Allergy Shots: Worth the Wait

Q. Why do I have to wait 15 minutes after allergy shots at the doctor's office? I've never had an allergic reaction.

A. Waiting for 15 minutes after receiving an allergy shot is inconvenient, I know. But allergy shots contain what the individual is allergic to, so the major risk from an allergy shot is an allergic reaction.

Intuitively, you might think such reactions would be most likely to occur during the build-up phase of allergy shots - the initial period of about three to six months where the dose of allergen you receive is gradually increased - but it turns out that's not the case. Reactions can happen at any time, even long after a maintance dose has been achieved (that's when the shots get less frequent and keep up your immunity to the allergen).

While most reactions to allergy shots are mild, there is a small risk of a serious reaction. And rapid treatment is key in preventing mild reactions from progressing into more serious ones. The vast majority of allergy shot reactions occur within 15 minutes of the injection, but occasionally they happen later.

The professional allergy associations' joint recommendation is that to ensure safety, individuals should stay in the doctor's office for at least 15 minutes after receiving an allergy shot. Patients who have experienced reactions more than 15 minutes after an allergy shot should be observed for a longer period of time.

Source: White MD, Martha. Allergy & Asthma Today, Volume 9, Issue 4. Winter 2011.

Treating peanut allergy through a patch

Can your peanut-allergic child be treated by simply wearing a patch? That is what researchers at National Jewish Health are researching. National Jewish Health, along with four other institutions in the Consortium of Food Allergy Research (CoFAR), are currently testing the safety of a peanut patch.

The peanut patch would work to desensitize allergic patiens by exposing them to increasing amounts of peanut protein, similar to the way allergy shots can desensitize people to pollen. The patch will release minute doses of peanut oil under the skin, like nicotine patches used by people trying to quit tobacco. The aim is to educate the body so it does not over-react to peanut exposure.

Human safety trials have started in Europe and the United States and it is hoped the patch could become available within three to four years.

One of its inventors, Dr Pierre-Henri Benhamou, said, "We envisage that the patch would be worn daily for several years and would slowly reduce the severity of accidental exposure to peanuts. The beauty of the patch is that it is absorbed just under the skin and is taken up by the immune system. But because it doesn't go directly into the bloodstream there is no risk of a severe reaction. We have carried out a number of small safety trials and now moving to trials that will establish the size of the dose needed and for how long the patch would need to be worn."

They believe that after about a year of wearing the patch, patients may be cured of a severe reaction to peanut. But it would need to be worn for several more years before a nut allergy sufferer could safely be exposed to peanut.

Dr Benhamou said, "At best we are talking about a sufferer eventually being able to eat modest amounts of peanut without a reaction. But what we want to do most is eliminate the severe reaction that occurs when people are exposed to the tiniest speck of peanut."

Read the whole article from physorg.com at http://bit.ly/dGGkAD

Red-and-White Milk and Egg free Holiday Cookies

2/3 cup dairy-free shortening

1/2 cup brown sugar

1/2 cup white sugar

1/4 cup apple sauce

1 tsp. vanilla extract

1-3/4 cups all-purpose flour (contains wheat/gluten)

1/2 tsp. baking soda

1/2 tsp. salt

3/4 cup dairy free white chocolate chips (can substitute carob chips)

1/2 cup currants or sundried cranberries

Directions:

Preheat oven 375 degrees. Mix together shortening, sugars, apple sauce and vanilla. In separate bowl, combine flour, baking soda and salt; combine wet and dry ingredients until smooth. Add in fruit and white chocolate chips. Roll dough into balls and place on baking sheet lined with parchment paper. Bake 12 minutes or until lightly browned. Cool and serve!

Puppy Love Tied Up in a Bow

Nothing is sweeter than a puppy, except perhaps one with a Christmas bow on her head. But is it a present that will make somebody at home sick?  Things to think about:

Family member with furry pet allergies? Not a great idea to have an indoor dog, even if it is supposed to be "hypoallergenic".  All dogs share certain proteins in their dander that can trigger allergies.

Family member with pollen or mold allergy?   An indoor dog that doesn't roll around on the grass or chase squirrels through the leaves might be better.   But it's still best to keep the dog out of the bedrooms, to minimize the likelihood of developing a new allergy to dog dander.

Allergic to dust mites? All dogs shed dander. One flake feeds an entire dust mite family. 

But then, plenty of allergists and veterinarians have asthma and furry pet allergies. How do they do it? They use immunotherapy (allergy shots) to improve their tolerance, and a host of environmental management techniques.

Here's a few to consider before you buy a puppy this Christmas:

• Frequent grooming - a clean coat harbors fewer pollen and mold spores. 


• Flea and tick prevention - Use products recommended by your veterinarian.  Avoid powders or sprays or chemical bombs that can irritate the airways.


• Out of the bedroom -  Unless you are disciplined enough to train the new puppy to stay outside the bedroom and provide positive reinforcement for good behavior, you are inviting trouble.

• Clean the house daily - Dogs increase the cleaning work load. Use a HEPA vacuum daily, dust with microfiber cloth (but don't use dust sprays) and make sure puppy accidents are cleaned and neutralized immediately. 

• Diet - Read the label. You don't want your dog eating any food that contains an ingredient your child may be allergic to. Otherwise, the first kiss after dinner might lead to a hospital visit.

Want to know more about building a tolerance to your pets with allergy shots?  See if you might be a candidate, by coming in for an allergy evaluation.  

Source:  Allergy & Asthma Today. Volume 9, Issue 4. Winter 2011

Handling the Holidays

Do asthma and allergies threaten to be the Grinch in your holidays? The American Academy of Allergy, Asthma & Immunology (AAAAI) offers these tips to help keep your season merry:

• The holidays are filled with hustle and bustle, but stress can trigger an asthma attack. Shop early or late in the day to avoid crowds. If "quiet time" isn't a part of your normal routine, now is the time to start.

• Fires burning in the hearth bring warmth and ambiance to a holiday get-together. However, the smoke and ash can smother the spirit for some, provoking breathing difficulties or triggering an asthma attack. Request the Yule log remain unlit.


• Prepare for visits to homes with pets by taking your allergy and asthma medication before the visit. The medication may help reduce your reaction. You can also ask party hosts to keep Fido in a separate room.


• Food is central fixture in most holiday gatherings. Remember that homemade items don't come with ingredients lists. If you or your child has food allergies, be cautious, especially around homemade treats. Foods can become tainted through cross-contamination in the baker's kitchen or food storage containers - and even a trace amount can trigger a reaction.

Ingredient Notice - PowerBar/Nestle Nutrition

PowerBar/Nestle Nutrition would like you to know that the allergen declaration format on PowerBar ProteinPlus Reduced Sugar Bar (chocolate peanut butter variety) labels have changed.  There is no longer a "Contains:" allergen statement on the product label.   All allergen declarations currently exist on the label ingredient statement and will remain as such.   No changes have occurred in the product allergen content; this is a change to label format only.   This change took effect in October.

Additionally, the allergen declaration format on PowerBar Fruit Smoothie Energy Bar (creamy citrus variety) labels have changed. There will no longer be a "Contains:" allergen statment on the product label.   All allergen declarations currently exist on the label ingredient statement and will remain as such.   No changes have occurred in the product allergen content; this is a change to label format only. This change took effect in October.

