Family Allergy Asthma & Sinus Care is located in Charlotte, NC, (Pineville), Enjoy our Educational Blog:

4/13/2020: Surviving Spring Allergies

March through May is peak tree pollen season.  A single plant can release up to a billion grains of pollen per season.  While most of the pollen grains fall within a few feet, some may blow in the wind for many miles.  For those persons allergic to pollen, only a few hundred pollen grains are needed to cause itchy, watery eyes, nasal stuffiness, sneezing, runny nose and fatigue.  These symptoms can decrease your quality of life: interfere with sleep and daily activities, become less productive at work, less effective learning at school and lead to sinus infections.

It is difficult to avoid exposure to pollens, but here are some tips to minimize exposure:

  • Keep windows closed to prevent pollens from drifting into your home.
  • Minimize early morning activity when pollen is usually emitted between 5-10 a.m.
  • Keep your car windows closed when traveling.
  • Stay indoors when the pollen count is reported to be high, and on windy days when pollen may be present in higher amounts in the air.
  • Wear sunglasses/eye goggles to prevent pollen entering the eyes.
  • Wear mask outside around freshly cut grass and mowing the lawn.
  • Wear hat outside to keep pollen out of your hair. 
  • Shower and wash your hair before bed to prevent tracking pollen into your room.
  • Avoiding drying clothes outside on peak pollen days.
  • If you have pollen-food allergy syndrome, avoid fresh fruits and vegetables with cross reactive proteins.

When avoidance measures are not enough, various medications can relieve the symptoms.  For those persons with moderate to severe symptoms, allergy shots can improve symptoms, potentially prevent developing new allergies and possibly prevent the development of asthma and prevent asthma exacerbations.  Allergy shots can reduce symptoms in up to 85% of patients with seasonal allergies.  Find relief now and schedule an appointment or telehealth visit for your evaluation and individualized treatment plan.

4/2/2020: Trouble smelling: it could be Coronavirus infection or allergy

A loss of sense of smell (or taste) has been noted in COVID-19 infected patients!

On March 22, 2020, the American Academy of Otolaryngology— Head and Neck Surgery (ENT-ear nose and throat doctors) announced:

Anosmia (loss of sense of smell), Hyposmia (decrease in sense of smell), and Dysgeusia (distortion in sense of taste) can be symptoms of Coronavirus infection. Anecdotal evidence is rapidly accumulating from around the world that these symptoms are associated with the COVID-19 pandemic.  Anosmia, in particular, has been seen in patients testing positive with no other symptoms.  This professional society recommends symptoms of anosmia, hyposmia, and dysgeusia in the absence of other respiratory disease such as allergic rhinitis (allergies) and sinus infections be used as screening tools for the possibility of COVID-19 infection and if a patient answers “yes” to one or more of these, then seriously consider self-isolation and testing of these individuals.

Definitions:

·        Anosmia:  complete lack of sense of smell

·        Hyposmia:  decrease in sense of smell

Other causes of a decrease sense of smell include:

Other viruses:  nasal infection with viruses including the common cold virus (Rhinovirus), parainfluenza virus, non-COVID coronaviruses and even Epstein-Barr virus (“mono”) have been associated with impaired sense of smell that can last as long as 6 months.  This is termed olfactory dysfunction. https://www.ncbi.nlm.nih.gov/pubmed/?term=anosmia+and+coronoavirus

Allergies: seasonal allergies have many symptoms including itching (nose, eyes, throat, deep in the ears), sneezing, runny nose and nasal congestion.  The nasal congestion can be significant and decrease the sense of smell.  We are in spring tree pollen season!

Nasal polyps:  these non-cancerous growths originate from the sinus cavities and can “grow” into the nasal passages leading to nasal congestion that can be severe and lead to a decrease in the sense of smell.  Sometimes, the first sign of a nasal polyp is the loss of sense of smell.  Nasal polyps are more common in individuals with aspirin allergy and children with Cystic Fibrosis.

