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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.”

To learn more: http://www.nycallergydoctor.com/allergy

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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.

For futher information: http://www.nycallergydoctor.com/allergy

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Allergic Rhinitis Study – Factors in Teens

A German study of Allergic Rhinitis (AR) in adolescence reveals that AR can be predicted with a degree of certainty.

The study of 2810 prepubescent children followed into adolescence  compiled by Jessica Kellberger, Dipl-Stat, from the University Hospital of Munich, Germany, and colleagues shows the strongest predictors of AR is positive skin-prick tests for outdoor allergens.

“Our prediction models indicate a substantial increase in the likelihood of new onset of AR in girls with high socioeconomic status and parental history of asthma who have not been exclusively breast-fed for 2 or more months and who presented with a positive [skin-prick test] response to both outdoor and indoor allergens at age 9 to 11 years,” they write.

“The risk factors indicated in our study are in accordance with those of other studies. However, thus far, none of these studies have used the information for individual prediction of disease course.”

Reaction to the findings suggest the positive allergy test may help in answering is it a cold or allergies question when dealing with a specific patient’s health.

“I think this paper is probably more useful to general pediatric practitioners, because they are the ones who eventually tell the difference between colds and allergic rhinitis when deciding to make the referral and when to look further to see what the patient’s allergic to,” said Weihong Zheng, MD, an allergist at Tufts Medical Center and assistant professor of Medicine at Tufts University School of Medicine in Boston, Massachusetts. Dr. Zheng was not involved in the study.

The study’s abstract is available here: http://www.jacionline.org/article/S0091-6749%2811%2901317-0/abstract

If you have questions about Allergic Rhinitis in adults or children- contact my office for a consultation 866-632-5537.

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Can a pet help your baby avoid future allergies?

Yes, exposing a child in the first year of life to pets can help to avoid pet allergies later in life.  Watch Dr. Lubitz discuss pets and infants in this WCAX news brief.

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Updated Guidelines for Stinging Insect Hypersensitivity

The American College of Allergy, Asthma and Immunology (ACAAI) has updated guidelines for diagnosing and treating stinging insect hypersensitivity.

Recommendations

Specific summary statements in the Practice Parameter include the following:

