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The Flu And Your Child

Cooler temperatures have moved into the area and with them, the threat of the flu. I tell my patients that they should take certain measures to watch for symptoms of the flu, especially in their children.

The flu season starts in the fall but peaks in February and can continue into May, so it is important that people get a flu vaccine starting now.

Flu symptoms are more severe than a childhood cold. And may include:

*A high fever up to 104 degrees F
*Extreme tiredness
*Body and headaches
*Dry cough, sore throat
*Vomiting and stomach distress

An important advisory from The New York State Department of Health warns that “children aged 6 months through 8 years old age who have never received a seasonal flu vaccine need to get two doses of vaccine spaced at least 4 weeks apart. And healthy children over the age of two who don’t have a history of wheezing or asthma may have the option of getting the nasal spray influenza vaccine.”

Also, the State Department of Health recommends that “pregnant women and caregivers of children younger than 6 months or children with certain health conditions should be vaccinated.”

If your child gets the flu, remember that the flu is a virus and using antibiotics to treat it are useless since they treat bacterial infections. Antiviral medications can be used for high-risk cases, but there a number of home remedies that can be used to treat it:

*Plenty of rest
*Plenty of liquids
*Use acetaminophen or ibuprofen to lower fever, but avoid giving aspirin to children or teenagers since this could lead to Reye’s syndrome, a rare disorder that might cause severe liver or brain damage.

The FDA recommends that over-counter-medicines should not be given to children younger than 4, and as with all over-the-counter medicines for children, in general, it is advisable to consult your doctor.

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What You Should Know About The Enterovirus

Flu season has just begun yet a lot of my patients who have kids, are concerned about another illness that may affect their children–the Enterovirus D68.

This enterovirus virus first appeared back in August, in the Mid-West It has now spread to many states throughout the country. The New York Health Department has reported 14 cases in the western part of the state in early September, with new cases having now spread to New York City and Long Island.

In an interesting post on Web MD, Dr. Mary Anne Jackson of Children’s Mercy Hospital, Kansas City, MO said that the D68 virus doesn’t follow the normal course of most viruses. She said “viral infections start out with a fever, cough, and a runny nose. But kids with D68 infections–from 6 mos of age to 6 years old– have a cough and trouble breathing, sometimes wheezing. They act like they have asthma, even if they don’t have a history of it.”

Since it is a virus, there is no vaccine to prevent it nor do antibiotics help since it is non-bacterial in original. Symptoms, however can be moderate to severe.

For moderate symptoms, give children plenty of liquids and rest, says Roya Samuels, MD, at Children’s Medical Center in New Hyde Park. But for more severe symptoms she says “if there’s any rapid breathing, and that means breathing more than once per second consistently over the span of an hour. Or there is labored breathing, it’s time to head to the doctor’s office or emergency room.” Once hospitalized, children may receive supplemental oxygen or get medications like abuterol to open airways.

Prevention is key. The New York State Department of Health advises the public to take the following preventive measures:

*Wash hands often with soap and water.

* Avoid touching eyes, nose and mouth with unwashed hands.

*Avoid kissing, hugging, and sharing cups of eating utensils with people who are sick.

*Disinfect frequently touched surfaces.

*Use the same precautions you would to prevent the spread of influenza.

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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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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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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:

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.


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.

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.
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.

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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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