In The News: Fall Allergies

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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Woman blowing nose in field

Ragweed Pollen is Here!

We’re starting to see cooler weather (if you can call it that), leaves are falling, our kids are back in school and football is on the television that can only means it’s ragweed season. The biggest allergy trigger for fall that runs from September through October. It is a flowering plant that grows six to eight inches tall and is commonly mistaken for goldenrod.

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