In The News: Fall Allergies

Allergy and Immunology: A Misunderstood Medical Field

Ever wonder why there is a specialized medical field just for allergy? How about those old tales you’ve heard of classic allergy symptoms only to realize they were caused by something else? Believe it or not, there are plenty of misconceptions about allergy and asthma, which is why our team is dedicated to educating our patients on their condition and treatment every step of the way. Dr. Lindsey S. Steadman took the time to share about her experience becoming a board-certified allergist and how our team’s training equips us to give our clients the very best allergy and asthma care.

 

How does an allergist become an allergist?

In order to become an allergist, we go through many years of medical school and clinical training:

  • 4-year undergraduate degree – Most healthcare providers choose a major that they feel best prepares them for medical school, such as biology, chemistry, biochemistry, etc.
  • 4-year medical school degree – Medical school provides the basis of education in becoming a doctor, covering a wide variety of medical care and topics to ensure a well-rounded education.
  • 3-year residency program – All physicians must enter a residency program of some kind to complete their specialty training. As allergists and immunologists, we all have to receive training in either pediatrics or internal medicine. These are both 3-year residency programs, and they are each followed by a board exam that must be passed in order to become a certified pediatrician or internist.
  • 2 to 3-year fellowship – Residents interested in specializing further can then apply to various fellowship programs. The majority of allergy and immunology fellowship programs are two years long (occasionally three years long). Once we graduate from fellowship, we must pass a board exam in order to be certified in allergy and immunology.

After passing our boards, we are able to treat patients of all ages with any sort of allergic or immunologic disease. This includes, but is not limited to, environmental/seasonal allergies, food allergies, stinging insect allergies, anaphylaxis, hives and swelling, eczema, asthma, chronic/recurrent infections and immunodeficiencies.

 

Why is allergy and immunology such a misunderstood field?

Allergy and immunology is a poorly understood field not only in the general population, but also within the medical community. There are many different myths and “old wives’ tales” out there about allergy signs, symptoms and treatments amongst the general population. When patients are not properly educated by allergy experts, these myths and misinformation continue to circulate and become accepted as fact. Even in the medical field, allergy is a misunderstood because there is very little, if any, dedicated teaching or training on allergy and immunology in medical school or residency programs. Fellowship is where the true allergy and immunology training occurs, so a board-certified allergist is always recommended for patients suffering from any sort of allergic disease or immune deficiency.

We are trained on how to obtain a detailed history to determine whether or not testing and further work-up is needed. We are taught how to interpret the results of both skin and blood tests for various types of allergies, lung function testing for asthma, and blood work for immune disorders, all of which are oftentimes not very straightforward. We are also taught how to appropriately manage these issues with medications, allergy shots, biologics, immunoglobulin replacement, oral food/drug challenges and oral immunotherapy for select food allergies. Therefore, it is always recommended to seek the help of a board-certified allergist because we are the experts in the disease process, pathophysiology, diagnosis, management and treatment of all allergic and immunologic diseases.

 

What are some common myths about allergy and immunology?

  • Every sniffle or sneeze is an allergy and every cough or episode of shortness of breath is asthma… FALSE. Fortunately, we are trained to determine whether or not patients have allergies and/or asthma. Not only can we diagnose and treat these issues, but if patients’ allergy- or asthma-like symptoms are caused by something else, we can often help with those problems as well.
  • Every hive or episode of swelling is due to an allergic reaction… FALSE. This can be true at times, but there are also instances when hives are caused by other things as well. We are trained on how to determine whether or not there is an allergy-causing patients’ hives and swelling and how to treat them no matter the cause.
  • All allergic reactions get worse with subsequent exposures… FALSE. There is no way to predict the severity of an allergic reaction based on previous reactions or testing methods. However, we can help diagnose the cause of the allergic reaction (foods, insect stings, medications, etc.) and educate patients on what exposures would be unsafe and how to handle reactions in the future.

 

If you believe you’ve been experiencing allergy or asthma symptoms but you’re unsure of what to do next, leave it to the experts! All of our allergists are board-certified and our team is dedicated to helping you breathe better, feel better and live better. Schedule your appointment with the experts today.

 

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Child blowing nose

Childhood Allergies: What You Need to Know

With childhood allergies afflicting around 30% of children, many parents are left wondering what to do. If your child is wheezing, sniffling and coughing often, you may be curious about the cause and what you can do to help. We’ll run through many of the common questions that parents have about childhood allergies, so you can put your mind at ease.

What are the most common symptoms of allergies?

There are many common symptoms that children deal with when suffering from allergies. These symptoms can vary greatly depending on whether the allergy is environmental, a food allergy, a drug allergy or an insect sting allergy.

Environmental allergies, also known as allergic rhinitis, are the most common form of allergic reaction. Most commonly, children will be sneezing or coughing and will experience a runny nose and itchiness in the nose and roof of the mouth. It is also common to experience red, watery eyes. Symptoms are similar to but not the same as the common cold.

Symptoms for allergic rhinitis will usually be seasonal, although this isn’t always the case. If your child is experiencing allergy symptoms only during the spring and summer, allergic rhinitis is likely. However, you should see a board-certified allergist to confirm the root cause.

