In The News: Allergies

Safe Spring Cleaning

Recently, we have all become part of a whole new world brought on by the COVID-19 virus. As we are isolated and quarantined to our homes to reduce exposure, we are finding ourselves cleaning…and cleaning out…and cleaning some more! A spring cleaning would seem like a great way to occupy our time and help our family’s underlying allergies and asthma; however, many of us have allergies and asthma, which can frequently be triggered by indoor household exposure. Not to worry, you can still give your space a good cleaning, just be careful with your choice of cleaning products. Our goal is to keep you safe and healthy!

Dr. Harper once had a patient who was hospitalized because they were cleaning floor tiles with diluted bleach. Unbeknownst to the patient, her supervisor had sprayed ammonia ahead of her cleaning efforts. The mixture of diluted bleach and ammonia produced chlorine gas, which was used as chemical warfare in WWI.

Certain household cleaning products that are readily available can trigger significant respiratory problems, even in individuals without prior lung disease. A recent study in the American Review of Respiratory and Critical Care Medicine indicates that women who are employed as household cleaners have an accelerated loss of lung function, particularly if they are using spray cleaners.

Allergy sufferers should make household chores part of their allergy management plan. Cleaning reduces the number of allergens in homes which can ultimately help alleviate your allergy and asthma symptoms. Indoor allergen avoidance would include reducing dust-collecting clutter, regularly vacuuming with a HEPA filter vacuum, regularly washing blankets and throw rugs, washing all bed linens in hot water once a week, keeping counter surfaces clean and dry, and not leaving food out. 

Individuals who have asthma have increased airway twitchiness which can be triggered by irritant and noxious odors including cigarette smoke, chlorine, fragrances and ammonia. If one has asthma or allergies, care should be taken to choose cleaning products which are milder and do not trigger worsening of your symptoms. 

 Certain potent cleaning products can be mucosal irritants and can cause a worsening of respiratory symptoms in patients with allergies and asthma. The best way to avoid irritation from cleaning products is to have someone else in the household do the cleaning when the allergy sufferer is away from home. This could be a perfect time for your spouse to clean while you enjoy a walk!

There are particular home cleaning products which should be avoided by individuals with allergies and asthma. These products include formaldehyde, ammonia, sodium lauryl sulfate, D-limonene and sodium hypochlorite (bleach). Unfortunately, these chemicals can be found in a wide variety of available cleaning products including furniture polish, disinfectants, mold removers, dish detergents, hand soaps, laundry detergents, fabric softeners, all-purpose cleaners and drain/oven/grill cleaners. “Green” cleaning products can be milder and better for those with allergies, but labels should be read carefully. Interestingly, simple baking soda and vinegar in varying concentrations can clean just about anything in your home!

The best cleaning tools for allergen reduction include a vacuum cleaner, particularly with a double bag system or HEPA filter system. Additionally, a fabric allergen sanitizer vacuum can eliminate 99.9% of dust mites and bacteria from fabric surfaces. Washable microfiber cleaning cloths are safe and effective. Likewise, disposable dust wipes, protective mask and gloves and unscented and dye-free laundry products are safe and work well.

There are many, many cleaning products advertised on the internet, although the safety and effectiveness of these products can be questionable. How do you choose a safe cleaning product? The Allergy and Asthma Foundation of America (AAFA) has developed a certification program to document specific advertised products as being safe from false, exaggerated, or misleading claims. These products can be found on the AAFA website.    

If one is inclined to be a “do-it-yourselfer,” safe gentle homemade cleaners can be prepared without an advance chemical degree or access to industrial-strength petrochemicals. The following is a list of a safe products which can be easily prepared.

