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

11/19/2016: Air Quality Alert as Raging Wildfires Continue to Burn

There are 16 wildfires burning in NC, with the largest being Chestnut Knob fire in Burke County and the Party Rock fire at Chimney Rock. Each wildfire is only 30% contained. With limited chance of rain and potential strong winds, the air quality could worsen this weekend.  As smoke continues to roll much across NC, the best advice for patients with asthma, other respiratory illness, and  heart disease is to stay inside with the doors and windows closed. Smoke can also irritate your eyes and sinuses, trigger allergies and headaches, and increase the risk of heart attacks. The elderly and children should be cautious and reduce prolong or heavy exertion exercises or activities outside. There is a Code Orange Quality Day forecasted for the immediate Charlotte area and Code Red Air Quality Day the further west you go closer to the fires.

There are six criteria pollutants: carbon monoxide, ground-level ozone, lead, nitrogen dioxide, particulate matter (PM), and sulfur dioxide with known health impacts. PM2.5 or "Fine particles" are found in smoke and haze. These are less than 2.5 micrometers in diameter (less than 1/30th the diameter of a human hair). These particles can be directly emitted from forest fires, or formed when gases emitted from power plants, industries and automobiles react in the air. Air Quality Data is reported in visibility, index ranges and various colors:

Follow the Air Quality Index at:

Even though the air may look clear, there still may be smoke present which can trigger your asthma. If you must go outside, use albuterol prior. Change your clothes and take a shower when you come inside since particles can get stuck in your clothes and hair. If you start to experience breathing problems outside, you should use your albuterol and rest inside. Seek medical attention if your respiratory symptoms does not resolve. Remember, dusk masks are not enough to filter air from smoke. Have a fun and safe weekend by enjoying your indoor activities. 

6/12/2016: I was stung and had a reaction! Do I need to see an allergist?

Summer is the time for yellow jackets, wasps, hornets and honey bees to be active.  Most insect stings will cause a local reaction (pain, redness and swelling at the sting site) lasting a day or so.  Sometimes, the reaction is more than that and the question arises, do I need to see an allergist?

Here is a simple check list to assist you in making decisions.

When to go to the ER or call 911:

  • Feeling of “impending doom,” loss of consciousness, shock (low blood pressure), dizziness, seizure
  • Lower Respiratory:  difficulty breathing, wheezing, chest tightness, coughing or shortness of breath
  • Upper Respiratory:  tongue or throat swelling, difficulty swallowing, talking or breathing
  • Skin:  persons over 16 years old with generalized hives (welts), swelling, itchiness, flushing
  • GI:  cramps, abdominal pain, vomiting, diarrhea

When to see an allergist:

Allergic reactions to stings can occur at any age, even after many normal reactions to stings. Any person who has experienced one or a combination of the above symptoms should be evaluated by an allergist. The single best predictor of the outcome of a future sting is still the severity of the previous sting reaction.  It is estimated that potentially life threatening reaction occur in 0.4% to 0.8% of children and 3% of adults.

A person who has experienced recurrent large local reactions (swelling, redness that extends well beyond the  sting site), spends considerable amounts of time outdoors where stinging insects are present and has needed recurrent courses of oral steroids (prednisone) for treatment.  The risk of a systemic reaction in patients who experience large local reactions is about 5-10%.  

Why see an allergist?

Allergy injections to the insect venom (called venom immunotherapy or VIT) are a very effective treatment and can decrease the risk of a future severe allergic reaction to less than 5% for many patients.  If not treated with VIT, up to 60% of patients if re-stung will have a severe reaction.  Venom allergy skin testing combined with blood IgE to the specific venom can determine which insect is the problem and help differentiate a toxic reaction or other non-allergic reaction from a true allergic reaction.  In addition, a blood test for tryptase will be done.  If the tryptase level is elevated, there is an increased risk of severe reaction to an insect sting, increased chance of reaction to VIT, failure of VIT and increased risk of severe reaction after VIT is stopped.

Venom immunotherapy should include all venoms that are positive. The recommended dose for each venom protein is 100 mcg. This is equivalent to the venom content of 2-4 insect stings. The amount of venom injected by a honeybee sting is about 50 mcg; however, the amount of venom injected by other vespids is in the range of 2–20 mcg per sting.

More than 5% of the population has insect sting allergy, yet few patients are referred for diagnostic testing and specific treatment.   At Family Allergy Asthma & Sinus Care, we specialize in sorting out the reaction and offer state-of-the-art approaches for diagnosis and treatment of insect sting reactions.  Why?  We want our patients to BEE healthy and happy!

1/30/2016: Did Your Grandma Smoke? You bet your asthma she did.

Smoking cigarettes is unhealthy.  Second hand smoke exposure is unhealthy.  Everybody knows that!  When pregnant women smoke, their child is more likely to have low lung function in childhood and adulthood.  But, what happens to her grandchildren when granny smoked when she was pregnant?

This question was addressed in a study from the European Lung Foundation entitled: “Grandmother’s smoking when pregnant with the mother and asthma in the grandchild: the Norwegian Mother and Child Cohort Study.”  The article was published in 2015 in the medical journal Thorax and may be accessed at Thorax article on Grandma Smoking

Researchers used data from the Swedish Registry that included 44,853 grandmothers from 1982 to 1986 to
investigate whether grandmothers who smoked while they were pregnant with their daughters were linked with an increased risk of asthma in grandchildren.  Information from questionnaires completed at 18 and 30 gestational weeks (during pregnancy), and when the child was 6 months, 3 years and 7 years old were evaluated.

To evaluate whether the grandmother’s smoking had an independent association with asthma development in the grandchild from maternal smoking during pregnancy, the researchers classified the children into 4 mutually exclusive exposure groups:

  1. Not exposed to smoking.
  2. Only exposed to the grandmother’s smoking.
  3. Only exposed to the mother’s smoking during pregnancy
  4. Both the grandmother and the mother smoked.

Results: The risk of asthma in grandchildren was increased by 15 to 21%, even if the child’s own mother had not smoked in their pregnancy!

Why does this happen?

  • It’s not entirely clear, but a possible explanation is “trans-generational epigenetics.”  This 25 cent word means that the smoking by grandmother led to a change in the methylation of the DNA (the way the gene works) that is passed on to the mother, then to the grandchild making them more susceptible to asthma.

What if grandpa smoked?  That data is not yet available. For women who intend on having children and eventually grandchildren, we hope you stop smoking so you leave your grandchildren a better legacy than asthma.

At Family Allergy Asthma & Sinus Care, we treat asthma and encourage smoking cessation in all family members.  It’s in our name!

1/17/2016: 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.


  • 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! Go Panthers!!!

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

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