All posts by Charleston Allergy and Asthma

Celebrating Dr. Harper's Retirement

Celebrating 40 Years of Patient Care with Dr. Thomas Harper

If you’ve been with Charleston Allergy & Asthma for quite some time, you’ve likely had the opportunity to share a smile with Dr. Harper! Whether it’s for his love for sharing a good laugh, his incredible necktie collection or his understanding and compassionate care, patients of all ages have grown to love Dr. Harper over his 40 years of owning an allergy practice.

While it’s bittersweet for our Charleston Allergy & Asthma team, we are excited to celebrate Dr. Harper’s retirement and honor the tremendous impact he has had on our staff, patients and community. After all, he’s been with Charleston Allergy & Asthma since day one, having founded the practice with Dr. Bruce Ball in 1992. Since then, we’ve had the opportunity to share many fond memories, walk through life’s highs and lows together, and become our own little “work family” here in the Lowcountry.

We took a moment to sit down with “Dr. H” and learn more about his story, his experience in caring for generations of families throughout his tenure, and to hear what he has planned next!

Where are you originally from and what brought you to Charleston?

My family is from Berkeley County, although my dad was an air force pilot and we moved 14 times in 10 years. We lived in Tokyo, Honolulu, Maine and New Hampshire. I come from a family of seven MDs over the course of three generations. My dad was from St. Stephens, SC and my mom from Moncks Corner. After going to medical school in New Orleans and fellowship in Denver, I wanted to be back with my folks here in the Lowcountry.

How long have you been practicing medicine and why did you decide to go into the allergy field?

I’ve been practicing medicine for 40 years. Initially, I wanted to be a pediatric cardiologist, then decided during my residency at Charity Hospital in New Orleans that I wanted to be in the busiest field; and at that hospital, it was allergy/immunology. I stayed in New Orleans for an additional two years at the National Institute of Health (NIH) for my immunology research fellowship and then my mentor helped me get into the National Jewish Hospital where I studied immune function of Cystic Fibrosis patients. I had the opportunity to study and treat children with various lung problems and received a lot of specialty training. When I came back to SC, there was no pediatric pulmonologist in the lower half of the state, so I became the de facto lung specialist.

How did you come to begin Charleston Allergy & Asthma?

I decided to join forces with Dr. Bruce Ball after working alongside each other. We quickly realized we would make a great team. Bruce is incredible at the “business side” and I don’t care for it, so we were a good fit! We eventually brought on Dr. Davidson four years later and have continued to grow over the years with an extraordinary team of board-certified allergists. There are seven of us now!

How has the field of allergy and asthma transformed over the years?

Forty years ago, the allergy field didn’t have the greatest reputation. A lot of people thought it was some sort of “hocus pocus.” There were also some major misconceptions about allergy injections and allergists putting everyone on allergy shots, like it was a shot factory. Our field has now developed tremendously and has a strong scientific footing with justification for what we do and the treatments we choose.

A huge positive change has been seen in severe asthma. Decades ago, individuals were considered invalids if they had asthma. There was little good medicine available in the 60s and 70s and the few medications that were prescribed had a lot of side effects. It’s been rewarding to treat people who weren’t aware of good asthma control medications and change their lives.

What is your favorite part about being a doctor?

The one-on-one interaction with patients, particularly the children. The opportunity to teach patients over the years, whether for their own care or their children’s care, has been rewarding. I’m the doctor but what I really want to be is your expert advisor. It is ultimately the patient’s role to choose their therapy. My job is to share what the problem is and then provide options for treatment. Working alongside patients on their health journey is what I enjoy.

How many patients do you believe you’ve had the honor of caring for over the years?

I’ve seen three generations of patients throughout my career. It’s been amazing for some of my patients who I took care of as children, to now take care of their children and their grandchildren!

What will you miss most after retirement?

Dr. Harper and his dog, GabeThe people! The patients, my staff, my colleagues. I’ll miss improving patients’ quality of life. Seeing the benefits of the therapies that people didn’t know were available. I’ll miss seeing them healthy, when they didn’t think they could feel any better!

It’s amazing to share a treatment plan with a patient, to tell them that it will change their life and then to see them become healthier, breathe better and start enjoying activities again.

What are you most excited about in this new chapter?

Time off doing other things that I love! I haven’t had more than three days off in five years. I haven’t taken a week off in 15 years. I know my dog Gabe will be really happy! I’m looking forward to spending time out on the water, hanging out with Gabe, white water paddling, kayaking and traveling around the U.S.

Can you share a bit about your family?

I’m excited that retirement will bring more time with my family as well! I have a wife, Joanna, a daughter, two step kids and a granddaughter. Here’s hoping they don’t get too sick of me now that I’ll be around more.

Are there words of encouragement that you would like to share with the Charleston Allergy & Asthma family?

I’ve enjoyed working with our team. It’s incredible to see that the average employee in doctors’ offices nationwide lasts around 18 months. Most of our staff has been with us for many years, and some even decades! It’s been wonderful to have a staff that works well together, that I work well with, and to see how we’ve come to know each other and anticipate what needs to be done.

