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

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!

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!

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:

· Get vaccinated!

· Wear a mask to decrease transmission of virus.

· 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)

What is NOT available? Specific antiviral medication

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!

Does you mouth itch when you eat fresh fruits


The Pollen-Food Allergy Syndrome (formerly call Oral Allergy Syndrome) is a common yet benign condition caused by cross-reactive proteins in fresh fruits or vegetables and pollens. The symptoms of lip, tongue, mouth and palate itching, tingling and mild swelling occurs after the ingestion of fresh, but not cooked fruits and vegetables, and occasionally nuts and spices. The particular protein is heat-labile which means that the high temperature from cooking breaks down (denatures) the protein such that it does not cause symptoms. This syndrome is especially common in individuals with “hay fever” or seasonal allergic rhinitis.

Common Pollen-Food Allergy associations include:

Birch tree pollen—-fresh apple, peach, pear, plum, cherry, carrot, celery, and hazelnut

Ragweed pollen—- fresh melons (watermelon, cantaloupe, honeydew), banana, cucumber, zucchini, tomato

Mugwort pollen —- fresh apple, carrot, celery, kiwi, peanut, spices (aniseed, fennel, caraway, parsley, coriander)

Grass pollen ——-fresh peaches, tomato, celery and melons

Treatment typically includes avoiding the fresh food if symptoms are bothersome especially during the allergy season. Another way to reduce reactions is to bake or microwave the food. Eating canned food may limit the reaction. Peeling the food before eating may be helpful, as the offending protein is often in the skin.

The risk of a severe allergic reaction such as anaphylaxis is low; however, if symptoms include difficulty breathing, cough, wheeze, hives, severe throat tightness, rapid pulse or loss of consciousness (shock), seek emergency care as this could indicate a severe food allergic reaction.

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

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