The Epi-Pen that talks to you!

Click here to read the article that was in the New York Times about the newest epinephrine device.

Awesome new site for food allergy patients - The Allergy Menu

This is a new searchable database of recipes where food allergic individuals can enter the foods they need to avoid (among the most common food allergens such as milk, egg, wheat, peanut, sesame, tree nuts), click a button and voila! A series of recipes that would be safe and allergen-free for them.  It costs $297 per year for a subscription -- which seems pricey at first, but in fact that is less than a dollar a day to get rid of the hassle of trying to navigate through recipe books and hundreds of labels to figure out what would be safe to eat.  Very nice idea, something we have needed for a long time!

Click here for the link.

Visit our website at: www.southbayallergy.com

Monitor Lung Health By Blowing Into A Smartphone

An app may be on its way to help monitor lung health by blowing into a smartphone.  Read the whole article here.

An allergy app for drivers!!

Ford greenlights first health app: Allergy Alert!  Read the full article here.

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.

"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 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.

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).

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.

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.

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)

Could ladybugs or cockroaches be causing your allergic respiratory symptoms?

Home infestations with ladybugs (Harmonia axyridis) occur throughout the U.S.   During a screening of blood bank donors,  about 10% had evidence of allergy to ladybug.  However, the test used may not always distinguish between ladybug and cockroach specific allergy antibodies.  A skin test using ladybug extracts was more successful in distinguishing the two, but is not commercially available at this point.

Cockroach allergy is quite common, especially in urban areas where people are more likely to be exposed to cockroaches in the home as well as in public buildings.  Cockroach exposure can trigger a sensitized person to have a major asthma attack or nasal allergy symptoms.  Now we should also consider the possibility of ladybug sensitization as a cause of similar symptoms.

Ann Allergy Asthma Immunol 2009 Nov; 103(5): 432-5.  Clark MT, Levin T, Dolen W.  Cross-reactivity between cockroach and ladybug using the radioallergosorbent test.

Ann Allergy Asthma Immunol 2010 Aug; 105(2): 182-3. Goetz DW. Clinical efficacy of asian ladybug whole-body extract skin testing.

Is there really a hypoallergenic dog?

Unfortunately, no -- all dogs can trigger allergic symptoms in a sensitized person.  However, there may be other things one can do to limit the amount of exposure in homes with pets.

What influences the amount of dog allergen in homes?  It seems obvious that there would be more dog allergen in a bedroom if pets are allowed in the room, and there would be even less dog allergen in the home if pets are kept outdoors or there are no pets at all.  However, does the type of coat make any difference?  How much the dog sheds?  How many dogs are in the home? How long the family has had the pet?  How many hours the dog spends in the home?  The size of the dog?  Whether the pet is altered (spayed or neutered)?

As it turns out, the type of dog coat, amount of shedding, and number of dogs in the home make no difference in the amount of dog allergen in the home.   However, the amount of time there are dogs in the house does correlate with dog allergen levels in the home, and the larger the dog, the higher the allergen levels.  For unknown reasons, spayed or neutered dogs seemed to release more allergen than unaltered dogs.

Ann Allergy Asthma Immunol 2010;105(3):228-33.  Nicholas C, Wegienka G, Havstad S, Zoratti E, Ownby D, Johnson CC.  Dog characteristics and allergen levels in the home.

Gene studies may help guide length of bee allergy shot treatment course

Allergy to bee venom can lead to severe, life-threatening reactions to stings.  Venom immunotherapy has been found to be extremely effective in protection from reactions to stings, however, how long to treat with bee venom "allergy shots" has remained a complex question.  Initially, researchers thought it would be necessary to continue treatment indefinitely, but more recent studies suggested that 5 years of immunotherapy is usually adequate in developing a long-lasting tolerance to the venom used for treatment.  This is the guideline most physicians today use in determining the length of treatment for bee venom allergy.

While this may be the case for some patients, others may take longer to become completely tolerant of bee stings.   It has now been discovered that there are genetic differences in patients with successful immunotherapy as compared with those who go on to have severe allergic reactions after stopping treatment with bee venom injections.   Therefore, it may be possible in the future to use genetic studies to help identify patients at risk for sting reactions after discontinuation of shots.

J Allergy Clin Immunol 2010;125:1092-7. Niedoszytko M, Bruinenberg M, de Monchy J et al.  Gene expression analysis in predicting the effectiveness of insect venom immunotherapy.