Nestle Nutrition encourages its consumers to read the product label for all allergen information. For more information, contact PowerBar Service Center at (800) 587-6937.

Exercise Improves Asthma Control

Among patients with asthma, those who are physically active use less health care.  A recent study in Europe showed that a 12-week supervised aerobic and strength training exercise program led to improved asthma control, quality of life, and aerobic fitness in 21 adults with partially controlled asthma.  The benefits were maintained with another 12 weeks of self-administered exercise.

The improvements were not supported by measurements of airflow obstruction, however there was clearly a benefit suggesting that this "natural" adjunct to asthma treatment may be helpful -- and there is no copay or authorization needed for this prescription!

Dogra S, Kuk JL, Baker J, Jamnik V:  Exercise is associated with improved asthma control in adults.  Eur Respir J. 2011; 37: 318-323.

Oatmeal Snowball Cookies

Oatmeal Snowball Cookies

Milk, Egg, Peanut and Nut free.

2 cups light brown sugar, firmly packed
1 cup milk-free margarine, softened
3 T. water, 3 T. oil, 2 tsp. baking powder, mixed together
1 1/2 cups flour
2 tsp. ground ginger
1 tsp. baking powder
1 tsp. baking soda
1/2 tsp. vanilla extract
4 cups quick oats
confectioners sugar

In a large bowl, with an electric mixer on medium speed, beat brown sugar and margarine until creamy. Beat in water, oil, and baking powder, baking soda, and salt. Beat in vanilla extract. Stir in oats. Shape dough into 1-inch balls and roll in fectioners sugar. Chill 1 hour. Preheat oven to 375 degrees. Bake 10 minutes.

How Can You Tell if It's a Cold or Allergies?

With more than 200 types of viruses circulating in the community, and lots of sharing going on (the kind you don't really want), we are seeing more stuffy noses, sneezing, and cough these days. But if you also have allergies, how can you be sure whether it is a cold or your allergies flaring? And when does it matter?

1. Does it itch?

If there is itching of the nose, throat, or eyes involved, you are more likely dealing with allergy symptoms. Remember the seasonal allergies that go with the holidays -- old decorations coming out of storage (along with dust and maybe a little mold), stagnant water at the base of a Christmas tree, dust blowing out of air ducts the first time the heater is turned on -- more exposure means more allergy symptoms.

2. Is there fever or muscle ache?

Respiratory infections can come with fever and other symptoms such as fatigue, muscle aches, or nonrespiratory symptoms such as stomachaches, nausea, or diarrhea. This is often the tip-off that the stuffy nose is not due to allergy this time.

3. Why does it matter?

If your symptoms are due to allergy, a few changes in the environment might be very helpful, like using a HEPA air filter, cleaning ducts, wearing a mask while moving old boxes out of storage; and your allergy medications are more likely to work for this type of problem.

If it is a respiratory infection, especially with thick or discolored mucus, it may be better to clear out secretions with a decongestant and expectorant, or salt water rinse of the nasal passages, rather than drying up secretions with an antihistamine.

Ingredient Notice - General Mills

General Mills Dark Chocolate Chex Mix labels have changed. No changes have occurred in the product allergen content (it contains milk, wheat, and soy); this is a change only to the advisory/cautionary "May Contain" statement on the label due to a change in the manufacturing location. The product may contain peanuts. Product packaging with the new "May Contain" statement took effect in October.

Fiber One Mocha chewy bars label has changed. No changes have occurred in the product allergen content; this is a change only to the advisory/cautionary "May Contain" statement on the label due to a change in the manufacturing location. The previous allergen statement was: Contains soy and milk, may contain wheat ingredients; the new allergen statement will be: Contains soy and milk, may contain wheat, peanut, almond, and sunflower ingredients. Product packaging with the new "May Contain" statement came on the market in October.

General Mills urges you to read all labels for current allergen information. For more information, contact General Mills Consumer Services at (800) 231-0308.

Ingredient Notice - Wendy's

Wendy's Premium Buns are not buttered and toasted. The buns are brushed with a clarified butter prior to toasting. Clarified butter is butter that has undergone purification to separate the solid particles and butter oil.

The purification process may not remove 100% of the solids; therefore clarified butter may contain trace amounts of milk protein. Individuals with a milk allergy should request the bun to be untoasted (without butter).

Anaphylaxis: Better Safe than Sorry

Q. How can I tell when to use auto-injectable epinephrine? I don't want to use it or go to the hospital if it's not necessary.

A. There's no way to predict how severe an anaphylaxis episode might become, so the time to begin treatment is when symptoms first develop.

Only epinephrine stops anaphylaxis. Injected into the thigh, it begins to take effect within 5-8 minutes. It often takes more than one dose - and if something were to go wrong with the first dose, you'll need a back-up. By comparison, antihistamines don't start working for an hour and won't touch the respiratory or cardiovascular effects of anaphylaxis.

After you administer epinephrine, call 911. Don't drive yourself to the hospital! Adults should lie down with feet elevated to help protect the heart and brain while they wait for help. If possible, be ready to explain what you were doing before symptoms appeared and what's happened since you used epinephrine. Children tend to have breathing compromised more so than cardiovascular function and it's important they be kept comfortable, so they can remain or be held by a parent sitting upright.

Epinephrine is not a dangerous drug; adverse effects typically are mild and affect only elderly and frail patients. Anaphylaxis, however, can be fatal - it's safer to treat!

source: Wallace, Dana MD, Allergy & Asthma Today, Volume 9, Issue 4. Winter 2011.

Allergy Alert!

The rain has kept the pollen levels low. However, mold spores are still prevalent. In addition, the Santa Ana winds will be picking up this weekend which can cause allergy flare ups. Please close your windows and take allergy medications if you are pollen allergic.

Don't forget about those moldy pumpkins.

Did you know that a carved pumpkin can grow enough mold within one day to trigger major allergy and asthma symptoms? If someone in your family is mold allergic, be sure to get rid of that Jack o' Lantern before it becomes a health hazard!

Hope you had a Happy Halloween!

Be well for the holidays.

Flu season is just around the corner. Make sure to come in for your flu vaccination. No appointment necessary.

Don't Get Blown Away!

There is a high wind advisory. Remember to close your windows and stay indoors to decrease your exposure to pollens.

The Tricks to Treats

An all-ages guide to ensuring that food-allergic ghosts and goblins have a spookily great Halloween.

1. Have a nice dinner first. On a full stomach, there will be less temptation to sneak a piece of candy.

2. Stash a few pieces of safe candy (Tootsie Rolls are peanut-, nut- and gluten-free) in your pocket. When the other kids inevitably indulge along their route, your child will have something safe to enjoy and won't feel left out.

3.Keep the essentials with you. Don't leave home without a cell phone, flashlight, wet wipes and, of course, the epinephrine auto-injector and an emergency dose of Benadryl (diphenhydramine) in a chewable, liquid, or meltaway form in case of accidental ingestion of a food allergen.

4. Consider supplying a few neighbors with pre-filled sealed treat bags. When your child rings the doorbell, the neighbor can pass out the safe loot and you'll be certain that he'll get to keep some of what he has collected.

