FCAAIA Notes: Omalizumab is a humanized murine (mouse) monoclonal antibody against IgE, the immunoglobulin associated with allergies. About 1/3 of patients with chronic idiopathic urticaria (CIU, hives lasting at least 6 weeks that do not have any other identifiable cause) make an antibody to the receptor for IgE that sits on the surface of cells called mast cells that are found (among other places) ion the skin). Activated mast cells release histamine and other chemicals (that’s why ANTI-histamines are used in allergies). Omalizumab helps prevent mast cell activation by preventing IgE from binding to its receptor. Until now, it only had FDA approval for asthma.
Patients with CIU should still be treated with antihistamines first. Continue reading
FCAAIA Notes: This the first and only sublingual (under-the tongue) treatment for allergies approved for use in the United States. It is only useful for northern grasses (prevalent in Connecticut). It has no utility for any other allergen. It is given daily, starting 4 months before the start of grass pollination and used throughout the season. In Connecticut, we are talking about 6 months worth of treatment.
Sublingual immunotherapy (SLIT) has gained a lot of attention over the last few years. Some practitioners use SLIT “off-label”. That is, they give extracts approved for injection under the tongue. Most of the time, patients receive only small doses of allergen. Continue reading
FCAAIA Notes: The title of this article is misleading, because it implies a great safety risk with allergy shots. We know that allergy shots (subcutaneous immunotherapy, SCIT) are extraordinarily safe, but not risk free. Most significant reactions occur within 30 minutes of an injection. Practice parameters for allergen immunotherapy therefore recommend a 30 minute in-office wait period after allergy shots are given. This study confirms the safety. In fact, the numbers reported are even better than when the last similar survey was done.
Allergy shots are a highly effective treatment for allergy and asthma. Continue reading
FCAAIA Notes: If you have a child with asthma, the results of this study might not surprise you. Although this study was done in Israel, we see the same thing here in the United States. There are probably several things that might contribute. No matter where one goes to school in the Untied States, there is a spike in viral illnesses about one month after school starts. Of course, viruses contribute to asthma exacerbations. Outdoor mold levels peak in September/October when weed pollen is still prevalent. Mold sensitivity can contribute to asthma and allergies. Finally, children start spending more time inside at the start of school and might have more exposure to indoor allergens (dust mites, cat, dog, and indoor molds) than they do in the summer.
So, what can you do to prevent your child’s asthma from flaring? Continue reading
FCAAIA Notes: Another benefit of allergy shots! Bacterial infections of the upper airway (including sinus infections and ear infections) are a common co-morbidity, or complication of nasal allergies. In addition, people with poorly controlled allergies get more frequent, prolonged, and viral infections than those whose allergies are well-controlled or people without allergies.
What ever it takes, you should get your allergies under-control. Continue reading
FCAAIA Notes: We are always looking for a “cure” for food allergy. Today, the best and only proven long term option is still avoidance. Food allergy and food avoidance has a great impact on a child’s and his family’s quality of life. Wouldn’t it be great to not have to worry about accidental ingestions?
On going research in to herbal formulations, oral desensitization, and injection therapy with fragments of food proteins are still in the research phase. Current research shows that Continue reading
FCAAIA Notes: These days, the risks associated with deficient vitamin D levels and the benefits of vitamin D supplementation is an area of intense research. Vitamin D insufficiency (currently defined as a vitamin D level <20 ng/ml) has been associated with a multitude of health risks, including allergic and other conditions we treat every day at FCAAIA (including asthma and infections).
Of course, vitamin D supplementation is going to have the greatest potential benefit in those with the lowest levels to start. It is estimated that an extra 100 IU per day will increase vitamin D levels by about 1 ng/ml. Who is at risk for vitamin D deficiency? Continue reading
FCAAIA Notes: Ever since warnings about lack of efficacy data and appropriate doses arose, we frequently hear, “You can’t give young children those medications”. This article indicates that you CAN give these medications. Doses should be adhered to unless you are otherwise instructed by your physician. It is also important to know what you might expect from each class of medication. Antihistamines will not help a run of the mill viral infection. Decongestants will not prevent or treat ear infections. These are just symptom relievers. They will not cure anything. But, when symptoms are bothersome, it can be useful to find the most effective symptom reliever for you child. Continue reading
FCAAIA Notes: Chronic urticaria (hives lasting 6 weeks or longer) is a frustrating problem for patients and their doctors. The frustration arises because the majority of cases are “idiopathic”, meaning there is no identifiable trigger. We now know that about 1/3 or more of chronic idiopathic urticaria are not idiopathic at all; in those cases, patients make an autoantibody to a certain molecule on the surface of cells called mast cells. When mast cells are activated by that autoantibody, they release histamine and other chemicals that cause hives. Technically then, those hives are not idiopathic. But, there is still no specific therapy for them and no way to avoid an external trigger. Idiopathic urticaria are uncomfortable and can be unsightly, but are completely benign.
The next largest group of chronic hives is those with a physical trigger (cold, scratching, heat, etc.). The smallest group is the one of most concern. Continue reading
FCAAIA Notes: Peanut oral immunotherapy (OIT) allows patients to gradually increase the amount of peanut they eat each day to protect them in the event of accidental ingestion. It has been shown to improve food-specific quality of life. In some cases (50% or less), peanut OIT “cures” the allergy so that patients no longer need to take a daily dose and can still eat peanut without a reaction.
However, there is a very high rate of clinically significant reactions during peanut OIT that requires many patients to drop out completely. OIT to foods should NEVER be tried at home. If you have any questions about OIT to food, discuss it with your allergist. Continue reading