The most common culprits for environmental allergies in the Lowcountry are dust mites, cockroaches and mold. These often have a year-round impact on an allergic individual’s health.

Food allergies can cause a variety of symptoms, such as tingling or swelling in the mouth, hives, or even anaphylaxis in more severe cases. When food allergies are less severe, they can often be hard to diagnose, especially when the allergen is less common.

If your child ever experiences these symptoms, you should investigate as early as possible. Knowing the cause of a food allergy provides invaluable information so that you know how to best care for your child and eliminate risks of allergic reactions.

How are allergies in children treated?

There are three main ways that allergies can be treated: avoidance, medication and immunotherapy.

Avoidance

Avoidance simply means not coming in contact with the relevant irritant. This will help greatly, but can sometimes be hard to keep up. If your child wants to play outdoors during summer, but comes home with a runny nose or worse, it can be hard to find a balanced solution.

When symptoms are more severe, this can require children to miss school or be unable to see their friends. Finding a way to deal with allergy symptoms can greatly impact a child’s life well into the future, so make sure to deal with the issues head-on.

There is usually a comfortable middle ground to find if the allergies aren’t too severe. For example, dust-proofing your child’s bedroom or making sure to shower after coming indoors to remove any pollen spores can aid in the quick cessation of allergy symptoms.

One question we often get asked is, “Do I need to get rid of my pet if my child is allergic?” While pet allergies can be a nuisance to say the least, your board-certified allergist can provide recommendations on how to best avoid allergens within the home. We certainly won’t ask you to get rid of your pet! Our top recommendation for individuals with pet allergies is to receive immunotherapy, which has shown to be extremely beneficial in treating the cause of pet allergies.

Medications

Allergy symptoms can be further aided by using certain medications. Do not give your child any medications without first consulting your doctor or board-certified allergist. If you are told that a given medication doesn’t come with any risk, it may be worth a try.

Medications don’t make allergies go away permanently, but they help deal with symptoms and inflammation. Especially when symptoms get severe, medications can be the difference between a normal day at school and a day spent wheezing and unable to focus. Once you know a given medication is safe and effective, it can be good to have on hand in case your child’s symptoms flare up unexpectedly.

One thing to consider when finding the best medication treatment for allergies are common symptoms, such as drowsiness. It’s important to find the right medicine if that’s the treatment route you wish to take, and your allergist will always be able to recommend the best medication treatment plan for you or your child. If medication isn’t doing the trick, immunotherapy is the closest thing to a cure.

Immunotherapy

Lastly, most patients benefit greatly from immunotherapy. This is a long-term treatment option that involves injecting small doses of an allergen into the patient so that they build up immunity. Each patient receives an individualized treatment plan that is custom-tailored for your child’s specific allergens.

This option can have some difficulties when it comes to kids — it can be hard to drag them to the allergist each week! But, it is the best long-term solution and the only way to get truly permanent relief from allergies without using medications. Immunotherapy is available for a variety of allergies. It is also helpful to see a board-certified allergist who specializes in care and treatment for pediatric patients. Our allergists are double-boarded to treat both adults and pediatric patients. Oftentimes, they know how to make children feel right at home during their doctor’s visits and can make shot appointments far less scary or intimidating.

Key Things to Remember

As always, the best option to pursue if you suspect your child is suffering from allergies is to see a board-certified allergist. Through allergy testing and detailed health evaluations, this can provide you with an understanding of the best treatment path that is specific to your child’s situation, rather than just a guess.

 

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When are allergy tests needed?

If you have allergies, you likely know it. Sneezing, sniffling, itchy and watery eyes, the symptoms are sometimes overwhelming. Your immune system controls how your body defends itself and it overreacts to allergens you’ve inhaled, touched or ate. For example, if you’re allergic to dogs, your immune system identifies dog hair or dander as an invader. Your immune system produces antibodies called Immunoglobulin E (or IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. These reactions can range from annoying sniffles to a life-threatening response called anaphylaxis.  

If you’re experiencing symptoms, but aren’t sure why or what’s causing them, allergy testing may be needed. Symptoms that usually prompt testing include:

  • Respiratory – itchy eyes, nose or throat; nasal congestion, runny nose, watery eyes, chest congestion, cough or wheezing
  • Skin – itchiness or eczema  
  • Abdominal – vomiting or cramping and diarrhea consistently after eating certain foods
  • Severe reactions to stinging insect stings (other than swelling at the site of the sting)
  • Anaphylaxis (pronounced an-a-fi-LAK-sis): a serious allergic reaction that affects many parts of the body at the same time

Allergy tests are the best and safest way to tell exactly what triggers your symptoms. The most common triggers include dust mites, animal dander, mold, pollen, insects, foods, latex and drugs. An allergist/immunologist can perform multiple types of allergy tests.