5. Choose costumes with gloves if your child is extrememly contact-sensitive.

6. At home, pass out low-cost toys or trinkets.

Different approaches may need to be used for different ages:

0-2 year-olds: It's a treat just to answer the door and pass out trinkets.

2-4 year-olds: Make sure your child knows that all candy should be checked for safety by a parent. We prefer that even young kids be trained from the start to not dive into the goodies before they are checked (not only for allergy reasons but to make sure they are sealed, wrapped candies that have not been tampered with).

5-8 year-olds: Use the "Trade Up" tactic. Buy a variety of safe candy, as well as a few inexpensive toys. When your child returns home from trick-or-treating, trade unsafe candy for safe candy, toys and trinkets.

8 and up: Cash is king at this age. Trade their unsafe candy for nickels, times, quarters or even dollars. Some kids might be more excited by a larger-ticket item, like a doll or game that can be traded for an entire bag of candy.

Siblings: Offer to trade siblings' candy too or consider saving a stash in a safe place and promise to take your non-allergic child on a "peanut date" where they can indulge in the forbidden candy without endangering their brother or sister.

Source: Allergic Living, Fall 2011

Don't Scare Up Other Allergies On Halloween Night

Halloween can be a frightening time for those with allergies. And it's not just peanuts in candy that put trick-or-treaters in danger.

Allergy--and asthma triggers--may be lurking among your Halloween goodies and decorations, warns the American College of Allergy, Asthma and Immunology.

"When people think of Halloween-associated allergies, they focus on candy and often overlook many other potential triggers," said Myron Zitt, M.D., former ACAAI president in a released statement. "By planning ahead, you can ensure not only safe treats, but also safe costumes, makeup, accessories and decorations."

To keep your gasps of horror from turning into gasps for breath or spine-tingling scares into skin-itching nightmares, look out for these other six potential culprits, says the ACAAI:

Ghastly gelatin -- The gelatin found in gummy bears or other candies might be a potential, though less common, allergy trigger.

Nightmarish nickel accessories -- Watch out for nickel in costume accessories, such as tiaras, magic wands, cowboy belts and pirate swords. One of the most common causes of allergic contact dermatitis, nickel can cause some to break out into an itchy rash.

Cobwebbed costumes -- If you are reusing an old costume, wash it first. Halloween costumes packed away since last year can harbor dust mites, which trigger asthma and allergies.

Menacing makeup -- Cheap Halloween makeup may include preservatives that can cause allergic reactions. Opt for high quality theater makeup instead. It might take a few days for an allergic reaction, such as a rash or swelling, to appear. Test the makeup on a small area of skin before the big candy-grabbing eve.

Frightful fog -- Fog, real or man-made, can trigger asthma in some.

Perilous pumpkins -- Pumpkin allergies, though rare, can cause everything from itching to chest tightness and can happen suddenly, even if you haven't had a problem before. Pumpkin picking might trigger allergy and asthma for some, as pumpkin patches are often moldy and dusty. Consider buying a pumpkin from a grocery or discount store. (Or wash your pumpkin at the farm before bringing it home.)

By keeping these things in mind, your Halloween will be fearsome for all the right reasons.

Have A Safe (and Spooky) Halloween

Halloween is a challenge for many parents of children with food allergies. With all the candies being distrubted it is a time that we all need to be extra careful to avoid an allergic reaction.

Here are some tips to help keep everyone safe and still have a good time:

-Keep the emphasis on the fun, rather than the candy.

-Check with your child's teacher to ensure that you are made aware of any food-related celebrations taking place at school.

-Stock up on safe treats and inexpensive trinkets to trade for any "forbidden" candies that your child might collect.

-Start a tradition by allowing kids to leave their unsafe candies out for the "Good Witch" to collect and leave behind small gifts and safe treats.

-Make it a rule that no candies will be consumed while your child is trick-or-treating. If possible, talk to your child's friends in advance about not encouraging him or her to eat any candies collected until a trusted adult checks the ingredient label.

-Consider makingsmall and safe "goody bags" for neighbors to give to your child. Deliver the bags in advance and describe your child's costume to your neighbors. Encourage your child to trick-or-treat at the houses in which you've delivered the bags.

-Forgo trick-or-treating, and have a Halloween party instead, featuring safe and delicious treats.

-Remember that a candy that has been safe for your child in the past may now have different ingredients. Read the label, every time.

- Avoid candies with a precautionary statement (ie, "May Contain") if your child's allergen is listed.

We wish you a happy and safe Halloween!

The Food Allergy and Anaphylaxis Network 2011. Having a Spooky- and Safe - Halloween

Helpful Hints for Safe Trick-or-Treating

From the community

Trick or Treat? Food Allergies and Halloween Candy

By Victoria Gestner Oct. 6 at 2:01 p.m.

Candy – commonly a big part of Halloween – can be a challenge for those with food allergies. But just because you have a food allergy doesn’t mean you can’t partake in the fun this month.

If you have food allergies, you simply need to exercise caution and make different choices when celebrating the holiday. Several of the most-common food allergens – milk, eggs, peanuts and tree nuts (almonds, cashews and walnuts) – are found in beloved Halloween candies. The FDA requires food manufacturers to include these allergens on food packages, but it’s really our responsibility to take action and avoid risks as well.

Here are some helpful tips from Midwest ENT Consultants, to help keep children safe when it comes to Trick-or-Treat time!

- Since peanut allergies are on the rise with children (these allergies have nearly doubled in the last 10 years), stray away from candy that contains peanuts, has traces of peanuts or has been processed in a facility with peanut products.
- Depending on the particular allergy, some safe candy options could include Smarties, gum, mints, hard candy, Tootsie Rolls or jelly beans.
- Consider making a "safe" treat bag and delivering it to your neighbors prior to trick-or-treating time. That way, they can give it to give your child when they ring the doorbell!
- Make it a rule that no candy will be consumed while trick-or-treating or before an adult can check the ingredients.
- Try avoiding candy altogether and pass out non-food items and low-cost trinkets such as stickers, fake tattoos, pencils or coins.
- Make the holiday about costumes, cards and spooky stories, and NOT about the food and candy. Plan a Halloween party where you have the control instead of trick-or-treating.
- Remember that food allergies are really serious and can even lead to severe life-threatening reactions. Those with a known food allergy or history of food reaction – including hives, trouble breathing, throat swelling or anaphylaxis – should always carry a twin pack of epinephrine injector pens (EpiPens) in case of an emergency.

If you suspect your child may have food allergies, a quick blood test called a RAST for IgE antibodies is commonly used to determine if an allergy exists. If an allergy does exist, our nurses can advise what foods and food classes to avoid and what to do in the event of an emergency to avoid an unwanted frightful Halloween.

Beware of ghosts & goblins AND HALLOWEEN ALLERGIES

Halloween allergy and asthma triggers, and how to avoid them

Oct 14, 2011 6:00 AM

For millions of children with asthma and allergies, and their parents, Halloween can be a frightful time of year. Not only because of the usual suspects—candy and treats—but some more unexpected culprits as well. Costumes, makeup, and other accessories can bring on dangerous allergy and asthma symptoms, according to the American College of Allergy, Asthma, & Immunology. But fear not—be smart and consider these important tips on how to help your little ghost or goblin stay wheeze and sneeze-free on Halloween night.