Medications:

·        Nasal preparations of Zinc: Taken off the market in 2009, Zicam Cold Remedy nasal gel and swabs were believed to lead to permanent damage to the sense of smell. Zicam continues to produce homeopathic nasal spray preparations without zinc.

·        Nasal steroid sprays: Common nasal corticosteroid sprays used for treating allergies have been associated rarely with an “alteration or loss of sense of taste and/or smell and, rarely, nasal septal perforation, nasal ulcer, sore throat, throat irritation and dryness, cough, hoarseness, and voice changes” from the FDA package insert for Flonase.

Age: older individuals tend to have a less keen sense of smell and taste especially if on multiple medications that can influence taste and smell.

Smoking:  current tobacco smoking can result in a decrease in sense of smell but it may return if smoking is stopped.

Neurological Disorders: multiple disorders of the brain can result in impairment of the sense of smell including post-traumatic brain injuries.

If you are experiencing new onset loss or decrease in your sense of smell (especially if you don’t have allergies or sinus infections) or taste distortion, contact your doctor!

3/9/2020: Coronavirus (COVID-19) and Asthma

What is asthma?  An inflammatory lung disease with symptoms of cough, wheezing, chest tightness and/or shortness of breath triggered by exercise, allergies, cold air, sinus infections and yes— viruses.  The usual viruses that trigger asthma are the common cold virus (Rhinovirus), Influenza virus (A & B), parainfluenza, coronavirus and metapneumovirus.  25 million persons in the U.S. have asthma (about 1 in 13).  Most people with asthma have mild disease while 10% have severe persistent asthma.   About 10 people die from asthma per day in the U.S.

What is Coronavirus?  The novel Coronavirus (COVID-19) was originally identified in China and in the last 2 months spread to other areas of the world including the U.S and 5 new countries in the last 24 hours.  As of today, globally there are 101,927 cases (80,813 in China) with fatalities (3073 in China).  In the U.S. there are 716 cases with 26 deaths in 36 states.  Infection with Coronaviruses can range from mild d to severe, life threatening respiratory failure, pneumonia and septic shock.  Symptoms of coronavirus (COVID-19) include: fever, cough, and shortness of breath.

Who is at risk for Coronavirus (COVID-19)?  Current limited evidence shows that older adults, and persons who have underlying chronic medical conditions (heart, lung, liver or kidney disease, diabetes, cancer, high blood pressure, pregnancy and immune deficiency) may be at risk for more severe outcomes.  Unfortunately, specific information for patients with asthma is not available.  Death rate in adults who are otherwise healthy was 0.9%.  In patients with chronic respiratory conditions (can include COPD and asthma) the death rate was 6%.  Based on current limited data from China, children appear to be at lower risk for severe symptoms with 2.1% of cases in less than 20 year olds and no deaths in children less than 10 years old.

Asthma and Coronavirus:  Respiratory infections including Coronavirus can set off asthma symptoms.  It is unknown what the risk of this current novel coronavirus is to patients with asthma.  If you are concerned about what might happen if you catch coronavirus, the best action to take is to follow these asthma management steps:

 ·       Do not panic.

 ·       Keep taking your daily controller medications as prescribed. This will help decrease your risk of an asthma attack being triggered by any respiratory virus, including coronavirus.

 ·       Keep your rescue inhaler (typically albuterol) with you every day, in case you feel your asthma symptoms flaring up.

 ·       Follow your asthma action plan to help recognize and manage asthma symptoms when they come on.

 ·       Prednisone or other steroid treatment: Steroids like prednisone are NOT helpful in individuals infected with the Coronavirus who do NOT have asthma.  Steroids did not help patients with acute respiratory distress syndrome and they tended to have more side effects.  https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30317-2/fulltext

However, in patients with asthma, treatment with oral steroids is considered standard of care with an exacerbation.