  • Persons who have had a systemic reaction to an insect sting are at greater risk for subsequent systemic sting reactions. Venom immunotherapy (VIT) can significantly lower this risk.
  • Acute reactions to stings should be managed symptomatically:
    • Acute systemic reactions to insect stings should be treated like any anaphylactic reaction, with epinephrine injection, supportive treatment, and transport to an emergency department. Symptoms may include chest tightness; difficulty breathing; edema of the tongue, throat, nose, and lips; dizziness; and/or loss of consciousness. Complications may include shock and heart failure.
    • For patients who have a history of only cutaneous systemic reactions, antihistamines and close observation may be appropriate initial therapy for cutaneous systemic symptoms.
    • However, delaying epinephrine administration may result in fatal sting reactions.
    • For large local reactions, treatment may include antihistamines, cold compresses, and a brief course of oral corticosteroids, in severe cases. Antibiotics are usually not required.
  • For patients with a suspected systemic reaction to an insect sting, consultation with an allergist-immunologist is recommended. This is especially true for patients who:
    • Need education about their risk for another reaction if they are stung, emergency and preventative treatment options, and/or how to avoid insect stings;
    • Have a comorbid condition, such as high blood pressure or pulmonary disease, or require regular use of a medication (eg, beta-blockers or angiotensin-converting enzyme inhibitors) that might complicate a potential reaction to a sting; or
    • Request referral for more detailed information or specific testing.
  • Patients who have a history of systemic reactions to insect stings should:
    • Be informed regarding insect avoidance in ways to avoid insect stings;
    • Carry epinephrine and be educated regarding proper use and indications for emergency self-treatment;
    • Have specific immunoglobulin E (IgE) testing for stinging insect sensitivity;
    • Be considered for immunotherapy; and
    • Consider wearing a medical identification bracelet or necklace.
  • Patients who are candidates for VIT should undergo immediate hypersensitivity skin tests to stinging insect venoms, with the following special considerations:
    • Except in special circumstances, skin tests should be used for initial measurement of venom-specific IgE, rather than in vitro assays.
    • Patients who have a severe allergic reaction but negative skin test responses at 6 weeks or longer after the sting reaction should have further testing (in vitro testing, subsequent skin testing, or both) and baseline testing of serum tryptase.
    • The degree of sensitivity shown by skin and serologic testing for venom-specific IgE does not correlate consistently with the severity of a reaction to a sting.
    • For sensitivity to imported fire ants, skin testing is performed with whole-body extracts.
  • For all patients who have had a systemic reaction to an insect sting and who have specific IgE to venom allergens, VIT is recommended, with the following special considerations:
    • VIT is usually not needed in children 16 years or younger who have had cutaneous systemic reactions without other systemic findings after an insect sting.
    • The need for immunotherapy in adults who have had only cutaneous reactions to an insect sting is controversial, but these patients are usually considered candidates for VIT.
    • VIT is typically not needed in patients with only large local reactions to stings, but it may be considered in those with frequent, unavoidable exposure to stinging insects.
  • All patients who have had a systemic reaction to a sting from a fire ant and who have positive skin test responses or allergen-specific serologic test results should have immunotherapy with imported fire ant whole-body extract. However, immunotherapy may be considered for children with only cutaneous manifestations who live in areas where fire ants are prevalent, because the natural history of fire ant hypersensitivity in these children has not been completely elucidated.
  • VIT should usually be continued for at least 3 to 5 years once it is started. Most patients can then safely discontinue immunotherapy, but some patients may need to continue it longer or even indefinitely, based on the following:
    • High-risk factors include near-fatal reaction before or systemic reaction during VIT, honeybee allergy, increased baseline serum tryptase levels, underlying medical conditions and concomitant medications, and frequent exposure.
    • Quality-of-life considerations include limitation of activities and/or anxiety regarding being stung.
    • Optimal duration of immunotherapy with imported fire ant whole-body extracts has not been completely determined.

“There remain some unmet needs in the diagnosis and treatment of insect sting hypersensitivity,” the guidelines authors write. “Improved diagnostic accuracy with better positive predictive value might await studies to validate new tests, such as those using recombinant allergens or epitopes or those designed to detect basophil activation or basophil sensitivity. Similarly, there is a need for a better predictor of relapse after stopping VIT.”

A complete description of the disclosures of the guidelines authors is available at the Journal of Allergy & Clinical Immunology Web site .

J Allergy Clin Immunol. 2011;127:852-854.e23. Abstract

 

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Potential Link Between Pain Killers and Asthma

Acetaminophen (or Paracetamol outside the US) may increase a patient’s risk of asthma, according to a published study in The Journal of Clinical and Experimental Allergy.

Conducted by the Medical Research Institute of New Zealand, children and teens exposed to the popular painkillers at least one a year were twice as likely to suffer from asthma.

Although these tests are not conclusive, many thoracic doctors believe that painkillers may cause people to have difficulty breathing.

“We have seen Aspirin to have the highest impact on patients by causing wheezing,” stated Dr. A. Chithrakumar of Madras Medical College, adding that Acetaminophen has also shown this tendency, though not to the same degree as Aspirin.

Consult your Health Care provider for more information on the link between common painkillers and troubled breathing.

Ref:
S. C. Dharmage and K. J. Allen, Clinical & Experimental Allergy, 2011 (41) 459–460.