Treats: Peanuts, tree nuts, milk and eggs are common ingredients in chocolate and other confections. For kids with food allergies, eating these Halloween treats can bring on a life-threatening reaction called anaphylaxis. But candies containing gelatin, such as gummy bears are potential triggers, too. For children prone to food allergies, have some non-candy treats on hand, such as stickers, pencils and small toys, be wary of “fun size” candy which may contain different ingredients than regular size packages, and teach your child to politely say no to food that may not be safe. Verify that adults or friends accompanying your child understand his or her food allergies and what to do in an emergency. And always make sure your food-allergic child carries their EpiPen with them.

Costumes: Thinking of re-using last year’s Halloween costume or taking a hand-me-down? Here’s something to consider: Halloween costumes packed away in a box for months can be laden with dust mites, which could trigger an allergic or asthmatic response. Be sure to wash the dusty and hand-me-down costumes in hot water. Or spring for a new costume. And, whenever possible, watch out for nickel in costume accessories, from cowboy belts and pirate swords to tiaras and magic wands. Nickel can cause allergic contact dermatitis, making for an itchy, bumpy, uncomfortable kid.

Makeup: Cheap Halloween makeup may include preservatives that can cause allergic reactions, such as a rash or swelling. Opt for higher quality theater makeup, and test the makeup on a small area of your child’s skin well in advance of Halloween.

Pumpkins: Pumpkin allergies, while rare, can cause itching, chest tightness, and other symptoms, and they can appear suddenly, even if you haven’t had a problem before. If you think you might be allergic, beware of pumpkin carving and pumpkin. And keep in mind that pumpkin patches are often moldy and dusty, allergy and asthma triggers for some.

Decorative contact lenses: If your Twilight fan is asking for colorful, vampire-inspired contact lenses, consider this warning from the Food and Drug Administration before saying “yes”. An eye doctor must measure each eye to properly fit the lenses and evaluate how the eye responds to contact lens wear. A poor fit can cause serious eye damage, including cornea scratches and infection, conjunctivitis (pink eye), decreased vision, and even blindness. Never buy the lenses from places that sell them without a prescription, such as street vendors, salons, novelty stores, and the Internet.

Fog: If you’re planning on using a fog machine at your Halloween party, keep in mind that fog can trigger asthma in some sufferers.

Sources
Don’t Let Allergies, Asthma Haunt Halloween Fun [American College of Allergy, Asthma, and Immunology]
Avoid the Danger of Anaphylaxis this Halloween [American Academy of Allergy, Asthma, and Immunology]
Decorative Contact Lenses: Is Your Vision Worth It? [U.S. Food and Drug Administration]

Food Allergy Basics

A food allergy occurs when a person's immune system identifies proteins in a food as an allergen and begins to produce antibodies - called Immunoglobulin E or IgE - against that food (e.g. nuts or milk).

These antibodies attach themseleves to mast cells in the body, and when the person again eats the allergenic food, the proteins from it become attached to the IgE antibodies. This causes the mast cells to release histamine and other powerful chemicals. It is these chemicals that cause the symptoms of allergy.

The symptoms: Not everyone will get all symptoms, and reaction severity varies widely. The symptoms may include:

-Tingling in the mouth

-Swelling of the tongue and throat

-Itchy skin, hives or skin redness

-Breathing difficulty, wheezing

-Abdominal cramps

-Vomiting

-Faintness due to a sudden drop in blood pressure

-In a severe anaphylactic reaction, the allergic person can lose consciousness and is at risk of death.

Anaphylaxis- This is a serious form of allergic reaction that occurs rapidly and can be fatal. Symptoms may involve the respiratory tract, the gastrointestinal tract, the skin and or the cardiovascular system. It is essential that those with food or insect sting allergies carry an epinephrine auto-injector, so treatment can be given promptly while arranging to get to emergency care (call 911 for ambulance).

Source: Allergic Living, Fall 2011.

5 facts about Ragweed

Fast Facts about fall's nastiest weed.

1. There are dozens of varieties of ragweed, but common and giant ragweed are the biggest culprits.

2. Ragweed pollen can travel; it has been measured in the air 400 miles out to sea and two miles up in the atmosphere.

3. A ragweed plant lives only one season, but produces up to 1 billion pollen grains.

4. People with ragweed allergy may also get symptoms when they eat cantaloupe and banana. That's an allergic cross-reaction.

5. Some people relocate to get away from ragweed, and while that often helps for a few years, it's common to develop allergies to plants in the new location within a few years.

Source: Asthma & Allergy Foundation of America

Desperate for a donut?

Gluten-Free Baked Donuts


Ingredients:
1 cup sorghum flour or millet flour
1/2 cup organic brown rice flour
1/2 cup tapioca starch or flour
1/2 cup packed light brown sugar
1 tsp baking powder
1 tsp xanthan gum
1/2 tsp baking soda
1/2 tsp fine sea salt
1/2 tsp ground cinnamon
1/4 tsp ground nutmeg
1/3 cup organic coconut oil or shortening
1/2 cup vegan sour cream or plain vegan yogurt
2 large organic free-range eggs, or egg replacer
1 tsp rice milk or coconut
2-4 tbsp rice milk or coconut milk
Powdered sugar and ground cinnamon for dusting


Method:
-preheat the oven to 350. Grease a 12-count mini-donut pan
-In a large mixing bowl, whisk together the sorghum flour, brown rice flour, tapioca starch/flour, brown sugar, baking powder, xanthan gum, baking soda, sea salt, cinnamon and nutmeg.
-Add the coconut oil or shortening by spoonfuls, and us a fork or pastry cutter to distribute it until the flour mix becomes sand textured.
-Stir in the vegan sour cream, eggs or egg replacer and vanilla. Mix until smooth.
-A tablespoon at a time, add the rice milk and mix until the dough is pliable. It should be slightly sticky, but not wet.
-Divide the dough into 12 sections and roll each piece in your palms to form a ball the size of a golf ball. Your hands should be slightly oily from the shortening - this is good. (If the dough is too wet and cannot easily form a ball when you roll it, add a bit of brown rice flour.)
-Using your palms, gently roll the dough into a cigar shape about 4 to 5 inches long. Drape the dough into one well of the donut pan, and slightly overlap the two ends to make a circle. Don't get fussy yet. Just lay it in there.
-Continue as above with the remaining dough balls.
-Using oily or wet fingers, smooth out the dough. But don't smoosh it down into the well - simply finesse a bit so that you're forming a ring.
-Bake in the center of the oven for 12-15 minutes, until firm to the touch.
-Remove the pan to a wire rack to cool for five minutes. Then gently remove the donuts from the pan and place them bottom side up on a wire rack (to help prevent soggy bottoms).
-When cooled, sift confectioner's sugar or a mix of confectioner's sugar and ground cinnamon all over the donuts.
-Best eaten the day you bake them.


Makes: 1 dozen mini donuts.