  1. All-purpose cleaner: Mix 2 cups of vinegar and 2 cups of water to create an all-purpose cleaner and disinfectant. Do not use this cleaner on marble. It can be used on both kitchen and bathroom surfaces.
  2. Scouring cleaner: Mix ¾ cup of baking soda and ¼ cup of water to create a paste for cleaning sinks, tubs, toilet, ceramic, aluminum, chrome, and stainless steel. This same paste can be used to polish silverware. Alternatively, mix ¼ cup of baking soda, 1 tablespoon of liquid detergent and enough white vinegar to make a creamy texture. You can also add a squeeze of lemon into the paste for a fresh and clean smell.
  3. Drain cleaner: Pour ¼ cup of baking soda in one cup of vinegar down drains.      The combination of the two will create a fizzy cleaner that will scour inside of your drain pipes. Rinse with hot water.
  4. Dishwasher cleaner: Pour ½ cup of vinegar into the reservoir of your dishwasher and run an empty cycle to disinfect and cleaning the interior of your dishwasher.
  5. Mold and mildew cleaner: Spray vinegar on shower walls and curtains to clean and prevent mold and mildew. Wait 15 minutes, rinse and let dry thoroughly.
  6. Window cleaner: Mix together one cup of water, one cup of rubbing alcohol and 1 tablespoon of vinegar. This cleanser works great at cleaning glass without leaving streaks or residue.
  7. Garbage disposal cleaner: Grind peels from oranges, lemons and limes in the garbage disposal with a handful of ice. The ice will sharpen the disposal blades while the citrus peels cleans and freshen the air.

So, while we’re all at home right now twiddling our thumbs for the next clean out project, make sure you are using the best cleaning product for your allergy and asthma needs. If you can’t find what you need, hopefully this list of DIY cleaners is helpful. But if you have suspected or confirmed COVID-19, please see the CDC’s cleaning instructions.

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Flu, coronavirus & allergies: Do you know the different symptoms?

Coronavirus (COVID-19) has very similar symptoms to the flu, like fever and cough. But, patients with the flu often experience additional symptoms like a runny nose, nasal congestion, sore throat, headaches, muscle/body aches and fatigue (overall tiredness). With allergies, on the other hand, you will NOT have a fever. But, allergies can cause a runny nose, nasal congestion, sinus pressure, sneezing, post-nasal drip, itchy/watery eyes and worsening cough/wheeze for those with asthma.

Symptoms of Coronavirus

The primary symptoms of Coronavirus include fever (100.4 or higher), cough and shortness of breath. Patients usually begin experiencing fever and cough first, then several days later develop an acute or rapid onset of shortness of breath and difficulty breathing. There has been very little wheezing, nasal congestion, runny nose or sinus pressure reported. Symptoms occur within 2-14 days after exposure to this virus. Coronavirus can be transmitted within six feet of infected patients through their cough or sneeze. Patients who are at particularly high risk for severe Coronavirus symptoms are the elderly population and those with a weakened immune system.

How to avoid the Coronavirus

Ways to help decrease the spread of Coronavirus include good hand hygiene, avoiding those who are sick, wearing masks and gloves while in a large crowd, refraining from handshakes and hugs and limiting travel as much as possible. Good hand hygiene includes washing hands for at least 20 seconds with warm soap and water or using waterless alcohol-based hand sanitizer. 

Most patients have fairly mild symptoms and only need a lot of rest, fluids and over the counter medications. But, those who develop more concerning symptoms like shortness of breath and difficulty breathing require treatment. 

Here’s a comprehensive look at the symptoms you need to look for:

If you are experiencing fever and cough or shortness of breath, please either call our clinic or utilize the Roper or MUSC Coronavirus telehealth screening resources.

For revolving information on the Coronavirus/COVID-19, please follow the CDC here

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Tackling food allergies

Food oral immunotherapy? You’re probably wondering what that means exactly. Let’s break it down into two parts. “Immuno” is derived from the word immune which means to protect from and “therapy” means the treatment of a disease or disorder that entails some type of rehabilitating process. So, when we provide oral immunotherapy to our patients we are providing a therapy by mouth to reduce a person’s sensitivity to foods that cause allergic reactions.

Food oral immunotherapy helps patients tolerate food proteins (allergens) they would otherwise be allergic to by introducing small amounts of the proteins on a daily basis. It is important to note that food oral immunotherapy only works on food allergies caused by allergy antibodies. These are antibodies released from your immune system that cause your allergic reaction.

How does it work?

If you and your board-certified allergist decide food oral immunotherapy is right for you, you will start eating gradually increasing amounts of the specific food over an extended period of time. The amount of food is precisely measured in milligrams based on protocols developed from oral immunotherapy research. This dose will increase over time to reduce your body’s sensitivity to the food allergen. This is known as building tolerance. Tolerance for a food allergen only continues if the food is eaten regularly. 

What is involved?