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Potential of Asthma Adherence Management to Enhance Asthma Guidelines

A shocking 50% of asthma patients do not adhere to physician  medication recommendations.  The result is unnecessary suffering and even death.
This statistic is the driving force behind a study The potential of asthma adherence management to enhance asthma guidelines as published in the Annals of Allergy, Asthma and Immunology
The result…
Studies using individual interventions by themselves were modestly effective in promoting adherence. Two uncontrolled studies of children with severe asthma, treated in both inpatient and outpatient rehabilitation settings, used 4 intervention strategies to achieve marked reduction in morbidity and cost. These strategies included: (1) objective adherence monitoring; (2) identification of the cause(s) of nonadherence; (3) delivery of specific strategies for each cause; and (4) use of motivational interviewing communication skills to enhance the delivery of the strategy.
Conclusion:
Nonadherence continues to be a significant problem.

Examining successful, organized adherence management programs in a controlled environment is needed “to increase adherence management evidence for future asthma guidelines.”

Bottom line… asthma is a serious condition.  Proper control of  your asthma depends on the complete partnership between you and your doctor. If you have any questions or concerns about your asthma treatment plan, do not hesitate to contact your healthcare provider.

Live in NYC and looking for answers to your asthma questions, please contact me – together we can devise an easy to administer treatment plan that will keep your asthma under control.

Visit nycallergydoctor.com for more information.

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Why are you sneezing?

Allergic rhinitis, commonly called hay fever, is a collection of symptoms, mostly in the nose and eyes, which occur when an allergen is inhaled.  As the pollen from trees, grass, flowers and plants become airborne these characteristics of spring trigger allergic responses such as runny noses, sneezing, post nasal-drip, itchy, coughing, fatigue watery and red eyes, and headaches.  The immune system identifies pollens as foreign substances, and it subsequently responds by triggering the release of histamines to expel the perceived invaders, which can brings forth the above listed of allergy symptoms.

The American Academy of Allergy Asthma and Immunology, nearly 36 million people are affected. It is a common chronic condition, affecting 10% – 30% of adults and up to 40% of children in the United States.  If this includes you, you don’t have to suffer.  An allergist can help determine which allergens cause your symptoms.   A detailed health history, physical exam and allergy testing can supply results in as little as 20 minutes. All this information will be taken into consideration when developing a plan of treatment.

If you live in the NYC area, call my office at 866.632.5537 and start enjoying springtime again.

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Understanding Allergic Asthma

Asthma and allergies often work in tandem against the patient.  Asthma is a disease affecting bronchial tubes, which transport air in and out of the lungs.  There are several different types of asthma, allergic asthma is provoked by an allergen.  The American Academy of Allergy, Asthma and Immunology estimates that 10 million Americans suffer with allergic asthma.

To explain allergic asthma we review the breathing process.  It begins as air is taken in through the nose and trachea then into the bronchial tubes. Inside the bronchial tubes are alveoli, little air sacs that transports fresh (oxygen) to the blood. These sacs also collect carbon dioxide to be exhaled out of the body. During normal breathing, muscles circling the airways are at ease while air maneuvers about effortlessly.

On the contrary during an asthma “attack,” complications keep air from moving freely into airways:

  • Muscles surrounding airways tighten, known as a “bronchospasm.”
  • Bronchial airways may become swollen and/or inflamed.
  • Mucus may be produced in over abundance and may be thicker than normal.

These tightened airways result in difficulties in moving air in and out of the lungs. People with asthma struggle with their breath and feel they cannot get enough air.  All of these changes make breathing difficult.

Some patients experience long breaks between asthma episodes while others have some symptoms every day.  Symptoms of asthma occur when patients encounter the biological events previously described.

Common symptoms of asthma are:

Coughing, especially in the evening
Shortness of breath
Wheezing
Tightness, pain, or pressure in the chest

It is important to note that not all people with asthma have the same symptoms.  Symptoms may differ from one asthma episode  to the next. Symptoms may fluctuate in severity, from mild during one attack to severe during another.

Milder asthma episodes are more common. The airways calm may down within minutes, but sometimes symptoms  can last for a few hours. Although less common, the longer lasting and more severe episodes require immediate medical treatment.  Patients should treat even mild symptoms to help prevent severe attacks and keep asthma in control.