Gluten-Free Apple-Pear Muffins

Gluten-Free Apple-Pear Muffins


Ingredients:
1/2 cup sorghum flour or millet flour
1/2 cup brown rice flour
1/2 cup millet flour
1/2 cup rice bran
1/4 cup tapioca starch/flour
2 tsp baking powder
1 tsp xanthan gum
3/4 tsp fine sea salt
3/4 tsp ground cinnamon
3/4 tsp ground ginger
1/4 tsp ground nutmeg
2 large organic free-range eggs, beaten, or egg replacer
1/2 cup pure maple syrup
1/4 cup coconut oil or vegetable oil
1/4 cup coconut milk or vanilla rice milk, more as needed
1 tbsp bourbon vanilla extract
1 cup diced apple
1 cup diced pear


Method:
-Preheat the oven to 350. Line a jumbo 6-muffin tin with jumbo paper liners.
-In a large mixing bowl, whisk together the sorghum flour, brown rice flour, millet flour, rice bran, tapioca starch, baking powder, xanthan gum, sea salt, cinnamon, ginger and nutmeg.
-Add the eggs or replacer, maple syrup, oil, coconut milk and vanilla extract. Beat until smooth. The batter should be think and a bit sticky, but not too wet. If the batter is stiff of dry, add more coconut milk one tablespoon at a time until it loosens.
-Using a spatula, stir in the diced apple and pear until combined.
-Spoon the batter evenly into your pan's 6 jumbo liners. Bake in the center of the oven for 22 to 25 minutes, until domed, golden and firm to the touch.
-Cool the pan on a wire rack for a few minutes, then pop the muffins out of the pan (to avoid soggy bottoms). Lovely warm.
-Wrap leftover muffins in foil, bag and freeze to preserve taste and texture.


Makes: 6 jumbo muffins

Avoid "Triggers" at The Gym

Here are some factors to consider when deciding to work out at the gym. The decision to exercise is good news for your health, but there are a few precautions you may want to take if you have allergies or asthma. Our doctors as well as The American College of Allergy, Asthma and Immunology suggest the following tips to keep your visits to the health club sniffle, sneeze, and wheeze free:

Bring your own mat. Yoga isn't relaxing if you break out in hives due to contact with a latex mat, the most common material used. If you have had any signs of latex allergy -- perhaps itching or rashes around the mouth after dental work, rashes on your hands after wearing latex gloves while cleaning your home, or reactions to elastic in your clothing or latex in Band-Aids -- be sure to bring your own latex-free mat so that you can enjoy doing floor exercises or yoga.

Not everyone in the pool. Swimming is an excellent form of exercise, and is even recommended to our patients with asthma in order to improve lung volume and strengthen respiratory muscles. However, a heavily chlorinated pool can release irritant fumes that may trigger asthma. In addition, the irritant effect of chlorine can lead to itchy red eyes, or dry itchy skin. Remember to shower or bathe with a mild moisturizing soap after leaving the pool, in order to remove chlorine from the surface of the skin.

Check the label before you energize. Most patients who are allergic to foods are used to reading labels, but watch out for those energy bars and protein shakes. If you have a nut, wheat, egg, soy, or milk allergy, be sure you carefully read the ingredients first.

Protect yourself from the disinfectant. It is a good idea to use your asthma or allergy medication before you work out. Not only will exertion itself commonly lead to bronchial spasm and asthma symptoms during exercise, but many disinfectant sprays used on gym equipment have a strong odor and may contain problematic chemicals or VOCs (volatile organic compounds).

Warm up and cool down. Exercise induced bronchoconstriction can cause chest tightness and trouble breathing in people who have asthma, and sometimes can be the only sign of asthma. If you run into breathing problems when you exercise, this may be a sign of exercise induced asthma. See your doctor for an evaluation. You may be able to control these symptoms by easing in and out of workouts with a gradual warmup period; a preventative inhaler may also be helpful prior to exercise. Breathing through your nose rather than your mouth helps to moisturize the air entering your bronchial tubes, which helps alleviate exercise-induced asthma as well.

Ready for soccer season?

South Bay Allergy and Asthma is scoring goals in the community by educating future soccer stars about succeeding with asthma and allergy control at FRAMFEST 2011. We will be in Palos Verdes this Sunday, at Nansen Field from 12:00 - 5:00 PM.

Tips to Help Navigate Elementary School with Food Allergies

We don't want your child to feel different or be defined as "the kid with food allergies" at school. Here are a few tips that can ensure your child has a safe school year.

• Befriend the school nurse. Take your child to meet the school nurse before school begins so they can establish a relationship. Provide the nurse with your child's emergency medications and a list of what foods your child is allergic to, along with the action to be taken if the child were to accidentally eat that food. A Food Allergy Action Plan is available for download at http://bit.ly/alLobw . With the nurse you can identify important guidelines for your child's snack, lunch and class activities.


• Talk with your child's teacher. Request a conference with your child's teacher and provide them with basic information about your childs food allergies. It is important to leave additional copies of the infomation for substitutes.


• Send in reinforcements. There may be parties, science projects, and other celebrations that invariably include food. At the beginning of the school year, provide your child's teacher with an allergy-friendly snack box so your child can choose something from it during these special celebrations and not feel left out.


• Encourage extra-curricular activities. Don't shy away from birthday parties, play-dates, sports or scouts because of food allergies. These are all great oppportunities for social skill building and there should be no holding back if you do a little extra legwork and planning ahead.


• Volunteer. Volunteering in your child's classroom will allow for your input in class parties so you can help select safe foods. Attending class field trips will also ease your mind so you can oversee your child's food and medication needs rather than relying on chaperones.


• Say thanks! Nurses and teachers work hard throughout the year to ensure your child's safety, remember to show your thanks.

FAAN Food Allergy News 2011:20:6. Navigating Elementary School with Food Allergies. Pellicore K.

Study Up For A Sneeze and Wheeze-Free School Year

Make the Grade by Avoiding Asthma, Allergy Triggers Lurking in the Classroom

The new school year means new clothes, new classes, new teachers - and the same old misery due to sneezing and wheezing for children who have allergies or asthma. From the class hamster to dust mites residing in carpet to germs from cold and flu viruses, asthma and allergy triggers lurk throughout the classroom.

It's not suprising, then, that back-to-school season is associated with a 46 percent increase in asthma-related emergency department visits by grade school children. And allergies and asthma account for more than 14 million school day absences. But seeing an allergist can keep kids in the classroom: studies show that patients treated by allergists for asthma have better symptom control, including less wheezing and fewer absences, at lower cost.

To keep kids focused on their studies instead of their allergy and asthma symptoms, it's important that they recieve proper diagnosis and treatment, as well as work with their parents to develop a plan for avoiding classroom triggers.

Make sure your child doesn't suffer or miss school by following the advice, below, from South Bay Allergy and Asthma and the American Colelge of Allergy, Asthma and Immunology (ACAAI):

• Dust and mold and pollen, oh my - Many common triggers lie in wait for the allergic student. Dust mites and other allergens multiply in the class carpet, so suggset your child sit in a chair to read a book. Mold can grow in bathrooms and other dank areas, but are easily cleaned if brought to the janitor's attention. And ask teachers to keep windows closed this fall and next spring to keep sneeze-prompting pollens out of the classroom.



• The germ incubator - It's tough for the child with asthma to avoid germs at school, since they are pretty much everywhere from the pencil sharpener to the edge of the teacher's desk. Washing hands regularly and using tissues and antibacterial hand sanitizers also can help.