 

We are thankful that while Dr. Harper is retiring, he will remain on our staff as a consultant for our allergy and asthma practice. We’re also thankful for the six talented board-certified allergists on our team that will continue to provide care for patients throughout the Lowcountry. Interested in requesting an appointment? Contact our team today.

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10 Things People With Food Allergies Want You to Know

More than 30 million people in the U.S. alone have one or more food allergies. In other words, their immune systems deem certain foods harmful and overreact by triggering symptoms such as hives.

Food allergies may not seem like a big deal, especially if you don’t have them or have only ever heard of or witnessed mild reactions. However, they are very serious. With that in mind, there are 10 things that people with food allergies want you to know.

1. Food Allergy & Food Intolerance Are Different

Intolerance to certain foods is a digestive reaction. Think lactose intolerance resulting in gas, diarrhea, nausea and similar symptoms.

Food allergies, on the other hand, are immune reactions and have the potential to be lethal. Therefore, it’s much appreciated when you take the food allergies of those around you seriously.

2. The Most Common Allergens

Eight foods are responsible for nearly 90% of all food-related allergic reactions. They are:

  1. Milk
  2. Egg
  3. Peanuts
  4. Tree nuts such as walnuts and pecans
  5. Wheat
  6. Soy
  7. Fish
  8. Shellfish such as shrimp and crab

Due to the prevalence of these allergies, all of these foods are required by federal law to be named when used in packaged food or when present in a facility where such food was prepared. So when shopping for someone with food allergies, read the labels carefully so you know what items to steer clear of!

3. Any Food Can Cause a Reaction

While the eight foods mentioned are responsible for the vast majority of allergic reactions, no food is off-limits. A person can develop an allergy to any food, which is a good reminder to take any and every mention of food allergies seriously. Just because one may not be common doesn’t mean it’s not real and potentially dangerous.

4. Reactions Are Unpredictable

Allergens can trigger either mild reactions such as hives and an itchy nose or severe ones such as repeated vomiting, difficulty breathing and worse. The trouble is that there’s no way to predict how severe a reaction will be. Even if previous reactions have been mild, there’s no guarantee that future ones won’t be life-threatening. Hence the importance of doing everything you can to help those with food allergies avoid foods that trigger their symptoms.

5. It Doesn’t Take Much to Trigger a Reaction

It doesn’t take a full serving of an allergen to cause a reaction. Depending on the severity of their allergy, a single bite, cross-contact or even being in a room with an allergen can be a trigger. Therefore, it’s critical to avoid the attitude that “just a little bit can’t hurt” and to be understanding when a person has to refuse an offer of food due to an allergy.

6. “Free-From” Labels Are Misleading

Claims like gluten-free and nut-free don’t always mean “100% free of.” Rather, they indicate that the amount of allergens contained in a food is under a certain threshold. So, technically, such foods may still have the potential to trigger allergic reactions.

The solution? Rather than relying on the labels on the front of packages, take a close look at the ingredients list when shopping for people with food allergies.

7. The Symptoms of Allergic Reactions

Allergic reactions can take their toll quickly and unexpectedly so you need to know the signs. Symptoms include:

  • Hives
  • Flushed skin or rash
  • A tingling or itchy sensation in the mouth
  • Face, tongue, or lip swelling
  • Vomiting and/or diarrhea
  • Abdominal cramps
  • Coughing or wheezing
  • Dizziness and/or lightheadedness

By far, the most serious reaction is anaphylaxis, which can cause breathing difficulties, sudden drops in blood pressure, swelling of the throat and loss of consciousness. Anaphylaxis is life-threatening and can set in minutes or even seconds after exposure to an allergen. Swift action is essential to reverse its effects, which brings us to our next point.

8. How to Help in Emergencies

Many people with food allergies have a treatment plan in place for emergencies. Such a plan often includes an epinephrine auto-injector, which should always be nearby in the event of a severe reaction. If a family member or friend of yours has food allergies, get informed beforehand about what to do if they ever have a reaction in your presence.

9. The Time Window For Reactions

As mentioned, many reactions happen within minutes of exposure. However, remain alert beyond that time as some reactions can be delayed by as much as four to six hours.

10. Stay Alert

Food allergies should be taken seriously by both the person who is allergic and individuals who spend time with them. If someone makes you aware of their food allergy, consider how you might help keep them safe and avoid any foods that may contain that allergen. If it is questionable as to whether a food contains a certain allergen, it’s best to keep things safe and avoid that food altogether. Your food-allergic friends will appreciate your support.

 

If you believe you may be experiencing symptoms to food allergies, our team of board-certified allergists offers allergy testing and can advise on the best form of treatment or symptom management. You may even be a candidate for oral immunotherapy! Learn more by requesting an appointment today.

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Charleston Allergy & Asthma is offering allergy testing for the COVID-19 vaccine

If you’ve had a history of allergic reactions to vaccines or tend to be skeptical of vaccination side effects, you may have quite a few questions regarding the newly available COVID-19 vaccinations. 

While our team of board-certified allergists advises the majority of our patients to move forward with scheduling their vaccination appointments as they are able, there are some who have experienced allergic reactions to vaccines in the past and will need to proceed with caution. In order to best serve these patients along with other Lowcountry residents concerned about vaccine reactions, our team is excited to announce we are offering allergy testing specifically for the COVID-19 vaccine!