Oral immunotherapy requires a significant commitment of time and attention. Before you can begin this type of therapy your allergist will want to make sure all other allergic conditions are under control and routine immunizations are up-to-date. Depending on your allergy history, additional steps may need to be taken before starting oral immunotherapy.

The first step in oral immunotherapy is called escalation. This takes place in your allergist’s office and may last up to eight hours. It is important that the first step is monitored closely. After your first dose, the same amount will be eaten at home once a day until the next escalation dose.

Subsequent escalation visits can be as often as every one to two weeks. During these visits the patient will eat the new higher dose and then be observed for one hour to ensure there is no reaction. The goal is to reach what is called a “maintenance” dose. Once maintenance is reached, that dose is continued at home with no more planned escalation visits. At this point, the patient now has a significantly reduced risk of severe allergic reaction if they accidentally eat their food allergen and they do not have to avoid processed foods at risk of cross-contamination with their food allergen.

Whether it’s peanuts, tree nuts, milk, or some other food, oral immunotherapy may be an option to help you lessen the fear of allergic reactions from hidden food allergens and allow you to be more involved in life.  

What are the risks?

As with any type of therapy, there are risks. Adverse reactions to oral immunotherapy are common but the goal is to minimize the reactions through careful monitoring and escalation visits.

In carefully developed research studies, reactions occur in a significant number of patients. Most reactions are mild such as itchy mouth or abdominal pain and resolve without treatment or with antihistamines alone. Abdominal pain, nausea, heartburn and vomiting can be bothersome for patients after doses and can sometimes lead to changes in the treatment protocol. Our experienced physicians can tailor each treatment plan to the individual patient.

Anaphylaxis can occur with oral immunotherapy and families must be prepared to administer injectable epinephrine if needed. Studies show that less than 15 percent of patients are treated with epinephrine for a reaction during home dosing.

There have been reports of eosinophilic esophagitis (EoE) occurring more frequently in patients on oral immunotherapy. Eosinophilic esophagitis (EoE) is an inflammatory condition of the lining of the esophagus that can cause difficulty swallowing, severe reflux, nausea and/or abdominal pain.

Approximately 25 percent of patients discontinue oral immunotherapy before reaching the “maintenance” point. The most common reasons are reactions, especially gastrointestinal side effects, difficulty adhering to the protocol and rest requirements after dosing.

If all steps are closely followed under physician supervision and careful monitoring, oral immunotherapy can be a viable option for some patients and provide lifetime freedom from food fears and stress. If oral immunotherapy sounds like an option for you or a loved one, we encourage you to speak with your board-certified allergist

For more information and differing viewpoints of food allergy management, we recommend the following websites:

OIT101.org

AAAAI.org

ACAAI.org

FoodAllergy.org

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Peanut Allergy Treatment Approved

On January 31, 2020, Palforzia became the first FDA-approved “medication” for peanut allergy. Dr. Meredith Moore states, “As a board-certified allergist who has been providing oral immunotherapy (OIT) to patients for peanut, tree nuts, multi-nut and wheat for the past three years, I have been excitedly awaiting FDA approval of Palforzia.” The FDA’s decision helps move OIT to a more accepted option for food allergic patients. Additionally, the safety and efficacy data for Palforzia is comparable to the methods being employed by OIT allergists for 10+ years using other sources of peanut protein.

Palforzia treatment doses start at 0.5 mg peanut protein and gradually build to a 300 mg daily dose over a period of about six months. The 300 mg daily dose is equivalent to about one whole peanut or ¼ teaspoon of peanut butter. The studies show that 67% of patients in the Palforzia study were able to eat at least two peanuts without having allergic symptoms. Palforzia showed success in reducing reactions to amounts that would be expected to occur in accidental ingestions or cross-contamination.

The protocol used for patients undergoing OIT at Charleston Allergy & Asthma for the past three years uses a peanut flour that has been analyzed for OIT use and then transitions to whole roasted peanuts that can be purchased at the grocery store. The ingested amount starts at 0.005 mg and builds to 2000 mg as a daily maintenance. This maintenance has been shown to allow patients to safely eat up to 6000 mg of peanut protein or two tablespoons of peanut butter. Some patients may not want that high of a safety goal in which case our OIT protocol can be customized for each patient’s needs and preferences.