• Tag, you're - huff, puff - it - Jumping jacks during gym, tag during recess, soccer after school - these and other common school activities can trigger expercise-induced bronchoconstiction (EIB), commonly referred to as exercrised induced asthma. About 80 percent to 90 percent of those with asthma have EIB and 10 percent of people without asthma have EIB. If your child has difficulty breathing during or after exercise, see an allergist who can work with you on a prevention and treatment plan. Be sure to give teachers, from gym to homeroom, a heads up and make sure your child has medication available at school.



• Fear of furry friends - Kids love class pets, but many have allergies to the hairy or furry variety. Allergic children should be reminded not to touch the pet. You also might suggest the teacher consider a non-furry pet, such as a fish or hermit crab, which offer plenty of learning opportunities without the allergy-triggering dander. Children who have pets at home also may have pet dander on their clothes, triggering symptoms in a pet-allergic child. A new seat assignement may help.



• Food safety patrol - If your child has food allergies, potential problems can crop up almost anywhere, from the lunchroom to the classroom. Tell the teacher about foods that cause problems for your child. Also be sure to alert scouting and other club leaders, and suggest an allergen-free snack policy. It's also important to teach your child about what foods might trigger a reaction and advise them to ask a teacher or adult before eating food they are unsure about. Share a plan with teachers, coaches and the school nurse for dealing with an allergic emergency and make sure your child has medications with them like injectable epinephrine.



• The back of the class - Sitting at the front of the classroom - near the chalkboard - is a bad idea for kids whose allergies or asthma are triggered by chalk dust. And washing hands after writing on the chalk board is a must.

If your child is sneezing, wheezing and itching at school and you're not sure why, see an allergist to find out what's causing the problem and find relief. For more information about allergies in children, asthma in children, or take a self-relief test visit http://www.allergyandasthmarelief.org/.

My child is allergic to eggs, can he/she get a flu shot?

Since the influenza vaccine is made in chicken eggs, it is possible to have egg protein exposure when receiving the vaccine. This potentially could lead to problems in a severely egg allergic child, making this a contraindication for receiving "flu shots".

However, if a child has a history of a mild egg allergy (not a recent systemic reaction), it is generally safe for him/her to get the flu shot. Recommendation suggested in kids with a history of a mild egg reaction: Give 1/10 of the flu shot at the pediatrician's or allergist's office, and wait 30 minutes. If tolerated well, administer the remainder of the vaccine and observe in the office for another 30 minutes so that treatment can be promptly rendered in the unlikely case of allergic reaction.

What do you do if you get stung by an insect?

Brush the insect away from your skin and then walk away from the area.

• If the stinger is left in the skin, remove the stinger by scraping it off with a flat surface (ie. credit card). To prevent more venom from entering the stung area, do NOT use tweezers or your fingertips.



• To reduce the swelling, apply something cold (ie. ice, bag of peas or wet sand/mud).



• If you notice any of the following symptoms seek medical help immediately.

-Severe headache
-Dizziness
-Stomach cramps, nausea or diarrhea
-Hives or generalized itching (other than the site of the sting)
-Swelling of the throat or tongue
-Difficulty breathing

• If you have been prescribed an Epinephrine Auto-Injector because of a previous allergic reaction to a sting, use it right away and call 911 or go to the nearest emergency room within 20 minutes.
  

Mothers' Weight Tied to Youths' Asthma

Women who are overweight when they become pregnant may be more likely to have children who develop asthma as teenagers. Read the whole story from the New York Times here http://nyti.ms/oi82Qu.

A sweet treat for those allergic to egg and dairy

Brownie Bites (egg and dairy free)

8 oz silken tofu
1 1/2 cup unbleached flour
4 tablespoons flour
4 tablespoons applesauce
1/2 cup water
1/2 cup brown rice syrup (or 1 1/2 cup sugar)
1 tsp salt
1/2 tsp allspice or cinnamon
1 tsp vanilla
3/4 cup unsweetened cocoa
1/4 cup semi-sweet vegan chocolate chips
1/2 cup vegetable oil
1/2 tsp baking powder

Directions:
Preheat oven to 350 degrees.
grease and flour a 9 inch square baking pan.
In blender, puree tofu.

In a separate saucepan, mix 4 tablespoons flour with applesauce. Slowly add water until smooth. (This may not take the full 1/2 cup; use what is necessary.) Stir in pureed tofu until blended. Cook on low heat, stirring, for 3 minutes. Transfer to medium bowl and let cool completely.

When tofu mixture is cool, add brown rice syrup, salt, allspice and vanilla and mix until well blended.

In small bowl, mix cocoa, chips and oil; stir into tofu mixture.

Stir in 1 1/2 cups flour and baking powder until blended.

Bake 25 minutes.
Let cool; cut in miniature squares.

I'm allergic to animals, what can I do?

1. Cats: This antigen is the most potent known: a cat can walk through a carpeted home once, and antigen from the cat can be found in the carpet 5 years later.

2. Dogs: Yes, you can be more symptomatic around one dog than another; this could be due to allergy to multiple dog allergens in the pelts and hair of certain species of dogs. There is no such thing as a "hypoallergenic dog;" it is not worse to have a longhaired dog than a shorthaired one from an allergy standpoint.

3. Hampsters, Rats, Mice, etc: While we do not test specifically for these, the tendency to develop additional hypersensitivites to furry animals is high if there is alerady a known allergy to another type of animal. We do not recommend any indoor furry animals for patients with allergic tendencies.

4. Reptiles: While certainly not as problematic to most people with allergies, it is possible to become sensitized to the urine, saliva, or dander of any animal. Repeated scratches from the animal, or direct contact with the skin, speeds the sensitization process.

5. Fish: No problem as long as the tank is kept clean and mold-free. We worry about fish bowls (unfiltered water), which tend to get moldy and need frequent water changes. The bedroom is not a good place for the fish.

6. Horses: Lots of these animals are in RPV, RHE and RH. Many allergic people as well; degree of severity symptoms is variable. No allergy shots are available for this at this time (no literature to support efficacy of immunotherapy for horse). Avoidance, bathing after contact, and preventative medications for usual symptoms are recommended.

Treatment:

• Keep animals out of the house if serious allergy; if milder, just keeping them out of the bedroom may suffice.
• Wash animals weekly if possible to reduce antigen exposure
• Spray with "Allerpet-C (cat), -D (dog), or -B (bird)," "Allerpet Wipes," or similar product to reduce exposure to allergen from dander.
• Never sleep with an animal on the bed if there is a positive skin test reaction to it, even if symptoms are minimal at this time. It is likely that symptoms will worsen with continued exposure.
• Use a HEPA air filter.
  

I'm allergic to molds, what can I do?

1. Avoid excessive humidity in the home:

• Do not use humidifiers in the bedroom (encourages mold growth)
• No indoor plants except for succulents or cactus plants which do not require a lot of water.
• Avoid cut flowers in the home (move plants outside after one day)
• Avoid squeezy toys for the kids in the bathtub, which are difficult to drain of all moisture, therefore creating a perfect area for mold to grow, then be sprayed out into the air when the toy is squeezed.
• Avoid leaving wet towels or clothing in the hamper or on the floor, as this encourages mold growth.

2. Remove mold by killing it with bleach (Ajax or other sodium hypochlorite product would be fine). Scrub it on, leave for 20 minutes, then scrub off.