We took a moment to get all of the details from Dr. Meredith Moore, a board-certified allergist at Charleston Allergy & Asthma, to learn more about the vaccine and to find out who might want to consider an allergy test before moving forward with their vaccination appointment: 

Why would someone want to get tested to see if they might have an allergic reaction to the COVID-19 vaccine? 

Individuals should be evaluated by a board-certified allergist/immunologist if they have a history of severe allergic reaction to any vaccine in the past, any reaction within 4 hours of receiving the first COVID shot, or an allergic reaction to any of the components of the COVID-19 vaccine. At this time, it is not known which COVID-19 vaccine component(s) is/are causing allergic reactions. Polyethylene glycol is an ingredient in the mRNA vaccines and has been associated with anaphylaxis. Polysorbate 80 is used in the Johnson & Johnson vaccine and can cross-react with polyethylene glycol.

 

How will Charleston Allergy & Asthma test for COVID-19 vaccine allergic reactions?

We use a protocol that was developed by a team of allergists/immunologists specifically for COVID-19 vaccination. The protocol tests for immediate skin test reactivity to the vaccine components polyethylene glycol, polysorbate 20 and polysorbate 80. We use both skin prick testing and intradermal testing. With skin prick testing, we introduce the testing material to the immune system just under the skin. There is no bleeding and only minimal discomfort from the testing device that lasts for a few seconds. Intradermal testing uses a very small needle to inject the antigen under the skin. 

The tests can be administered at any Charleston Allergy & Asthma location. The test results are available immediately when the test is completed. The test can take up to three hours to complete. 

 

If someone tests positive for an allergic reaction to the COVID-19 vaccine, what should their next steps be? Will they be allergic to all three that are currently available (Pfizer, Modern, J&J)?

Patients will be tested for different ingredients of the vaccines. If you test positive for one component, but negative for a different component then that may suggest that one of the vaccines may be better tolerated than the others. In that case, you and your board-certified allergist may decide to proceed with vaccination to a certain brand of COVID-19 vaccine.

To note, there have been fewer reports of severe allergic reactions to the Moderna and Johnson & Johnson vaccines. However, most of this data is provided through reporting which may not be fully accurate. Additionally, only a fraction of the final doses have been administered so these numbers may change over time. It is recommended that individuals receive whichever vaccine is available unless they are at risk for a severe allergic reaction in which case it is recommended they seek evaluation by a board-certified allergist. 

 

Are there any risks associated with getting tested to see if an individual is allergic to the COVID-19 vaccine?

As with any allergy testing, there is a rare risk of an allergic reaction. Our experienced staff monitor patients for any sign of allergic reaction throughout the procedure.

 

If someone does not test positive for allergies to the COVID-19 vaccine, should they move forward with receiving the vaccine?

This will be a decision made between the patient and their board-certified allergist. It involves weighing multiple factors such as the severity of any prior allergic reactions, any medical condition that may increase the risk of an allergic reaction, their exposure risk to COVID-19 infection, availability of the vaccine in locations experienced in treating allergic reactions and the patient’s personal preferences.

 

How effective are the COVID-19 vaccines that are currently available (Pfizer, Moderna and Johnson & Johnson)?

The vaccines currently available in the U.S. have been shown to reduce COVID-19 infection by 72 – 95% and prevent 86 – 100% of severe infections.

 

What are some of the most common side effects experienced after receiving the COVID-19 vaccine? 

Most people experience mild side effects from the COVID-19 vaccine that are similar to common side effects from other vaccines. Most people, if they have an allergic reaction, will experience the following: 

  • Headache (22% of recipients)
  • Tiredness (17% of recipients)
  • Dizziness (17% of recipients)
  • Chills
  • Fever
  • Nausea
  • Muscle aches

These side effects are a sign that your immune system is recognizing the vaccine and developing protective antibodies. These symptoms generally go away on their own in 1-2 days. For some people, these common side effects are more intense after the second dose of a 2-shot series.

 

What are the most common allergic reactions that individuals are having to the COVID-19 vaccine? 

According to a paper published in the Journal of American Medical Association which tracked reactions in Mass General Brigham employees, the most common allergic reactions were rash, itching, hives, swelling that was not at the injection site and respiratory symptoms (Blumenthal). This occurred in a total of 2% of vaccinated individuals. Anaphylaxis, a more severe allergic reaction, occurred in 0.025% of vaccine recipients (16 people out of 64,900).

 

How serious is anaphylactic shock?

When someone experiences anaphylaxis they have allergic symptoms in multiple organs. These patients have difficulty breathing, low blood pressure or severe gastrointestinal symptoms in addition to hives or itchy rashes. Anaphylaxis can be life-threatening if the heart or lungs are severely involved. Fortunately, for those who experience anaphylaxis, injectable epinephrine is very effective at reversing anaphylaxis if used early. Among the Mass General Brigham employees, 16 developed anaphylaxis but only 1 required hospitalization. The Vaccine Adverse Event Reporting System has received reports of 3.8 anaphylaxis reactions per 1,000,000 doses of mRNA vaccines.

