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Midsummer Break From Allergies

Wed, 28 Jul 2010 09:46:38 -0700

For those of you with pollen allergies, you may be wondering why the past few weeks have been better than others. Many people have a terrible time in the Spring and Fall seasons, but the Summer tends to be more tolerable. Why does this happen?

The answer is pollen levels, which rise and fall according to a standard pattern. Early in the Spring, trees begin to pollinate. If you look in your backyard, at parks, or around town, you’ll see that tree leaves are beginning to grow again. If you look more closely one can even see “pollen spheres” on certain trees, much like the picture above. These indicate that tree pollen levels are on the rise, and for people with tree pollen allergies this can be a very difficult time of year.

Later in the Spring, around the end of May or early June, tree pollen levels fall, and grass pollen levels rise. People with grass pollen allergies are well aware of this transition, and June can be a troublesome month for these individuals. It’s a bit more difficult to observe grass pollen in the environment because lawn mowers cut the stalks before they get too tall! However, in parks or fields it’s very easy to note the tall stalks that release pollen, often rising much taller than the standard grass height.

Now comes the interesting part. In the middle of the Summer, typically in July, tree and grass pollen levels have risen and fallen, but nothing replaces their levels. For reasons we don’t fully understand, the middle of the Summer is often a time of sweet relief for allergy sufferers. Some people believe the high temperatures found in the midsummer can temper pollen release, but this is countered by evidence that pollen levels fall in the most temperate of environments. This July has been more mild here in Los Angeles, and one might expect pollen levels to remain high as a result. However, the levels have fallen and remain low.

Unfortunately, this trend will not continue indefinitely. In the late Summer, weed pollen levels typically rise, and in early Fall many mold spore levels rise as well.

What’s the bottom line? Enjoy July if you suffer from pollen or mold spore allergies! And of course, if you’re curious about your allergies and haven’t been tested, let me know and I’ll be happy to help.

Enjoy the rest of your Summer!

Asthma and Summer Camps

Tue, 23 Feb 2010 15:36:58 -0800

I know, we’re not even in Spring yet. However, summer camps have early registration, and I want to comment on summer camps for children with asthma. Parents can follow this Asthma Care Checklist if your asthmatic child is heading off to camp:

Find out who is responsible for medical care at the camp.  Is there a physician or nurse on site? Who is the medically trained person who will be administering medications? If your child is going to an overnight camp, is a medically trained person there 24 hours a day?

Plan a meeting with the person responsible for medical care and your child's counselor on or before the first day of camp.
Your child can be involved in the meeting. Topics to discuss include:

• What makes your child's asthma worse, especially in the camp setting.
• Asthma symptoms, including the child's awareness of the symptoms.
• Peak flow use (when appropriate), including technique and the use of peak flow zones.
• Actions to take when asthma symptoms occur or peak flows are in the yellow or red zones.
• Use of a metered-dose inhaler and spacer at camp, including the correct technique.
• Whether the healthcare provider and the parent recommend the child keep the metered-dose inhaler and spacer with him or her. If not, the metered-dose inhaler and spacer should be quickly accessible when asthma symptoms occur.
• Use of daily medicine, including the correct technique.

Provide a written Asthma Action Plan to support what you discuss at the meeting.
Talk with your child's healthcare provider before camp about the written Asthma Action Plan. The Asthma Action Plan should include what medication to take daily, what medication to use to treat asthma symptoms and decreases in peak flow zones, what medication to use as a pretreatment before exercise, emergency telephone numbers and what makes the child's asthma worse.

Provide the necessary equipment for the stay at camp.  This often includes enough medications for the child's stay at camp, a spacer, peak flow meter and possibly a nebulizer.

Ask where the medication is kept at camp.  Make sure the quick relief inhaler will be available when needed.

Talk with the medically trained person during the camp stay to see how the Asthma Action Plan is working.  This asthma checklist can help parents, children with asthma and camp staff work together to provide a safe camp experience for children with asthma.

Specific camps for children with asthma are available.  The American Lung Association is a good resource for further information about Champ Camp or for information about asthma camps in different parts of the country.

Summer camp is an experience children often have fond memories of as an adult. Children with asthma can attend camp with careful planning and by following the asthma care checklist.

Your Skin and Allergies

Mon, 22 Feb 2010 09:37:51 -0800

Do you often suffer from red, bumpy, scaly, itchy, inflamed/blistered or swollen skin? Dry skin, sunburn or an insect bite may be the cause. Or, you may have a skin allergy. The most common skin allergies include eczema, hives/angioedema and contact dermatitis.