 ·       Be sure you have received the influenza vaccine. Influenza infection can trigger asthma symptoms and we are in peak influenza season.  If influenza is diagnosed (nasal swab), treatment with an anti-viral medication such at Tamiflu can be offered if given within 48 hours of developing symptoms.

 ·       Other suggestions:


 ·       Wash your hands frequently with soap and water (at least 20 seconds) or use hand sanitizer with at least 60% alcohol.

 ·       Avoid touching your eyes, nose and mouth with unwashed hands.

 ·      Avoid shaking hands, high-fives, or fist bumps to decrease potential spread of coronavirus. 

 ·       Use tissues to wipe your nose (not your sleeve) and discard into a lined trash bag.  Cover your mouth when you cough then wash hands.

 ·       Avoid close contact (6 ft) with other individuals who are ill.

 ·       Stay home and avoid crowds. Take basic preparedness steps to ensure you have the supplies (food, medications) you would need to allow you to stay home comfortably should you need to avoid public places for a prolonged period of time.

 ·   Clean and disinfect surfaces that are frequently touched.

 ·       Rest

 ·       Drink plenty of fluids to stay hydrated

 ·       For fever, consider acetaminophen (Tylenol)

 ·       Wearing a face mask is not currently a recommendation from the CDC

What is NOT available?  Specific antiviral medication and vaccine for coronavirus is not currently available.

When to call your doctor:

 ·       If respiratory symptoms rapidly worsen including:

 ·       Difficulty speaking in full sentences or coughing until vomiting

 ·       Your rescue inhaler is not working

 ·       Coughing up blood

 ·       Shortness of breath while walking, talking, or at rest.

 ·       Use of the chest muscles to breathe. Skin between, above, and under the ribs collapses inward with each breath (retractions).

 ·       Wheezing. But if symptoms are very severe, you may not hear wheezing.

 ·       Peak expiratory flow less than 50% of your personal best if you use peak flow monitoring.

 ·       Most severe lower respiratory symptoms occurred by day 8 in Coronavirus infections.

 ·       If you call 911, tell them you may have coronavirus and are having an asthma attack.

  ·      Wear a mask to decrease transmission of virus. 

If your asthma is getting worse and there’s a risk you might have coronavirus, call your primary doctor who will then contact the local health department.  

Coronavirus Hotlines: 
      ·       Mecklenburg Co: 980-314-9400

      ·       NC: 866-462-3821

      ·       SC: 855-472-3432

Help if you’re feeling anxious: 

People with and without asthma may feel anxious and worried about coronavirus.  Tips to help cope with anxiety include:

 ·       Make sure you’re looking after yourself, so you feel more able to cope with whatever happens.

 ·       Only look at reliable sources for information (cdc.gov)

 ·       Stay connected to friends and family by social media, phone or video chat to talk about your worries.

A special thanks to my friend and colleague, Michael Zacharisen, MD for this timely educational blog! 


1/8/2020: Taming the Cold: Reclaim the Winter for Children with Asthma

Winter has arrived!  That brings 2 challenges to children with asthma.  First, they spend more time indoors where allergens and irritants (fireplaces) may trigger their symptoms.  Second, the cold dry air outside can trigger asthma, especially while playing or exercising.  Here are some tips for dealing with exercising in cold air for children with asthma.

How to prepare for the cold when you have asthma?

  • Control your child’s asthma first. (Asthma is not controlled if symptoms or albuterol use exceed twice a day during the day or twice a month at night).  If it is not controlled, see an allergist (asthma specialist) to provide a written plan.
  • Wear a scarf or cold weather mask that covers the nose and mouth.
  • Warm up in the same temperature you will be exercising in.
  • Use your quick-relief inhaler (albuterol or lev-albuterol) before going outside.
  • Make sure the inhaler has not expired and is not empty.
  • Shake the cannister well and “prime” with 3 puffs if the inhaler has not been used in the last 2 weeks.
  • Protect the inhaler from freezing:  less medication is released in very cold temperatures.
  • If asthma symptoms occur while exercising, stop and rest!
  • Follow the Asthma Action Plan provided by your doctor.
  • Exercise indoors:  if the asthma is not controlled or there has been a recent cold or flu play it safe and stay indoors until the asthma is controlled.