 

How are reactions treated at COVID-19 vaccination sites? Is every site equipped to handle reactions?

The CDC has created a Checklist of Best Practices for Vaccination Clinics Held at Satellite, Temporary or Off-Site Locations. This checklist includes expectations that vaccine providers are CPR certified and that an emergency medical kit is on-site. Most vaccine sites are advising patients to wait 15 minutes after receiving the vaccine to ensure they are in a location where medical assistance can be provided.

 

What signs should an individual look for or consider as they gauge their risk of an allergic reaction to the COVID-19 vaccine?

Most severe allergic reactions start within 15 minutes of the vaccine being administered. Common symptoms are hives, cough, shortness of breath, fast heart rate or nausea. Let a vaccine provider know if you experience these symptoms.  

 

Are there any additional details to note on allergy testing for the COVID-19 vaccine?

The COVID-19 skin testing protocol was developed by experts in the allergy and immunology field using our current understanding of the ingredients of the COVID-19 vaccines. The protocol has not been extensively evaluated so we do not know how reliable the test protocol is. The testing results will provide you and your allergist information that can be incorporated in decision-making regarding COVID-19 vaccine administration.

 

If you have a history of allergic reactions to vaccines or components of the COVID-19 vaccine, our team of board-certified allergists recommends you consult with your healthcare provider before receiving the COVID-19 vaccine. To find out if it’s recommended that you receive allergy testing for the COVID-19 vaccine, request an appointment with one of our board-certified allergists today.

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Lowcountry nurse shares what it’s like to be a COVID long-hauler

Throughout 2020 and now into our second year of the COVID-19 pandemic, many people might be able to relate when saying the coronavirus “felt close to home.” Whether you have received a positive diagnosis personally or a loved one has been affected by COVID-19, when someone you know has a difficult experience with the virus, it can truly shape perspectives.

Our team is thankful to report that Sarah, a nurse here at Charleston Allergy & Asthma, is now farther along on her road to recovery than she was just a few months ago, but her experience with COVID-19 as a 37-year-old, healthy and active woman is not as uncommon as you would think.

We sat down with Sarah to learn more about her experience as a “long hauler” (the nickname given to those with prolonged cases of COVID-19), and how she fought along the road to recovery from the coronavirus.

When were you first diagnosed with COVID-19 and do you know how you may have contracted it?

I tested positive for COVID-19 on June 28, 2020. I’d recently gone in for a surgical procedure and had to be tested prior to that on June 23. I didn’t go anywhere prior to the surgery or after, so I assume that I contracted COVID during my hospital visit for the procedure. I began having symptoms on June 25.

What initial symptoms did you experience with COVID-19 and how did they progress over time?

  • Day 1: extreme lower back pain, terrible headache.
  • Day 2: sore throat, mild sinus congestion.
  • Day 3: raw and sore throat, severe sinus congestion, loss of taste and smell.
  • Day 7: intense sinus congestion, headaches and fatigue. Still no signs of fever, body aches or chills.
  • Day 10: chest tightness, breathing issues, starting to really decline.
  • 4 weeks: breathing under control, but now experiencing heart issues including heart palpitations and chest pain. Received EKG that came back abnormal and was referred to a cardiologist.
  • Continued experiencing heart-related symptoms including an inconsistent heart rate. (i.e. Heart rate in the 140s while sitting and resting, 180s while standing, feeling short of breath, nearly passing out.)
  • 5 weeks: diagnosed with tachycardia and began treatment for myocarditis (inflammation of the heart muscles).
  • Also experienced a range of different symptoms in this time period, including hurting calf muscles, bloating, gas, heartburn, diarrhea, constipation and vomiting. Began to lose my hair in clumps, had extreme fatigue and felt “brain fog” (couldn’t remember words, had forgetful days, etc.) Felt like every nerve in my body was firing off at the same time, causing tremors. Taste and smell had only partially returned, certain foods tasted strange. Gained 30 pounds. Felt like every system in my body was failing.
  • Eventually diagnosed with Dysautonomia; autonomic nervous system was damaged by COVID-19, which controls heart rate, blood pressure, breathing and digestion. Severely deconditioned by the time physical therapy was started and had no muscles in hips or legs.

What specific treatment did you seek in hopes of recovering from COVID-19?

I have seen our wonderful Dr. Moore at Charleston Allergy & Asthma since my initial diagnosis. I also consulted with a pulmonologist, cardiologist, gastroenterologist, neurologist and I have now been in physical therapy twice a week since the end of October. I received a wide variety of tests including chest x-rays,  CT of the chest, EKG, ECHO, Holter monitor, cardiac MRI, endoscopy and colonoscopy. I’ve also been prescribed several medications including antibiotics, daily inhaled steroid, rescue inhaler, oral steroids, beta-blocker, colcrys, countless vitamins, turmeric, probiotics, peppermint oil pills and Pepcid.

Are you still receiving treatment for your COVID-19 symptoms?

I am still in physical therapy and follow up with my cardiologist and primary care provider every other month.

Are you still experiencing any lasting symptoms of COVID-19?

 I still have heart rate issues, extreme fatigue, shortness of breath with exertion, headaches, brain fog and occasional GI issues.