 

  • Skin tests: This is the most common kind of testing done in the allergist’s office. In this test, a small amount of allergenic liquid is placed on your skin and this area is pricked or scratched. Redness and swelling at a testing site tells us you are allergic to the tested allergen. It is generally not much more bothersome than a bug bite. The results of this test are ready in minutes, so you leave the office knowing what you are allergic to.
  • Intradermal tests: Intradermal tests are more sensitive than prick tests and may be used when prick test results are inconclusive. In this test, a very small amount of the sterile testing liquid will be injected just under the surface of your skin, similar to a TB test. The results are available in minutes.
  • Challenge tests: Challenge tests are sometimes used when a doctor suspects you have a food or drug allergy. In this test, a patient will eat or inhale a very small amount of the possible allergen under the close supervision of a board-certified allergist. The amount is gradually increased over several hours to ensure a full serving or dose can be tolerated. This type of test should only be done by a board-certified allergist with experience treating anaphylaxis. For your safety, do not try this test at home!
  • Blood tests: For this test, blood is drawn and then tested for allergies. This test is more expensive than skin testing and it takes longer to receive your results. Interpretation of this test should be done by a board-certified allergist as a positive result does not necessarily mean the patient is allergic. It is best understood in conjunction with an extensive allergy history and skin test. Unlike skin testing, blood allergy testing can be done when patients are still on oral antihistamines.

 

Many people with untreated symptoms aren’t aware of how much better they will feel once they are properly diagnosed and their symptoms are managed. We are here to help you breathe better, feel better and live better!

Give us a call or request an appointment online to begin your allergy treatment plan with one of our amazing board-certified doctors!

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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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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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Little girl in class wearing a mask. How COVID is making back to school look.

Back to School: COVID-19 and Asthma

Many families are faced with the unusual question of “Should I send my child back to school this fall?” COVID-19 has changed a lot about our lives, and it will affect how our children learn, too. For parents of a child with asthma, this can be a particularly difficult decision and many families are divided on how to proceed. The information presented here is based on our current understanding of COVID-19 to help families make informed decisions. Ultimately, the family will need to decide whether it is in their child’s best interest to return to in-person learning.

The risk of being exposed to COVID-19 is statistically higher when attending school in person; however, the individual clinical implications of COVID-19 are still largely unknown due to our limited and rapidly changing knowledge after limited experience with this new virus.  Early in the pandemic, the CDC identified asthma as a risk factor for severe COVID-19 illness.  Subsequent studies have not supported this, and the CDC guidance has changed to state that asthma may be a risk factor for severe COVID-19 illness. The American Academy of Allergy, Asthma and Immunology COVID-19 Response Task Force has stated, “…there are no data suggesting that asthma is a risk factor for becoming infected with SARS-CoV-2; and there are no data to suggest that, if infected, asthma patients have a more severe course of COVID-19 disease. Further, there are no data that suggest SARS-CoV-2 exacerbates asthma. As such, the task force members do not see a reason that asthma would be a reason to avoid school. ” 

In-person learning plays a critical role in childhood development with opportunities for hands-on education, consistent supervision, structure which is crucial for learning task & time management, and social and psychological support. Your family will have the best understanding of the social and educational risks to your child with continued social isolation.

Here are some things to consider:

  • Your child’s overall health.
  • Your family’s health – is someone in your household at high risk of severe COVID illness?
  • The community transmission rate – higher rates mean higher risks of infection.
  • Family work demands – is there someone who can supervise children at home in a healthy and engaging environment? Can the household support possible loss of income?
  • Your child’s academic needs. Does your child need the structure of the classroom and teachers for success? Does your child receive special services that require in-person learning?
  • Schedule uncertainty – if your child’s class or school is quarantined will your family be able to adjust to the changing schedule? How will your child adjust to a changing schedule?

For families who decide their children will return to in-person learning, then it is imperative to ensure all  CDC and AAP recommended social distancing measures are followed. Additionally, the CDC recommends remote learning when community transmission is substantial, as is currently the situation this August in Charleston. In-person learning during times of substantial community transmission would be expected to increase the likelihood of exposure to COVID-19.

Based on what we currently understand, well-controlled asthma does not appear to significantly increase the risk of severe COVID-19 illness. Your family will need to balance the physical risks, educational risks, and family impacts of returning to school versus virtual learning to determine the best course of action for your situation.  With either decision, it is always important to follow CDC COVID-19 social distancing guidelines.

 

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Charleston Allergy global warming

Climate Change: Making Allergy Seasons Worse?

Currently, the vast majority of climate scientists feel that climate change is occurring and that our planet is warming. Global warming is an increase in average global temperature that is mainly attributed – directly or indirectly – to human activities resulting in an increase in atmospheric greenhouse gases including water vapor, ozone, carbon dioxide, and methane.  Unfortunately, belief in, or rejection of, climate change and global warming have recently become a “political football” and now seems to define specific political parties.

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Young boy playing in leaves

What you Need to Know About Fall Allergies

There might not be a yellow coating on your car but fall still brings with it plenty of allergen exposure! Unlike the tree pollen of early spring, fall allergens can be more stealth with their arrival.  Weeds will start pollinating as early as August and can pollinate through the first frost, which in Charleston can be as late as December depending on the year.

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