3. Particularly stubborn mold regrowth walls should be painted with a mold resistant additive, and any leaks repaired.

4. Keep a 40-watt light bulb on at all times, shining on areas of recurrent mold growth (closets, behind dresser, etc.), and/or a dehumidifier which also needs to be cleaned frequently to avoid this becoming another source of mold.

5. Avoid storing leather items in closets that tend to be moldy (especially in the bedroom):

• boots
• jackets
• briefcases
• leather skates

6. Avoid having many bottles and containers in the shower stall, as each will tend to support mold growth underneath, especially if not frequently used.

7. Check the refrigerator and pantry weekly for old food or mold growth on foods. Also, mold on bread may contribute to symptoms by inhalation of the spores. Be sure to also check the water and ice dispenser for mold growth.

8. Cut flowers become moldy within a day or two (on the stems); frequently change water, and expect to throw them out after a week or less.

I'm allergic to dust mites, what can I do?

1. Identify major sources of dust mites in the bedroom so that these can be removed or covered to reduce dust mite exposure. In general, the older the item, the more "organic" (plant or animal material) the contents, and the more humid it is kept (ie. by frequent use of humidifier in the room, storage of a mattress or pillow in plastic in the garage, or flooding or water damage to the walls or carpet), the more likely it will contain dust mites. The closer the item is to your face, the more likely you will develop allergic symptoms.

• Feather pillow (especially if older than 6 months)
• Old mattress (especially bad are 20-30 yr old mattresses)
• Old carpet (over about 5 years old)
• Old couch (over about 5 years old)
• Stuffed animals
  
• Large bookcase in the bedroom, especially with old books (10 years or older)
• Wall hangings that are made from fabric (nonwashable), feathers, leather, rope, dried flowers, etc.
• Difficulty cleaning behind the bed
• Moldy areas on walls or behind furniture.

2. Dust mites are best avoided in the following ways:

• Remove feather pillows: replace with a new synthetic washable pillow. Pillow may be washed weekly, but an easier solution is to get dust mite proof encasings.
• Encase mattress, pillows and box spring with dust mite proof covers.
• Get a new mattress if old one is older than 10 years.
• Remove carpet if possible (hardwood floor or tile, linoleum would be better for elimination of allergen exposure)
• Do not lie directly on the carpet; put a mat down first.
• Stuffed animals should be limited, the ones that will be used should be put in the drier for 20 minutes or in the freezer in a bag for 24 hours once a week.
• Wash bedding once a week in HOT water.
• Eliminate books, if they need to be kept in the bedroom, stash them in a lidded plastic container, or in a closed cabinet or closet. Consider an e-reader that limits the paper.
• Dust mite and Anti-Allergen sprays work for carpets, drapes and fabric furniture.

Websites are available to order encasings and sprays on our website.

I'm allergic to pollens, what can I do?

1. Avoid contamination of your bedroom with outdoor pollens; this prevents constant exposure to pollens all night long, which may be even more important than acute exposure to outdoor pollens when outside for 1-2 hours at a time.

• Leave outdoor play or work equipment outside or in a separate area of your home - never bring shoes, tennis rackets, soccer clothes, golf clubs, etc into the bedroom. Find another place to store these items.
• Remove outdoor play or work clothes ideally before entering the bedroom. Change clothes in a bathroom or other room where clean clothes are kept, and put pollen-contaminated clothing in the laundry immediately. Hampers can hold the clothes till wash day provided this is not in the bedroom.
• Never throw contaminated clothing (clothes worn outdoors to play or work in yard) onto the bed, or sit/lie on the bed with these clothes on. This would contaminate the bed, with resultant prolonged exposure to the pollens all night long.
• Bathe or shower before bed, after being outdoors, especially if out in the wind or gardening, rolling or sitting on the grass, etc.
• Wash linens in hot water once a week to remove excess pollen that may have made its way into the room.
• Avoid opening windows during peak pollen seasons; or during peak pollen times of the day: pollen counts rise first thing in the morning when the sun comes up, and again in mid-afternoon when the wind is blowing.

2. Use a HEPA air filter to remove excess airborne pollen and other particulate matter.

• This is the only type of air filter/purifier which has been proven to eliminate pollen sized grains (very small, microns in diameter); we do not recommend non-HEPA systems such as ionizers and inexpensive small non-HEPA filters, due to lack of proof of efficacy in allergen removal.
• Run the unit on "HIGH" for 2-3 hours before bedtime, in the bedroom with doors and windows closed. This should clear out the majority of airborne particulates including pollen grains before you go in to sleep.
• Then it may either be turned to "LOW" for the night, or turned off at night; depends on severity of allergies, and whether there are symptoms upon turning it off.
• Charcoal prefilters need to be replaced every 6-12 months, depending on use, and the actual HEPA filter should be replaced about every 3-5 years.

3. Men should avoid mustaches, as the air tends to trap pollen and keep it directly under the nose where it can cause problems.

4. Contact lens wearers: frequently use lubricant or "rewetting" eyedrops to remove pollen and irritants which may be "stuck" to the lens causing additional eye symptoms. Soft lenses especially can "hold" pollen and irritants in your eyes, enhancing exposure during heavy pollen seasons. Clean lenses frequently during heavy pollen seasons.

"Gluten-Free" food labels, are they coming?

Having trouble finding gluten-free foods? The FDA is proposing a rule to label foods as "Gluten-Free," read more at http://1.usa.gov/BoGxi .

Can you lose allergies to foods?

If you have been found to have an allergy to a food such as milk or wheat by skin test or blood test (specific IgE antibody), and eating that food leads to hives, swelling, itchiness, diarrhea, or wheezing, you will of course be advised to avoid that food. But in many cases, after staying completely away from it for 6-12 months (longer if extremely allergic), you may eventually lose the hypersensitivity to that food and will again be able to safely eat it. Recent studies show that this may be due to down-regulation of receptors over time. This rule does not tend to apply to severe allergy to peanut, nuts, or seafood -- these tend to last a lifetime; only 1 in 5 children with peanut allergy will "outgrow" it.

Can anaphylaxis return after leaving the ER?

Anaphylaxis is basically a severe allergic reaction. It may include rapidly developing hives, airway obstruction (wheezing or throat swelling), vomiting or diarrhea, drop in blood pressure, and/or loss of consciousness. People with severe food or bee allergies, for example, are at high risk for this type of reaction, and are generally advised to carry an adrenaline auto-injector for emergency use. This can be life saving, since early treatment will often reverse symptoms and allow enough time to get to a nearby hospital for further care.

However, about 11% of these reactions have a second phase occurring 1-20 hours after initial recovery (usually about 8 hours after the first reaction). It is important to be able to predict who is likely to have a second reaction, so that overnight in-hospital close observation can be arranged.

A return of symptoms is more likely if more than one adrenaline injection was needed at the beginning, or if there was a drop in blood pressure requiring IV fluid resuscitation. However, treatment with Benadryl or steroids (Prednisone or Medrol) does not change the likelihood of a second anaphylactic reaction.

Clin Exp Allergy 2009: 39: 1390-6. Clinical predictors for biphasic reactions in children presenting with anaphylaxis. Mehr S, Liew WK, Tey D, Tang ML.

Why do nasal polyps form? What can we do about them? How do you know if they get worse or better?