How has COVID-19 affected your everyday life? 

COVID-19 continues to have an extreme affect on my everyday life, even now as I’m many months post-diagnosis. I haven’t been able to work full-time in the office for over seven months. I’m fortunate my work has been so patient, as I have just started to return to the office occasionally, for a few hours at a time so I’m not pushing myself too hard. My work has made it possible for me to do some things from home so I can continue to have income.  I haven’t been able to venture out anywhere, although we all should be staying home as much as possible to help reduce the spread of COVID-19 anyway. But I miss small, simple things, like going to the grocery store, picking up a coffee.

As I’ve started to feel better over time, I have experienced some exciting milestones. One big milestone was finally being able to clean my home on New Year’s Eve, it felt like such a big step after being bed ridden for so long. Who knew you could be so excited to clean your house?!

I’m incredibly grateful that Charleston Allergy & Asthma’s team has supported me throughout this journey. They have been super understanding if I’ve been unable to work or if I have a bad day. The people in my life, friends, family, co-workers, have had the greatest impact on my comfort and healing. There’s a big mental aspect to this disease and my support system has been incredible.

How are you currently seeking encouragement and support throughout your COVID-19 journey?

Early on into my diagnosis, I joined several Facebook support groups. After five weeks of being sick, I shared my story on Facebook and it went viral (pun intended) and was shared over 1,200 times all over the world. People were contacting me from New Zealand, Australia, Africa, Germany and throughout the U.S. I have honestly met people that I now consider friends or my “COVID sisters” as we joke, who are going through the same thing as me. My boyfriend, family and friends have been amazing and have helped me with so much. Plus, I am lucky to work from home right now and have also been able to do some self-care by reading books, binging shows, and even took up paint-by-numbers!

What encouragement do you have for those who have similar cases of COVID-19?

I think the biggest thing for people going through this is being your own biggest advocate. Doctors don’t know what causes these symptoms and you really have to fight for treatment and make sure your providers are listening to you. Most testing comes back normal which is frustrating, yet you have all these things going on in your system that can’t be explained. Also, be patient with the healing process. Early on, I knew that I was going to be in this for the long haul and tried my best to stay positive and not get discouraged when I had setbacks. Your mental attitude and fight toward this is everything.

Don’t underestimate COVID-19. Yes, a lot of people get through this illness, but sadly a lot of people have lost their lives. You truly do not know how your body will react. I was a healthy, active 37-year-old with no health issues and I had my life as I knew it stripped away from me. And, unfortunately, my case is not uncommon. There are thousands of people going through what I am going through and it just really is not talked about widely. We need our story to be heard so that more take notice and help figure out what is going on.

Sarah is still on the road of recovery from COVID-19 and continues to serve as an incredible member of the Charleston Allergy & Asthma team. She recently received her COVID-19 vaccinations along with the rest of the Charleston Allergy & Asthma staff and shares her story to help raise awareness of the potential affects the coronavirus can have on those diagnosed with the virus.

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New Asthma Guidelines Just Announced

The field of science is ever-changing with new discoveries and ideas about life and diseases. Scientific textbooks have become obsolete over past millennia and recently, as frequently as a decade or two! Our ideas about what causes various diseases and appropriate management have changed drastically over the last 500 years. Our team receives official updated recommendations for the treatment of our patients and we are pleased to share that the accredited organizations we look to for guidance have shared the latest recommendations on treatment for patients with asthma. In the last 30 years, we have learned much more about asthma pathophysiology and management as new medications have become available for treatment of asthma. If you’re wondering why these might change overtime, Dr. Harper has shared a bit of perspective…

In the 1970s and 80s, I had the opportunity to train at National Jewish Hospital in Denver, Colorado where the sickest asthmatics in the United States are referred. We managed children and adults from every state in the US. What we observed at that time was the marked disparity in asthma understanding and management by referring physicians and hospitals. For example, some of these patients referred to our hospital for severe asthma didn’t even have asthma! The National Institute of Health (NIH) was also concerned about this disparity in the understanding of asthma diagnosis and management. In 1991, an expert panel was convened by the NIH which included physicians, respiratory therapists, and nurses and they assembled uniform guidelines for assessment and management of asthma.

This organization was designated the National Association for Asthma Education and Prevention Program (NAEPP). The document generated by this group was extensive and covered recommendations for asthma evaluation and diagnosis, identification of asthma triggers, assessment of asthma severity, and a stepwise approach to medications for asthma management in children and adults. Simultaneously, the international community also developed guidelines for asthma management (Global Initiative for Asthma or GINA) which are updated yearly. The guidelines from this international group generally parallel American guidelines although there have been some recent differences.

Since 1991, this expert panel has reconvened periodically to update guidelines in an effort to share new ideas about asthma pathophysiology, triggers and new medications available for management with practicing physicians. These updates were published in 1997, 2002 and 2007. Since the last guidelines were released in 2007, our understanding of asthma pathophysiology has greatly changed and a wide variety of new asthma medications have become available. One of the most important new concepts is that asthma appears to be more than one disease with major differences in inflammatory pathways leading to the characteristic twitchy airways and airway obstruction seen in asthma. Depending upon which type of asthma inflammatory pathway is present in an asthmatic, certain therapies may be more or less effective. Monoclonal antibody therapies (medicine that targets the chemicals involved in the inflammatory reactions resulting in airway narrowing) to block these various inflammatory pathways are rapidly evolving and becoming available. In 2021, we have finally obtained a new NAEPP update for asthma management which was just published this past week.

