Wednesday, June 29, 2011

Chronic cough could be associated with mold in musical wind instruments


Musical wind instruments can be a perfect place for mold growth: warm, humid inside surfaces during playing of the instrument, often not cleaned thoroughly, create a “biofilm” on the inner surface. Cases of chronic cough have been linked to inhalation of mold spores during trombone playing in one instance, and saxophone playing in another. The harmonica, which is played during both inhalation and exhalation, may be another potential source of mold exposure. In the case of the trombone player with an allergic lung condition triggered by mold from his trombone, cleaning of the instrument regularly with 91% isopropyl alcohol resulted in marked improvement of symptoms for 20 months, except when he neglected to clean the trombone for over a month.

Chest 2010 Sep; 138(3):754-6. Metersky ML, Bean SB, Meyer JD, Mutambudzi M, Brown-Elliott BA, Wechsler ME, Wallace RJ Jr. Trombone player’s lung: a probable new cause of hypersensitivity pneumonitis.

Chest 2010 Sep; 138(3): 724-6. Metzger F, Haccuria A, Reboux G, Nolard N, Dalphin JC, De Vuyst P. Hypersensitivity pneumonitis due to molds in a saxophone player.

Friday, June 24, 2011

Visiting Physician





Beginning the week of July 5th, we will be welcoming Dr. Katie L. Marks to our practice as a guest physician to help cover vacation schedules for Dr. Buchsbaum and Dr. Schoettler. Please join us in welcoming Dr. Marks.



About Dr. Katie Marks
Dr. Marks, originally from Cleveland, Ohio, completed medical school at the University of Maryland in Baltimore and residency training in Internal Medicine at Northwestern University in Chicago. Following residency training, Dr. Marks moved to Philadelphia to complete a fellowship in Allergy/Immunology at the Hospital of the University of Pennsylvania. She now resides in Los Angeles where her favorite pastimes include hiking, dancing, and traveling.

Wednesday, June 22, 2011

Early daycare increases risk of wheezing in 0-2 yr old children


Anyone with small children in daycare or preschool can tell you that exposure to respiratory infections is rampant among young classmates. Many children also develop respiratory symptoms such as cough, wheezing, or difficulty breathing – a condition called “reactive airways disease” which may herald the onset of asthma. In children aged 0-2 yrs, there is more wheezing if they are placed in daycare, during a time when respiratory problems can be much more difficult to treat and more troublesome to the child and family.

Am J Respir Crit Care Med 2009;180(6): 491-8. Caudri D, Wijga A, Scholtens S, Kerkhof M, Gerritsen J, Ruskamp JM, Brunekreef B, Smit HA, de Jongste JC. Early daycare is associate with an increase in airway symptoms in early childhood but is no protection against asthma or atopy at 8 years.

Sunday, June 19, 2011

Is there a difference between having a wheat allergy and gluten sensitivity/celiac disease?


Wheat allergy is not the same as celiac disease. While both result in an intolerance to wheat, and both improve by removing wheat from the diet, the processes involved are very different.

With wheat allergy, as with any other food hypersensitivity, the immune system reacts to repeated ingestion of wheat protein by producing IgE antibodies -- a type of immunologic response that leads to sensitization of cells in the gut, skin, and respiratory lining. Once these cells are sensitized, all it takes is a small amount of exposure to wheat in the diet for them to release histamine and other chemicals that lead to a variety of allergy symptoms, ranging from itchy skin, hives, and lip or eyelid swelling to respiratory symptoms like wheezing or cough, to intestinal symptoms like cramping or diarrhea. Wheat-specific IgE can often be lost over time if wheat is eliminated completely from the diet for a year or more.

Celiac disease, on the other hand, is a condition where gluten (a protein found in wheat, oats, and barley) stimulates a different type of nonallergic immune reaction, leading to flattening of the fingerlike projections that normally line the intestines, and malabsorption of nutrients. This can be confirmed with a biopsy of the intestinal lining, and with blood tests for specific IgG antibodies commonly found in celiac disease. Symptoms are strictly gastrointestinal, and dramatically improve on a gluten-free diet -- but unlike wheat allergy, reintroduction of gluten in the diet is not likely to be tolerated.

Take home message: Distinguishing between wheat allergy and celiac disease is important in determining proper management and risk for future reactions.

Chronic hives may be effectively treated with high dose Xyzal or Clarinex


Chronic urticaria, or “hives”, can be very bothersome and may not improve with usual doses of antihistamines used for other conditions (e.g., nasal allergies). Patients often ask whether it would be safe and helpful to take 2-3 times the usual doses of antihistamines such as Clarinex or Xyzal. In a recent study, increasing the dose of Xyzal from the usual 5 mg up to 20 mg per day did result in markedly improved control of hives. Increasing Clarinex similarly was also moderately helpful. There was no increase in drowsiness or any other side effect with either medication. So, it may be safe to take higher doses of these medications when needed for severe chronic hives, though we would recommend starting with lower doses and increasing only if approved by your doctor.

J Allergy Clin Immunol 2010;125:676-82. The effectiveness of levocetirizine and desloratidine in up to 4 times conventional doses in difficult-to-treat urticaria. Staevska M, Popov TA, Kralimarkova T, Lazarova C, Kraeva S, Popova D, Church DS, Dimitrov V, Church MK (Bulgaria, UK, Germany)

Wednesday, June 15, 2011

What to Do With Expired Medications

If you have expired medications around the house, it is best not to throw them in the trash where they could end up in the wrong hands, nor down the toilet, where they could contaminate the water supply. Several local police stations are teaming up with the DEA and offering to dispose of your old medications properly. See the whole story in the Daily Breeze here.

Tuesday, June 14, 2011

July 4th Holiday Hours

Our office will be closed Monday, July 4th in observance of Independence Day. We will open additional shot hours on Tuesday, July 5th from 9:00 – 12:45 to help accommodate the closing.

Friday, June 3, 2011

Sleep-away Camp with Food Allergies: Just Do It!


With the summer quickly approaching, many parents of food allergic children ask if it is safe for their child to attend a sleep-away camp. The answer is "yes"...if you do the necessary homework. Here are a few steps to follow in order to ensure a safe and happy camp experience for your child.
  1. Look online or ask friends about camps that have had experience with food allergic children. Call the camp and speak with the director of the camp as well as the meal coordinator. Are they willing to develop a Food Allergy Action Plan with you? Can you review the menu ingredients with the kitchen and determine which foods will be safe for your child? Do you need to supply the camp with any foods to substitute for the forbidden foods in your child's diet?
  2. Make sure the camp has a doctor and/or nurse (RN) on the camp premises at all times. How far away is the nearest hospital? Are the counselors trained in treating allergic emergencies?
  3. Parents of bunk mates will often send "goodies" during the summer or come armed with special treats on Visitor's Day. Request the names and addresses of the other campers that will be in the same cabin. Advise the camp staff that you would like to write to the parents of the other campers in the cabin requesting that certain ingredients (within reason) be avoided when the treats arrive to be shared.
  4. Speak with your child's allergist and develop a written action plan to be followed by the camp staff in the event of accidental ingestion. Supply the camp with appropriate quantities of medications, both in your child's cabin and in the infirmary. In some cases, medications should be with or near the child at all times.
  5. As always, reinforce with your child the importance of asking questions and not taking chances!
Take Home Tip: It is safe for children with food allergies to attend sleep-away camp if the right steps are taken to ensure a summer free of allergies.