If you suffer from allergies and asthma, a reaction to any allergen substance can aggravate asthma symptoms.

For over 25 years, I have treated Allergy, Asthma and Sinus Patients in New York City. Help is available; you can breathe easier and live a greater quality of life. Call me, Dr Arthur Lubitz, NY Allergy MD and together we’ll devise a successful treatment plan that addresses your symptoms.

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Sinusitis and Your Child

What is Sinusitis?

Sinusitis refers to inflammation of the sinuses that occurs with a viral, bacterial, or fungal infection.

Sinusitis can be:

  • Acute — symptoms last up to 4 weeks
  • Sub-acute — symptoms last 4 – 12 weeks
  • Chronic — symptoms last 3 months or longer

These factors may increase your child’s risk of developing sinusitis:

  • Allergic rhinitis or hay fever
  • Cystic fibrosis
  • Day care
  • Diseases that prevent the cilia from working properly, such as Kartagener syndrome and immotile cilia syndrome.
  • Changes in altitude (flying or scuba diving)
  • Large adenoids
  • Smoking
  • Tooth infections (rare)
  • Weakened immune system from HIV or chemotherapy

The doctor will examine you or your child for sinusitis by:

  • Looking in the nose for signs of polyps
  • Shining a light against the sinus (transillumination) for signs of inflammation
  • Tapping over a sinus area to find infection

Viewing the sinuses through a fiberoptic scope (called nasal endoscopy or rhinoscopy) may help diagnose sinusitis.

A CT scan of the sinuses may also be used to help diagnose sinusitis or to evaluate the anatomy of the sinuses to determine whether surgery will be beneficial. If sinusitis is thought to involve a tumor or fungal infection, an MRI of the sinuses may be necessary.

If you or your child has chronic or recurrent sinusitis, other tests may include:

  • Allergy testing
  • Blood tests for HIV or other tests for poor immune function
  • Ciliary function tests
  • Nasal cytology
  • Sweat chloride tests for cystic fibrosis

Antibiotics are usually not needed for acute sinusitis. Most of these infections go away on their own. Even when antibiotics do help, they may only slightly reduce the time you or your child is sick. Antibiotics may be prescribed sooner for:

  • Children with nasal discharge, possibly with a cough, that is not getting better after 2 – 3 weeks
  • Fever higher than 102.2° Fahrenheit (39° Celsius)
  • Headache or pain in the face
  • Severe swelling around the eyes

Acute sinusitis should be treated for 10 – 14 days. Chronic sinusitis should be treated for 3 – 4 weeks. Some people with chronic sinusitis may need special medicines to treat fungal infections.

Call your doctor if:

  • Symptoms last longer than 10 – 14 days or a cold that gets worse after 7 days
  • Severe headache are unrelieved by over-the-counter pain medicine
  • Fever is present
  • Symptoms continue after taking all antibiotics properly
  • There are changes in vision during a sinus infection

A green or yellow discharge does not necessarily indicate a sinus infection or the need for antibiotics.

Prevention

The best way to prevent sinusitis is to avoid or quickly treat flus and colds:

  • Eat plenty of fruits and vegetables, which are rich in antioxidants and other chemicals that could boost your immune system and help your body resist infection.
  • Get an influenza vaccine each year.
  • Reduce stress.
  • Frequent handwashing, particularly after shaking hands with others.
  • Avoid smoke and pollutants.
  • Drink plenty of fluids to increase moisture in body.
  • Take decongestants during an upper respiratory infection.
  • Treat allergies quickly and appropriately.
  • Use a humidifier to increase moisture in nose and sinuses.

If you are looking for answers in the treatment of chronic sinusitis, please call my office for a consultation.  There are successful treatment plans that  will improve your quality of life.  In the NYC area, call 866-632-5537.

ref: PublicMedHealth

*The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsements of those other sites

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