New NAEPP asthma guidelines are similar to previous guidelines, identifying individual asthma triggers, determining the severity of asthma and suggesting a stepwise approach to the management of increasing asthma severity. Here are the new major changes outlined for you:

  1. A major change in the new guidelines is the concept of using a single inhaler containing an inhaled corticosteroid and fast onset but long acting bronchodilator (currently only Symbicort or Dulera) as both controller therapy and rescue therapy. This has not been recommended in previous NAEPP guidelines but has been present in GINA guidelines. This new strategy has been suggested for children over 4 years old, adolescents, and adults. It’s a safer way to use short term higher dose steroids to control an acute flair up for asthma than oral steroids.
  2. It is recommended that measurement of exhaled nitric oxide, which is a marker of eosinophilic driven airway inflammation, can be used to accurately direct specific therapy. Eosinophils are white blood cells that all people have but those with allergies and asthma tend to have higher numbers.
  3. The new guidelines also confirm the benefits of reducing indoor allergens in individuals with allergen sensitivity, particularly to dust mite.
  4. Lastly, allergy extract immunotherapy (allergy shots) has also been confirmed to be of benefit in select individuals with allergy triggers for their asthma.

These new guidelines have just been published and it is not certain when insurance companies will alter their coverage for asthma medications based on these new guidelines. These guidelines will help the board-certified allergists at Charleston Allergy & Asthma determine the most appropriate management strategy and medications for their many asthma patients.

If you’re seeking treatment for your asthma symptoms, request an appointment with one of our board-certified allergists today.

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Is it allergies or a cold?

Are you sniffling, sneezing, wheezing and coughing? You may be wondering if you have a common cold or suffering from allergies. The problem is, it’s not always easy to tell the two apart. The symptoms can be the same, but the treatments, not so much. So let’s take a look at each, see how they differ, and how to treat them.

The Common Cold

A cold is an infection caused by a virus, usually in the upper respiratory tract affecting the nose, throat and/or sinuses. Symptoms may appear less than two days after exposure and include coughing, sore throat, runny nose, sneezing, headache, and possible fever. A cold will usually develop over several days and takes a couple days to clear up.

While there is no vaccine or cure for the cold, there are ways to help prevent it, the most common being hand washing. While antibiotics will not help with a cold, nonsteroidal anti-inflammatory drugs such as ibuprofen can help with discomfort. You also need to stay hydrated and rested. 

Allergies

Allergies are your immune system’s reaction to things like pollen, grass, pet dander and foods like peanuts. An allergic reaction usually triggers symptoms in the nose, lungs, throat, sinuses, ears, and on the skin. In the most serious cases, a life-threatening reaction called anaphylaxis can occur.

Because allergies and colds have similar symptoms, like sniffles and stuffiness, many people get them confused. But, there are additional symptoms with allergies like red eyes, an itchy rash, shortness of breath, or swelling. But unlike a cold, which develops over time, allergies begin shortly after you’re exposed to what you’re allergic to. When it comes to the duration, allergies will last as long as you’re exposed. More than likely, if you’ve been experiencing symptoms for more than two weeks, it’s allergies.

So, what if you don’t know what you’re allergic to, but you have symptoms? How can you tell a common cold from allergies? Take a look at the list below and decide how many of the symptoms you have. 

    • Clear or watery mucus
    • Itchy skin or watery eyes
    • Unchanging symptoms 
    • Sniffles for more than a week
    • Symptoms only during certain situations

If you’ve been experiencing symptoms like these, all hope is not lost. There are multiple kinds of allergies, and treatments vary for each. Treatments include avoidance, medications and allergy injections. 

If you want relief from your allergies, or to find out what you’re allergic to, schedule an appointment with a board-certified allergist.

Sources:

https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/EL-allergies-colds-allergies-sinusitis-patient.pdf

https://www.aaaai.org/conditions-and-treatments/allergies

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What are inhalers & how do they work?

Bronchodilators, or most commonly called inhalers, are medications that are breathed through the mouth and into the lungs to help relax muscles that tighten around your airways. The medicine helps open the airway and lets more air move in and out of your lungs and helps you breathe more easily. 

People with asthma use inhalers during an attack when their airways swell and become narrower. These attacks cause the person to cough, wheeze and have trouble breathing. Almost everyone with asthma will use a bronchodilator to help open their airways. Others may use one at some point in their life if diagnosed with a persistent cough, COPD, bronchitis, etc. Different inhalers have different medications, or a combination of drugs, to address different illnesses. 

Different Kinds of Inhalers

There are three basic types of inhalers that deliver medications. The most common is the metered-dose inhaler (or MDI) which uses pressure to push the medication out of the inhaler. Nebulizers use air or oxygen and deliver a mist of the medication through a tube or mask that fits over your nose and mouth. Dry powder inhalers (or DPIs) deliver medication, but they require a strong and fast inhalation.

