergic asthma symptoms are coughing, wheezing, shortness of breath or rapid breathing and chest tightness. However, this type of asthma is triggered by inhaled allergens such as dust mite allergen, pet dander, pollen, mold, etc. resulting in asthma symptoms.

Over 50% of the 20 million asthma sufferers have this condition including 2.5 million children under the age of 18.

Like regular asthma, allergic asthma symptoms are coughing, wheezing, shortness of breath or rapid breathing and chest tightness. However, I tell my patients there is hope in treating their symptoms. “Allergic asthma is airway obstruction and inflammation that is partially reversible with medication,” states the Asthma and Allergy Foundation of America (AAFA).

So what are the treatment protocols? Well, the Mayo Clinic lists three:

*Leukotriene modifier. “Montelukast (Singulair) is a medication that eases both allergy and asthma symptoms. It is a pill taken daily which helps control immune system chemicals released during an allergic reaction.”

*Allergy shots (immunotherapy). “Allergy shots can help treat asthma by gradually reducing your immune system response to certain allergy triggers. It involves getting regular injections of a tiny amount of the allergens that trigger your symptoms, gradually building up your immune system.”

*Anit-immunoglobulin E (IgE) therapy. “When you have an allergy, your immune system responds by releasing antibodies (known as Ige) against the allergy, triggering a chemical called histamine as well as other chemicals into your blood stream. The medication omalizumab (Xolair) interferes with IgE in the body and helps prevent the allergic reaction.

To learn more, http://www.nycallergydoctor.com/asthma

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Allergy Shots or Oral Tablets. Which Is Best?

When I was recently at an allergy conference in Baltimore, a major discussion session was the coming shift in immunotherapy for allergies with the introduction of oral or liquid allergy tablets, soon to be approved by the FDA.

And my patients have asked me, “Dr. Lubitz, what is the best way to treat my allergies?” I tell them there are many factors involved in which treatment is best.

In the New York area, grass pollens are predominant in the Hamptoms and Central Jersey and for a longer allergy season. In NYC, the grass season is shorter, but other pollen-related allergies dominate. And the first oral allergy tablet to be introduced is for grass pollens.

The sublingual or oral allergy treatment is of course the least risky. There are no known side effects to oral medication. However, even with allergy shots, the mortality risk is still extremely rare. The Mayo Clinic states that in a 10 year study of allergy shots, the fatality risk was 2/10th of 1%. But oral immunotherapy also has drawbacks.

Immunotherapy studies have shown that sublingual tablets are 10% less effective in treating allergies than shots. Also, at present, the oral tablets only treat one specific allergy. Most allergy sufferers have more than one allergy and so allergy shots can be tailored-made to treat the patient’s specific allergy or more than one allergy in a single dose.

It is estimated that 35% who take allergy shots complete the three year therapy required to protect them. By contrast studies suggest that there is a 10% drop off in compliance with patients who took oral allergy immunotherapy. One of the problems in America is that people don’t comply with their medication schedule at home whether it be blood pressure, diabetes or oral allergy medication.

So consult with your doctor to find which treatment is best.

For more on the diagnosis of allergies visit “Allergies” here

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Whooping Cough Epidemic Spreads Over Several States

When I was growing up, several childhood diseases such as polio, measles and mumps, faded into obscurity. Now another childhood disease, whooping cough (pertussis) is unfortunately, making a strong comeback.

Some of my patients have expressed concern about whooping cough and it’s vaccine.

The latest outbreak can be traced to 2010 California, which has presently had the highest number of whooping cough cases in 55 years. It has since spread to a number of other states including South Carolina, New York, Michigan, Ohio and Minnesota.

In an article from the journal “Pediatrics reports that the high number of children who were intentionally unvaccinated also contributed to the rapid spread of the disease”. The reason for this, cites a study in USA Today was that “parents in California can obtain exemptions if all or some immunizations are contrary to their beliefs, whether religious or philosophical.”

As I have told my patients, the anti-whooping cough vaccine is safe for all children and most adults under 65. I urge all of them to get it. Pertussis has never completely gone away and it reappears cyclically every three to five years.

The CDC’s bulletine of vaccine recommendations are as follows: “1) for young children, five doses of the vaccine called DTaP (diptheria, tetanus, pertussis) given at 2, 4, 6, and 15-18 months, and 4-6 years; 2) for those 11 through 18, the CDC recommends one booster dose of Tdap; and 3) adults 19 through 64 should get a dose of Tdap.”

Have more questions on immunology and vaccines and live in the NYC area? Feel free to contact my office for a consultation at 212-247-7447.

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New Immunotherapy Research May Benefit those with Allergies to Cats

Additional help may be on the horizon for those that suffer from an allergy to cats.

Creighton University’s Dr. Thomas Casale is heading up clinical trials of a new immuno therapy that has shown promising results in European studies.

“We know the exact proteins that people are allergic to in cat dander and that’s what’s helped us develop these new vaccines,” said Dr. Casale. “They’re proteins and they’re part of the dander.”

For more on Allergies to Cats visit Allergy U – Allergy to Cats

See the video from Creighton University study here.

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