Nasal polyps are often triggered by allergies to inhaled pollen or dust mites, animal danders, etc., but they also occur in non-allergic people, for example in cystic fibrosis, or in patients sensitive to aspirin. They are little benign sacs of eosinophil-filled fluid, which look a bit like grapes. They are silvery, translucent sacs often visible in the nasal passages. Polyps grow from a stalk based in a sinus, then grow outward toward the nasal passages and upon filling of this area, can cause obstruction of airflow to the olfactory nerves (therefore decreasing sense of smell), and often obstruction of the sinus openings, leading to chronic sinus infections.

Treatment: Debulking surgically is sometimes helpful temporarily, but there is a high rate of recurrence of polyps after surgical removal -- and it could be 20 yrs later, or 6 weeks later. So, we try to go with medical treatment and allergen avoidance first. The only medications that significantly shrink nasal polyps quickly are those containing a corticosteroid. Oral corticosteroids like Medrol or Prednisone can be very effective in reducing nasal polyps temporarily. However, to avoid long-term side effects, once the polyps shrink down, treatment can be switched to a topical nasal steroid spray indefinitely. You would likely be able to tell if your nasal polyps are recurring based on symptoms (severe nasal congestion or obstruction, loss of sense of smell, recurrent sinus infections). If allergies are present, allergen immunotherapy ("allergy shots") may help keep nasal polyps under control as well.

Probiotics may help childhood eczema

Probiotics such as Lactobacillus acidophilus, and Bifidobacterium lactis – otherwise known as “good bacteria” -- are readily available as a natural food supplement. In a recent study from the Ukraine, a group of 1-3 yr old children with eczema were given a mixture of these supplements twice a day for 8 weeks, and were compared with similar children not receiving probiotics. In the end, about 2/3 of the children in the probiotic treatment group improved significantly, while far fewer of the others improved. The probiotic group also needed less steroid creams to maintain control of the eczema, without any apparent adverse effects from the supplements. Therefore, it may be worthwhile to try probiotic supplementation, under the supervision of a physician, in children with severe eczema. Further studies are needed to confirm this finding.

Am J Clin Dermatol 2010; 11(5): 351-61. Probiotic Supplement Reduces Atopic Dermatitis in Preschool Children. Gerasimov SV, Vasjuta VV, Myhovych OO, Bondarchuk LI. (Dept of Pediatrics, Lviv National Medical University, Ukraine).

Is there a difference between having a milk allergy and being lactose intolerant?

Milk allergy and lactose intolerance are two completely different conditions, with very different potential risks as well as treatment. Food allergies occur when the immune system excessively produces a type of molecule called IgE, which specifically targets a particular food protein. Cow's milk contains several proteins to which IgE can be formed. Once "sensitized" by production of these IgE antibodies, ingestion of products containing cow's milk can produce a variety of allergic symptoms involving the skin (hives, swelling, itching), the respiratory tract (stuffy nose, coughing, wheezing), the gastrointestinal tract (abdominal pain, diarrhea, vomiting), or other systems -- and with repeated exposure to even tiny amounts, the reaction often worsens progressively and may culminate in full-blown anaphylaxis (the most severe of allergic reactions, which can be life-threatening).

Lactose intolerance, on the other hand, is the inability to digest the sugar portion of milk called lactose. This is caused by the lack of an enzyme called lactase, which is necessary in order to break down this sugar. This is a very common condition in adults, as well as in many children. Symptoms may be minimal when ingesting small amounts of lactose, but worsen with larger amounts. However, symptoms do not progress to more severe or widespread systemic reactions as seen with milk allergy. Persons with lactose intolerance can generally tolerate lactose-free milk, or any milk product if preceded by a lactase enzyme tablet available at most grocery stores and pharmacies.

Take home message: If you develop respiratory or skin symptoms in addition to intestinal symptoms after drinking milk, it may be dangerous to continue having milk products in your diet; stop until you can have allergy testing done to confirm whether milk allergy is the problem.

Can a child "grow out of" a peanut allergy?

Peanut allergies only resolve in about 20% of patients. Loss of sensitivity over time with strict avoidance is more likely to happen in patients with mild to moderate initial reactions, not as likely for those with severe skin or blood test evidence of peanut allergy, nor those with a history of anaphylactic reaction.

We generally track peanut IgE antibodies in the blood every 1-2 years initially to see if there is a downward trend. If you are one of the lucky 20%, and your blood test drops to minimally positive or completely negative, we will generally confirm this with a skin test. Only if both the skin test and the blood test are negative would we consider an oral peanut challenge. Then depending on how severe the initial reaction was, we may recommend doing the challenge in the office under observation with emergency medications and personnel nearby, rather than at home.

Looking out for latex allergy

Latex allergy has become more prevalent over the past 2 decades, with the increased use of latex gloves by health care providers as well as food handlers. But there are many other potential sources of latex in the environment, which can trigger allergic reactions in sensitized individuals, including the following:

• balloons (except the mylar ones)
• rubber "bouncy house" at children's parties
• tires
• exercise resistance bands
• inflatable rafts (inner tubes)
• latex gloves (dental/medical, hospitals; South Bay Allergy is latex-free)
• tourniquets
• IV ports (if hospitalized, notify hospital staff and your doctors that you are allergic to latex so they can take latex precautions)
• some Ambu bags (used in resuscitation)
• black rubber garden hoses
• fresh asphalt (made with chopped up tires)
• foam rubber (look out for foam mattress toppers or pillows, or latex pillow-top mattresses)
• elastic (not usually a big problem unless there is direct prolonged contact with skin)
• full-head rubber Halloween masks
• some mouse pads (with rubbery underside)
• some pencil erasers (the pink rubbery ones; the white ones are generally non-latex) -- can be a problem if used to erase writing, then the particles blown into the air toward the sensitive person
• Koosh balls or rubber bouncy balls
• restaurants where food preparers use latex gloves -- for example, if they make their own bread, often the cook will wear latex gloves while kneading the dough
• dog toys (rubber Kong or other chew toys that are bouncy or flexible)
• rubber soled shoes (usually not a big problem if only on the bottom, like tennis shoes, but watch out for flip-flops that are all rubber with direct skin contact)

This is not an exclusive list; check out our Resources link to the American Latex Allergy Association for more information.

Vitamin D deficiency may contribute to poor asthma control

Patients with asthma respond differently to inhaled “controller” medications, such as Asmanex, Flovent, Pulmicort, etc. Some patients require very small doses to achieve excellent asthma control, while others are more resistant to treatment. A recent study linked low Vitamin D levels to poor airflow rates through the bronchial tree, increased bronchial hyperreactivity (more “twitchiness” of the muscles around the bronchial tubes), and poor response to inhaled steroids.

So, while it is not yet proven, there is evidence that taking Vitamin D supplements may help improve treatment response as well as general asthma control. Your physician should approve all supplements, including Vitamin D, before starting treatment, and asthma controller medications should not be replaced with vitamins as the sole treatment for asthma.

Am J Respir Crit Care Med. 2010 Apr 1;181(7):699-704. Vitamin D levels, lung function, and steroid response in adult asthma. Sutherland ER, Goleva E, Jackson LP, Stevens AD, Leung DY (from Dept of Med and Peds at Natl Jewish Health in Denver, CO, and Dept of Med and Peds at Univ of Colorado, Denver).

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.

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.

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.

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)

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.

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.

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.