Short-acting bronchodilators are used as “quick-relief”, “reliever”, or “rescue” inhalers. These bronchodilators open the airways and help stop or relieve acute asthma attacks very quickly. While they’re best known for working on sudden attacks, they’re also great to use before exercise to help stop asthma during your workout. 

While many people use short-acting bronchodilators, the overuse of an inhaler, tablet, or liquid/nebulizer, is a sign of uncontrolled asthma that needs better treatment. If you are using short-acting bronchodilators more than twice a week, call Charleston Allergy & Asthma about improving your asthma control therapy.

Long-acting bronchodilators provide control, not quick relief, of asthma. Your board-certified allergist will prescribe the medication, which is usually taken twice a day along with inhaled steroids for long-term monitoring of symptoms. 

Unlike short-acting inhalers, long-acting inhalers do not work on muscle inflammation directly. Instead, they help the airways relax, allowing more air to pass through.

If you’re struggling with your asthma or think you may be in need of a prescribed inhaler, request an appointment online today.

 

Sources:

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/asthma-inhalers

https://www.aaaai.org/conditions-and-treatments/conditions-dictionary/bronchodialator

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Vocal Cord Dysfunction (VCD) – A Very Misunderstood Illness

Have you noticed an increased shortness of breath or tightness in your chest when exercising? Do you feel like you’re choking or do you experience wheezing when you take part in strenuous activities? Does your voice feel hoarse after working out? Many of these symptoms are common in patients who are diagnosed with vocal cord dysfunction.

Commonly misdiagnosed as asthma, vocal cord dysfunction (VCD) is a function disorder of the vocal folds, which are located in the “voice box.” VCD is characterized by abnormal movement of the cords resulting in respiratory symptoms. Patients with VCD typically experience symptoms during inspiration or when they take a breath in. This is because the vocal cords close at a time when they usually would not. VCD can occasionally cause symptoms during exhalation, but this is less common. VCD poses challenges for both patients and providers as it can mimic and co-exist with asthma. However, an asthma attack is treated very differently than a VCD attack, and misdiagnoses can lead to inappropriate and unnecessary treatments.

The most common symptoms seen in VCD include difficulty with shortness of breath, throat tightness, difficulty swallowing, feeling like something is “stuck” in your throat, choking, gagging, voice changes (hoarseness, raspiness, loss of voice) and wheezing. The “wheezing” that occurs with VCD is a high-pitched wheeze-like sound that comes from the throat, not the lungs, as seen in asthma.

There are several possible causes of VCD, some of which result in irritation of the vocal cords, leading to the abnormal movements. Underlying issues or coexisting conditions are also common with VCD and can sometimes even lead to misdiagnosis. These include heartburn (GERD or reflux), post-nasal drainage from poorly controlled allergies, viral upper respiratory illnesses or colds, depression, anxiety, irritable bowel syndrome (IBS) and chronic pain syndromes. Exercise and inhaled irritants (strong scents/smells like colognes, perfumes, cleaning agents and fumes) are also very commonly identified triggers.

Direct visualization of the abnormal vocal cord movements via rhinolaryngoscopy (camera scope through the nose and down the back of the throat) is the gold standard for diagnosing VCD. However, if the patient is not actively having a VCD attack with the symptoms listed above, then this scope will be normal at the time, Therefore, normal rhinolaryngoscopy cannot definitely rule out a diagnosis of VCD. A pulmonary function test can help to diagnose VCD as well, but this can also be normal in VCD patients. More likely, your board-certified allergist can diagnose VCD based on symptoms and history. 

The mainstay of VCD treatment involves recognizing triggers, appropriately managing co-existent diseases, and utilizing breathing exercises. If patients have difficulty with these exercises, their allergist may refer them to a speech therapist to help as well. Education for patients on the signs and symptoms of VCD and how they differ from asthma can help to reduce unnecessary emergency department visits, hospitalizations, procedures, breathing treatments and steroids.

Statistics on VCD are really hard to find because of how often it is missed. It is almost always diagnosed as something else at first. Our practice has seen many patients who have been treated for “asthma” for years with inhalers and steroids, but all they really needed was vocal cord exercises and maybe some help from speech therapy. 

Treatment by a board-certified allergist for VCD is critical because of how much time, money, energy and unnecessary medications, procedures and emergency department visits/hospitalizations are present on misdiagnosed VCD patients. The treatments for these other issues are not only unnecessary and unhelpful for VCD patients, but they can have side effects of their own. Incorrect treatments for VCD often include inhalers, prednisone or the unnecessary use of EpiPens. Additionally, VCD is seen in a significant amount of the asthma population. VCD attacks and asthma attacks have subtle differences that can be picked up on once patients are better educated. The typical treatments for asthma don’t help with VCD and vice versa.

If you believe you might be experiencing VCD symptoms, scheduling an appointment with a board-certified allergist can lead to a diagnosis and proper treatment so that you can find relief. Request an appointment with our team today.

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The Flu Vaccine: More Important Than Ever

Like clockwork, we hear the warnings every year. When flu season rolls around, everyone is encouraged to get the vaccine to prevent the spread of influenza. There are many reasons why getting the flu vaccine is beneficial and highly recommended. What are some of those reasons and, more importantly, why is it more vital than ever that you get your flu shot during the COVID-19 pandemic?