At Family Allergy Asthma & Sinus Care, we encourage our patients of all ages to get out and enjoy those winter sports! Don’t be left out in the cold!

Decoding Food Allergies: Break the Code

Do you want to know how severe your milk, egg or peanut allergy can be? These tests can  help!

Allergies to egg, peanut and cow's milk are among the most common food allergies affecting children. These reactions can range from serious, life threatening (such as anaphylaxis) to milder reactions such as hives. But, how do you know if the reaction will be mild or severe?

While testing for egg, peanut and milk allergies have been available for many years, there have been limitations.  Allergy skin testing has been very useful but only offers insight into how likely a reaction will be.  A large skin test reaction suggests a reaction is “highly likely,” but is unable to predict how severe a reaction will be.  A negative reaction is helpful in predicting that a food allergy is not present.  Advances in food protein science have made it possible for allergists to now help predict the severity of food allergies to milk, egg and peanut.  A blood test where serum IgE (the allergic antibody) is measured to certain specific proteins in milk, egg, and peanut is now available.  This is called “component testing”.  Having these answers may alleviate the fear many patients and their families face every day

Egg
The two major egg proteins individuals with egg allergy may be allergic to are ovalbumin and ovomucoid.
  • If a person is allergic to ovalbumin, serious reactions may occur if undercooked egg is ingested but most will tolerate egg in baked goods.  Furthermore, the likelihood of resolution of egg allergy is high.
  • In contrast, if a person is sensitized to the ovomucoid protein, he/she is at risk for a severe reaction and unlikely to develop tolerance over time.  Strict egg avoidance is necessary if allergy to ovomucoid is identified while a food challenge in the allergist’s office may be helpful if ovomucoid testing is negative.

Milk
There are 2 major classes of milk proteins that can be used in differentiating severity of milk allergy.

  • Casein protein in cow’s milk is responsible for severe allergic reactions and less likely to be “outgrown.”
  • In contrast, whey proteins (alpha-lactalbumin and beta-lactoglobulin) tend to be associated with less severe reactions and the milk protein allergy typically resolves over time.  A milk challenge in the allergist’s office using baked goods containing milk can be a useful tool to assess tolerance.

Peanut
The proteins in peanuts, Arachis hypogaea, are identified as Ara h and divided into Ara h 1,2, 3, 8 and 9.

  • Those individuals allergic to Ara h 1, 2, 3 are more likely to have severe allergic reactions (anaphylaxis) and need to strictly avoid all contact with peanuts and carry self-injectable epinephrine (EpiPen®).
  • However, if the allergy is to Ara h 8, the risk is moderate and if sensitized to Ara h 9, the risk is low for anaphylaxis.

Why perform food component testing?

  • Testing for the specific protein components of milk, egg or peanut, can help predict the severity of an allergic reaction which can impact the recommendations by allergists when advising patients about safety, lifestyle, and long term risk.  While allergy skin testing is still valuable, the availability of component testing via the Pharmacia ImmunoCAP® test by ThermoFisher Scientific offers additional information on which to make important medical decisions and even long term predictions.

At Family Allergy Asthma & Sinus Care, we help patients understand their food allergy and get to the answer— 1 component at at time!  These pearls of information were brought to you by Jared Bozeman, Senior Medical Student at The Medical College of Wisconsin.

New Treatments for Asthma: Change Your Lifestyle

While the diagnosis of asthma has not changed significantly, the treatment has (and should).  Asthma affects 25 million people (including 7 million children) in the U.S.  The incidence of asthma has increased in the last few decades, and while the exact reason for this is unclear, evidence suggests a link between nutrition/diet, weight, air pollution and allergies.  The treatment for asthma is not just taking medications!