Multiple news sources have reported that Palforzia’s annual price has been set at $10,680 (or $890 per month). At this point, it is not known how much, if any, health care insurers will cover of this drug cost. Charleston Allergy & Asthma’s current OIT patients generally spend less than $300 for peanut protein capsules/flour and supplies before converting to roasted peanuts, Peanut M&Ms or peanut butter.

Aimmune Therapeutics is researching development of other OIT products such as tree nut and egg. Charleston Allergy & Asthma physicians have experience treating patients with OIT for tree nuts and wheat using sources currently available.

OIT, using Palforzia or another food source, helps food allergic patients reduce their risk of allergic reactions from unexpected or accidental ingestions. There are risks with any OIT protocol, including anaphylaxis, eosinophilic esophagitis, stomach aches and frustration with the daily dosing process. Dr. Moore includes, “There are very important precautions for patients on OIT regarding activity, exposure and illness that Charleston Allergy & Asthma physicians have experience educating patients about. Personalized OIT treatment also requires adjustments of dosing protocols for school trips, vacations, and day-to-day life that we understand and have the expertise to implement.”

Dr. Moore says, “For some patients, the benefit of having a ‘safety net’ brings freedom from fear of allergic reactions that is worth the risks and inconvenience. Some patients and families are more comfortable and skilled at avoiding their allergenic food and OIT is not the right path for them. Charleston Allergy & Asthma looks forward to partnering with patients and families to help determine which treatment options are best for you. Reach out today if you would like to learn more about our food allergy treatment plans.

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Girl touching arm

What is causing hives?

Hives (or urticaria) are often described as red, raised, itchy bumps or “welts” that move around and can occur anywhere on the body. Typically, individual bumps do not last for long periods of time, and once they go away, they usually leave behind normal skin with no bruising or scarring. 

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Winter Allergies Have You Down?

Winter allergy symptoms are the same symptoms that patients experience during other parts of the year. People often experience nasal congestion or stuffy nose, runny nose, itchy nose, sinus pressure, sneezing, postnasal drainage down the back of their throats, and itchy or watery eyes. Although there are not many grasses, trees, or weeds pollinating during the winter, there are plenty of other airborne allergens that can cause symptoms during the winter months. These primarily include indoor allergens that are present throughout the year, such as pet dander, dust mites, cockroach, and mouse. No matter how clean we all keep our homes and workspaces, environmental allergens are still present and can result in allergy symptoms.

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First Peanut Allergy Drug On Cusp of Approval

AR101 is an investigational biologic oral immunotherapy produced by Aimmune therapeutics.  If that sounds like a mouthful, it is, so let’s break down what that really means. AR101 will be a commercially available “drug” with a proposed trade name of Palforzia. As such, it requires approval by the Food and Drug Administration (FDA). It is currently considered “investigational” because it has not been approved by the FDA and is still under investigation. The term “biologic” refers to a product that is isolated from natural sources and not chemically manufactured. As explained by the American Academy of Allergy, Asthma & Immunology, “oral immunotherapy (OIT) refers to feeding an allergenic individual an increasing amount of allergen with the goal of increasing the threshold that triggers a reaction.”  In the case of AR101, the product is designed for peanut allergic patients and the treatment goal is to reduce the frequency and severity of allergic reactions due to accidental peanut exposure. 

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Top 9 Asthma Triggers

Asthma is an inflammatory condition of the airways in your lungs. It effects 8-10% of the population – that’s 24 million Americans! Asthma usually begins in childhood but can occur in adulthood and is the #1 cause of missed school and work. Asthma is triggered by a variety of exposures detailed below.

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5 Hidden Allergies To Watch Out For

Sometimes allergies can be fairly obvious and occur in response to common exposures, for instance, when pollen covers your car in the springtime, and you can’t stop sneezing!  Other times it can be hard to recognize what is causing an allergic reaction. The cause may be something that you would never relate your symptoms to. We will discuss a few of these less recognized allergies below. 

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Pesky Summer Bug Bites: 101

Summer is here and the time is right for…tiny critters that sting and bite. While it is certainly nice to be able to go outside and enjoy the nice warm weather, this is the time of year when people suffer from reactions to insect bites and stings.  Some bug bites are painful, some spread disease, and some are uncomfortable but harmless. There are some misconceptions out there, so we’ll discuss specifically what you need to know regarding bothersome bug bites – which ones can cause life-threatening allergic reactions and which ones are just pesky pests. 

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