The Usual Benefits of the Flu Vaccine  

The most obvious benefit of flu vaccination is that it can keep you from coming down with the flu. While 100% protection is not guaranteed, getting vaccinated does make a difference

In fact, during 2018-2019, it was estimated to have prevented more than 4 million flu illnesses, more than 2 million flu-related medical visits, tens of thousands of hospital visits and 40,000-60,000 deaths. It may have even been you who was spared from the flu and its potential complications as a result of vaccination (on your part or that of others)! 

What other compelling reasons are there to get your flu shot yearly? Besides reducing your risk of getting sick and reducing hospitalizations, the vaccine has been shown to:

  • Prevent and limit the severity of influenza illnesses in people with chronic health conditions that put them at higher risk for complications
  • Protect women during and after pregnancy, as well as protecting their newborn child(ren)
  • Reduce the severity of illness in people who get vaccinated but still get the flu anyway. Since every flu season and every individual’s response to influenza are different, you’ll want to have the most protection possible against things going south

Don’t forget that, even if you’re not pregnant or dealing with chronic illness, your flu shot can protect others around you who are. This is especially true during the COVID-19 pandemic.

How Flu Shots Can Save Lives During COVID-19 

Experts have predicted that the viruses responsible for the flu and COVID-19 will be co-circulating this fall and winter. This has the potential to cause several problems. 

  1. It could perpetuate the spread of COVID through individuals who mistake symptoms as mild flu and do not adhere to the recommended guidelines for the sick
  2. Contracting the flu and coronavirus at the same time comes with an increased risk of serious and even life-threatening illness
  3. Severe but preventable cases of the flu requiring hospitalization take away the staff and resources needed to treat COVID-19 patients

Protect Yourself, Protect Others 

As you can see, the flu vaccination is more important than ever before. While in 2018-2019, less than half of all Americans got the flu shot, we hope that many more will do their part to protect themselves and others this year, especially since the stakes have been raised by the pandemic. 

With fall already upon us and flu season looming, now is the time to get your flu shot. Since the vaccine takes about two weeks to trigger the creation of antibodies, the sooner, the better! 

 

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Calm Fall Allergies & Enjoy Every Second of the Season

There’s nothing quite like Charleston in the fall. In contrast to the hot and humid summer, most of us welcome the perfect balance of sun and comfortable temperatures, which make it an ideal time to enjoy the great outdoors.

However, this beautiful season isn’t completely free of downsides. Charleston is notorious for bringing on fierce fall allergies of all sorts. What are some allergens that are especially prevalent here in the fall? More importantly, how can you manage them effectively so that you can still enjoy the season to the max?

Allergens Common in the Fall

Along with year-round allergies that are found here in the Lowcountry, many are also affected by some allergies that are more prominent in the fall. Some of the most common culprits for seasonal allergies this time of year include:

Ragweed. Did you know that each ragweed plant produces 1 billion pollen grains that can travel hundreds of miles? Although not as obvious as its bright yellow counterparts, this form of pollen is everywhere in fall! An allergy to ragweed pollen can result in symptoms such as sneezing, runny nose, irritated eyes, a scratchy throat and more.

Alternaria alternata. Or, in simpler terms, mold, is a year-round issue here in the Lowcountry. In the fall, it grows on leaves thanks to the warmth and humidity. These mold spores, which can be easily disturbed, can cause headaches, coughing, fatigue and even skin rashes. And this is just one type of mold; there are many more (both indoors and out) that can produce similar symptoms.

Dust mites. While not limited to the fall season, dust mites love warmth and humidity. As a result, they thrive in late summer and into early fall, leading to sneezing, itchy and watery eyes, sinus pressure and itchy skin.

Pollen food syndrome. Some who have allergies to ragweed and other pollens, like birch trees, may notice they have reactions when eating certain seasonal foods. These can include cucumbers, zucchini, melons, bananas, apples, pumpkins and squash. In this case, the pollen cross pollenates with certain fruits and vegetables which can cause allergic reactions such as an itchy or tingly mouth when consumed. This is not a true food allergy but an allergic response to inhalant allergies.

Treating Fall Allergies Successfully

You shouldn’t have to miss out on enjoying the fall in the Lowcountry simply because you have allergies. There are things you can do to reduce and manage your symptoms. You can:

-  Try over-the-counter medications to combat sneezing, runny nose, throat irritation and other symptoms.

-  Wear masks when performing certain outdoor activities such as raking leaves or other yard chores to protect yourself from pollen and other allergens in the air.

-  Use a dehumidifier to reduce the humidity in your home, which can minimize the prevalence of dust mites.

-  Keep doors and windows closed to prevent mold and pollen spores from entering, along with showering as soon as you get home to reduce the spread of allergens.

-  Pay us a visit so that we can find the cause of your allergies with an allergy test and put together a personalized treatment plan. Such a plan may include avoidance measures, medications or even allergy immunotherapy, which can help you permanently increase your tolerance to allergens.

If you’re a fall allergy sufferer, take action now so that you can enjoy the season while there’s still time!

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