Think of the new asthma treatments as “lifestyle” changes.

Diet:

  • Antioxidants: While no diet will eliminate or cure asthma, evidence suggests those who embrace diets high in Vitamin C and E, beta-carotene, flavonoids, magnesium, selenium, and omega-3 fatty acids have lower rates of asthma.  Foods high in carotenoids include carrots, watermelon, mango and tomatoes.  Children who grew up eating a “Mediterranean Diet” high in nuts and fruits (grapes, tomatoes, apples) had less asthma symptoms.  Studies show a low Vitamin D level has been linked to asthma attacks and low lung function.  Vitamin D supplements may improve asthma control.  A high fat meal (over 48 grams) can lead to more lung inflammation and less recovery of low lung function with albuterol.
  • Obesity is associated with severe asthma (requiring ER visits) and decreased lung function. Inhaled steroid medications don’t work as well in patients with body mass index (BMI) over 25.  How much weight do you need to lose to help improve asthma?  Only 5 to 10%, and aim for a BMI less than 25.
  • Acid reflux is associated with asthma symptoms.  Heartburn is more likely if a person eats too much, too fast, or too late at night.

Exercise:  Although exercise can sometimes be a trigger of asthma, this is no excuse to be a couch potato.  Exercise has been shown to improve quality of life in persons with asthma with more symptom-free days, better oxygen consumption, and less inflammation.  How much exercise is enough?  At least 30 minutes three times a week, with a goal of 150 minutes per week (30 minutes minutes a day, 5 times a week).  Exercise can also be helpful with weight control.

Stress control:  Individuals with asthma who have anxiety and depression are at increased risk of asthma attacks.  A disorder called vocal cord dysfunction triggered by anxiety can complicate asthma but not respond to asthma medications.  Interventions may include counseling, breathing relaxation techniques, and sometimes anti-anxiety medications.

Allergen control: Up to 90% of children with asthma may have allergies and these allergies can trigger asthma.  In adults, about 70% of patients with asthma have allergies.  By treating your allergies, the asthma can improve.

Air pollution.  Air pollutants that include small particles can trigger asthma.  Sources include cigarette smoking, wood smoke (campfires, wildfires, poorly ventilated indoor stoves), diesel exhaust, soot and ash.  Strong chemicals and fumes are also triggers.

Vaccines:  viruses such as influenza, RSV, and the common cold virus called Rhinovirus can trigger asthma.  The flu vaccine is recommended for all individuals over 6 months old, but especially for those with asthma according to the CDC.

Medications:  They are still important!

  • Quick relief:  albuterol is still the most common inhaler in use today to help relieve symptoms of asthma and prevent exercise-induced asthma when used 15 minutes before exercise.  Whether it is by a nebulizer or inhaler, keep it on hand.  The newer devices have dose counters and are easier to use.
  • Daily controller:  this group includes the inhaled corticosteroids deemed the most effective treatment for asthma.  When combined with long-acting bronchodilators, the combination is even better for those with moderate to severe asthma.  The newest combination medications are taken only once a day.  Medications like Singular® block an inflammatory pathway without being a steroid medication and are taken as a pill once a day.  Spiriva, an inhaled medication long known to be used for COPD (chronic lung disease from smoking), was recently approved for treating asthma.
  • Biologicals:  The injectable medication Xolair® has been available since 2003 and blocks the allergic antibody IgE.  Mepolizumab marketed as Nucala® and approved in 2015 is monthly injection that works by blocking the protein interleukin-5 to prevent buildups of white blood cells called eosinophils in the lungs that can trigger asthma.

Individuals with asthma have choices.  While there is no cure for asthma, the available treatment options and lifestyle changes can help control asthma so individuals can lead healthy, productive lives.  By controlling asthma, it will not control you!

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These educational information does not take the place of your physician's advice.


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