The Greenwich office will be closed for the afternoon on Friday, June 9, 2017. Please call our Norwalk or Stamford office for questions, concerns, making appointments, etc. Normal business hours will resume on Monday. Thank you.
FCAAIA Notes: If you have been following this blog over the years (or search it now), you know that I have posted many articles about oral immunotherapy (OIT) to food. This study looked at the feasibility of OIT to wheat. The researchers found that desensitization to wheat is possible. However, only about ½-2/3 of the study participants tolerated a dose of about 4.4 grams (about 1 ½ slices of bread. More were able to tolerate larger amounts than before the study.
The flip side of this success is the high reaction rate. More than 10% had mostly mild reactions. So we have to ask, how many had accidental ingestions with symptoms after their diagnosis but before they entered the study? Continue reading
FCAAIA Notes: I have posted many articles on the safety and efficacy of allergy shots. This report confirms that allergy shots are a very safe treatment. However, it also addresses the risk of systemic allergic reactions to sublingual (under the tongue, SLIT) tablets and drops. It is now clear that those treatments also carry risk of severe allergic reactions. There are not large numbers of patients treated and reports yet because of the relative newness of SLIT tablets but by just doing the arithmetic, it is not clear to me that SLIT is all that much safer than subcutaneous immunotherapy (SCIT). Furthermore anyone who has an allergic reaction to SLIT does so at home, not in a medical office, thereby increasing the risk of a bad outcome. All patients on SLIT should have an epinephrine auto-injector at home. Continue reading
FCAAIA Notes: Sublingual immunotherapy (SLIT) tablets are already FDA approved for grass and ragweed. Personally, I have not found that they have a great role in the care of patients here in southwestern Connecticut. There are few patients so allergic to only those allergens that they require immunotherapy. If patients are on injections (subcutaneous allergen immunotherapy, SCIT) for multiple allergens, grass and ragweed are included if indicated. The tablets are very expensive and often not covered by insurance.
However, there are more patients allergic only to dust mites who are bad enough that immunotherapy is indicated. SLIT tablets are an alternative for those patients when they reach the market.
A great weakness in the study and marketing of new products is that they are usually not compared to existing products in head-to-head studies. Continue reading
FCAAIA Notes: Early introduction of solids including peanut decreases the risk of later allergy. This recently published guideline regarding early introduction of allergenic foods is an extension of the LEAP and EAT studies about which I previously posted. Babies with severe atopic dermatiits and/or egg allergy should be tested for peanut before introduction is considered. The new guideline also addresses approaches to groups with less risk,.
After years of recommending otherwise, I think many primary care practitioners will be slow to “get on board” with these new recommendations. Rather than delaying introduction, check with your allergist Continue reading
FCAAIA Notes: The world’s really going to pot, isn’t it? Over the years, I’ve told many patients that herbal and other natural supplements are potential allergens. Here is a perfect example, as marijuana is certainly natural. But should I call it a weed allergy? Continue reading
FCAAIA Notes: It is pretty rare that products placed on unbroken skin cause systemic allergic reactions. However, chlorhexidine is a notable exception. Chlorhexidine is in many over the counter antiseptic products. You should not avoid these products unless you react to them. But is you have an allergic reaction after using one, be aware that it may be the cause. Continue reading
FCAAIA Notes: Early introduction of solids including peanut decreases the risk of later allergy. This recently published guideline regarding early introduction of allergenic foods to infants is an extension and formal recommendation after the LEAP and EAT studies about which I previously posted. Babies with severe atopic dermatitis and/or egg allergy should be tested for peanut before introduction is considered. The new guideline also addresses approaches to groups with less risk.
After years of recommending otherwise, Continue reading
FCAAIA Notes: Everyone with allergies should make an attempt to decrease exposure to his or her triggers. Everyone should try to find an effective symptom reliever to use as needed. Everyone with moderate symptoms should use daily controller mediations. And, in accordance with current guidelines and practice parameters, everyone with moderate allergic rhinitis is a potential candidate for allergen immunotherapy (allergy shots).
BUT WAIT! This review doesn’t even mention immunotherapy as an option and I don’t know why. Immunotherapy has the potential to cure, not just control one’s disease Continue reading
FCAAIA Notes: So if it looks like a sinus infection, smells like a sinus infection, and eels like a sinus infection, it must be a sinus infection, right? Well, not necessarily. Every summary of chronic nasal and sinus disease will tell you that and that the overuse and abuse of antibiotics is common (Diagnosis and management of rhinosinusitis: A practice parameter update. Ann Allergy Asthma Immunol 2014; 113:347–385). If your symptoms do not clear with antibiotics, you have to start to wonder if there is something else going on. Continue reading