Eczema

Eczema usually affects the face, elbows and knees. The red, scaly, itchy rash is more common in infants and those who have a history of allergies or asthma. Older children and adults with eczema often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp.

Triggers include allergens, overheating or sweating, emotional stress, food and contact with irritants such as wool, pets or soaps. Preventing the itch is the main treatment goal. Applying cold compresses and topical steroid and calcineurin inhibitor creams are the most effective. Antihistamines are often recommended to help relieve the itchiness.

Hives/Angioedema

Hives are red, itchy, raised areas which may be triggered by food, la- tex or drug allergies. Hives can also result from non-allergic sources like rubbing of the skin, cold, heat, physical exertion or exercise, pressure and sunlight. Hives usually go away within a few days. Chronic hives can linger for months to years.

Angioedema is a swelling of the deeper skin layers that sometimes occurs with hives. Angioedema appears on the eyelids, lips, tongue, hands and feet and is typically not red or itchy—just swollen. The allergens that trigger hives may take days to leave the body, so an allergist/immunologist may prescribe antihistamines or in severe cases, steroids. Other tips for symptom relief are cool showers, applying a cool compress or wearing loose/light clothing.

Contact Dermatitis

Contact dermatitis is often more painful than itchy. It is character- ized by an itchy, red, blistered reaction from poison ivy, nickel, perfumes, dyes, latex products or cosmetics. Some ingredients in medications can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams.

Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment. Contact dermatitis can be treated by scrubbing the skin with soap and water after exposure and using prescribed antihistamine and cortisone medications. Calamine lotion, oatmeal baths/milk soaks and cool compresses can offer relief.

One Note About Food Allergies

Mon, 14 Dec 2009 09:39:42 -0800

I recently commented on the difficulties that food allergic patients face during the holiday season. With all of the parties and family gatherings, it can be difficult to avoid certain allergens. I stumbled upon a great resource for some recipes that eliminate common food allergens. Remember, the “Big 5” food allergens include: egg, wheat, soy, peanut and cow’s milk. These 5 foods account for over 85% of food allergies. Here’s a link to the recipes, sponsored by the American Academy of Allergy, Asthma & Immunology:

http://www.aaaai.org/patients/specialfeature/recipes.stm

All you have to do is scroll down and select the recipe of your choice. Each recipe lists the food allergens that have been removed.

Happy Holidays!

-Dr. Davidson

H1N1 Flu Vaccine and Immune Disorders

Thu, 3 Dec 2009 10:57:37 -0800

Flu season has been in full force since October, and while some outlets are reporting a decrease in the number of H1N1 cases, it is still a major public health concern. As an allergist/immunologist, I treat patients with allergies, asthma and immune disorders. One of the major risk factors for H1N1-related complications is asthma.

What about patients with immune disorders? Should they be given the seasonal or H1N1 influenza vaccines?

Patients with immunodeficiencies are defined by a weakened, or in rare circumstances, absent immune system. Regardless of the cause, individuals with deficient immune systems face a greater risk of developing serious infections. These infections can also cause unexpected complications. In the case of influenza, these complications can be quite serious.

Vaccines largely come in two different forms: live and killed. Live vaccines contain weakened versions of the original virus or bacteria. For this reason, live vaccines are often referred to as live-attenuated. One good example of a live-attenuated vaccine is the Varicella or Chicken Pox vaccine. Another example is the nasal spray preparation of the seasonal (FluMist) and H1N1 influenza vaccines.

Since these vaccines carry live, but weakened virus or bacteria, individuals with severe immunodeficiencies should not receive these vaccines. In these circumstances the attenuated virus can reactivate and become a dangerous threat to patients with a compromised immune system.

Killed vaccines are more straightforward -- they contain whole or portions of dead viruses or bacteria. Since the virus or bacteria contained in these vaccines is dead, they may safely be administered to patients with deficient immune systems.

One other important note applies to family members who live with someone who has an immune deficiency. These family members should also refrain from receiving live-attenuated vaccines. This is because they may shed inactive virus through nasal or oral secretions, much like the common cold is spread. If the family member with an immunodeficiency acquires such a virus, it may reactivate and pose a significant health risk.

In addition to any vaccine, and when considering H1N1/seasonal flu in particular, preventive measures should always be taken. Good hand washing is one of the best ways to limit the spread of a bacteria or virus. If a family member or immunodeficient patient develop signs of flu-like illness, anti-viral medications may provide significant benefit.