In 2015, FCAAIA will be offering a trial of high-dose sublingual immunotherapy (under the tongue, SLIT) drops to select patients with severe spring time allergies. Patients must be at least 8 years old, have allergy symptoms limited to the spring that are not well controlled with medications, and if they have asthma it must be only mild and intermittent (according to NIH definitions). Patients who had a severe reaction to allergy shots or have eosinophilic esophagitis are not eligible. Patients who are currently on allergy shots are not eligible.
SLIT for tree pollen is NOT FDA approved nor is there data telling us how well it works. However, SLIT for grass and ragweed are FDA approved. Our formulation is prepared in the accordance with the same principles of the FDA-approved tablets (high dose). FCAAIA will assess the effectiveness of this trial treatment in 2015 before we decide if we will offer it again in 2016. Interested patients should call and schedule a visit with their allergist soon. To be effective, the drops should be started by early January 2015.
SLIT drops for trees are NOT covered by insurance.
FCAAIA Notes: This brief review of food-induced anaphylaxis does not present new science or new information. However, it is concise and highlights important points about the condition. Also, if you are interested, you can take the quiz! Continue reading
FCAAIA Notes: Eosinophilic esophagitis (EoE) is a relatively newly described condition that has been the focus of intense research for the past 10 or more years. It can present as severe gastro-esophageal reflux (GER) unusually resistant to typical GER treatments. However, it can also present as food refusal (especially in young children), weight loss, and a sensation of food getting “stuck” while swallowing. The diagnosis is often suspected, but must be confirmed by endoscopy and biopsy. An excellent review of EoE can be found in another Medscape article.
Sometimes, EoE is caused by a particular food or foods, in which case elimination of that food is essential. Other times, it is independent of diet. Continue reading
FCAAIA Notes: Several months ago, I posted an article announcing that the FDA approved omalizumab for the treatment of chronic idiopathic urticaria (hives). Rather than repeat my commentary here, I refer the reader to it for review.
This study is among those that supports the FDA’s decision and supports the most recent published guideline’s recommendation for treatment with omalizumab in recalcitrant chronic idiopathic urticaria. But, omalizumab is not a first line treatment Continue reading
FCAAIA Notes: Research into the potential benefits of probiotics in atopic diseases is confounded by lack of good controls, lack of fully comparable study designs, and difficulty in deciding what question to answer. This study is a good example.
Not all probiotics are created equally; some might have more or less of an effect on the development of atopic dermatitis (AD) and food allergy than others. Furthermore, the age of introduction and the dose might affect outcomes. Continue reading
FCAAIA Notes: There is no question whatsoever that food allergy has a huge impact on the quality of life of patients and their family members. Our relatively recent recognition that many children with milk and egg allergy can tolerate the foods in baked products certainly helps ease the burden on the family. However, it does eliminate the burden. Speak with your allergist about strategies to improve you and your family’s food-related quality of life.
Along those lines it is important that you not be labeled allergic to a food that you tolerate. I have frequent conversations with my patients Continue reading
FCAAIA Notes: This is really exciting research, but let’s not get too excited yet. First of all, “hypoallergenic” does not mean “non-allergenic”. Peanut allergic patients would still need to be cautious. More importantly, until EVERY peanut in the environment is hypoallergenic, the peanut allergic patient is still at risk of accidental ingestion of unmodified peanuts.
So, peanut allergic patients: Keep reading those labels, keep asking questions about what is in a food before you eat it, and keep Continue reading
FCAAIA Notes: Guidelines for allergy shots recommend that patients stay on injections for about 5 years and then discuss the potential risks and benefits of stopping or continuing. When patients start allergy shots in our offices, they come in every 3-14 days to build up to the top dose (called the maintenance dose). After that, patients are generally able to get shots every 3-4 weeks. The build up phase is the most inconvenient part and requires 20-25 visits to get to maintenance for most patients. But, the good news is that most of the 5 years of allergy shots only requires a visit every few weeks or so.
Allergy shots are a potential cure for allergies. Continue reading
FCAAIA Notes: Pregnant? Congratulations! It is important to take care of your baby’s health, but don’t forget about your own. Many women are afraid to take any mediation during pregnancy. Unfortunately, some doctors encourage their patients to STOP medication during pregnancy. But, what is worse, the treatment or the disease? It is clear that poorly controlled maternal asthma during pregnancy is dangerous to the fetus.
During pregnancy one third of women with asthma get better, one third get worse, and one third stay the same. It tends to be the same from one pregnancy to the next. During pregnancy, asthma tends to improve as one nears delivery.
Take care of your self (and by extension your baby) during pregnancy. Continue reading
FCAAIA Notes: Up to 95% of people who report penicillin allergy are NOT allergic. Some never were and the rest “outgrew” the allergy. This interview with 3 of the nation’s experts on penicillin allergy is revealing and useful.
If you or a family member were told that you “can never take penicillin”, you should speak to one of our allergists about penicillin testing. Of all medications to which testing can be done, penicillin is probably the only one we really know how to interpret the test results.
Importantly, penicillin only tells us about one kind of reaction that people can have Continue reading