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Meet the Girls: Our Charleston Allergy Trio!

Let’s hear it for the girls! Our Charleston Allergy & Asthma team has been blessed with some fantastic board-certified providers who all go above and beyond in giving exceptional care for our patients. For more than 30 years, we’ve been providing relief from allergies and asthma to the people of the Lowcountry.

To celebrate the incredible women in our lives, we’re thrilled to introduce you to our three female providers and share their stories of how they came to lead the way for women in healthcare. Get to know our favorite female allergists below!

Dr. Meredith Moore
Did you want to be a doctor when you were a little girl?
“Yes, I had to have a surgery when I was young and afterward, had to stay in a big ward with no parents. A burn victim was next to me and they would change her dressings. She was so sad and would cry. One night, she was crying and hysterical. All the physicians and nurses had left her, no parents were there and I went over and sat with her and made her feel better. I knew that I wanted people to have a better experience.”

What is your favorite part about being a doctor?
“Hard to answer because there are so many things! It’s the relationships you develop with people. They have allowed you the privilege of sharing their lives with you. It’s an awesome privilege and an amazing experience that someone was able to open themselves up to you and then you help make their lives better.”

What’s it like to balance personal and work life as a doctor?
“Practicing medicine with passion takes a lot out of you, whether you are a man or a woman, mom or not. Universally, it’s difficult if you want to approach medicine as a calling. It’s a very rewarding but demanding profession, no matter who you are.”

Dr. Carolyn Word
Why did you become a doctor?
“Growing up, my grandfather was a general practitioner and when we visited him in his office, I loved seeing how he interacted with patients and how he was able to help them. It seemed like a great way to help people. I always loved math and science, so I did biomedical engineering for undergrad. In the process of that, I realized that though I loved science, I loved working with people more. It’s a great way for me to take my love of science and apply it to patient care, which led me to medicine. I loved my rotation in allergy/immunology and all the ways we can make a difference in our patients’ lives.”

Have you overcome any obstacles as a female in the medical field?
“I think there certainly are stereotypes about women in medicine. There have been times when patients have thought I was a nurse because I was a woman or question my knowledge but more often, they have been grateful. When I was a medical student, I felt more pressure as a woman to work harder, push harder and prove myself to be accepted. I have never felt like that in my practice now and I’m grateful to work in such a wonderful practice.”

What’s your favorite part about your job?
“When I get to see a patient for a follow-up and hear that they are feeling so much better. When a patient has recently started allergy shots and has been coming in for frequent injections for a couple of months, then they share that after years of medicine, they had no idea how they could feel so much better; that’s the best part! Patients who have been struggling with a food allergy and who have passed their food challenge, then seeing their excitement. It’s a great thing to be a part of. And just getting to know my patients in general. We catch up about their lives beyond helping them find relief. We’re building relationships. It’s personal.”

Dr. Lindsey Stoltz Steadman
Why did you want to become a doctor?
“I was always interested in the sciences: biology, anatomy, physiology. On top of that, I enjoy interacting with people and going into a profession that was going to allow me to give back was important to me. I really enjoy teaching. I believe as a physician, my job is to educate our patients, our patients’ families and the community about our field.”

What’s it like to balance personal and work-life in the medical industry?
“My husband is a physician as well, so a major part of our relationship is that we’re very understanding of what the other person is going through. We bounce ideas off of each other and educate each other. There are a lot of sacrifices made when you decide you want to be a doctor and it doesn’t end after graduation of medical school, fellowship, etc. We understand that about each other. I understand when he needs to do a surgery in the middle of the night and he understands when I have to take a call over the weekend. Our training kept us a part in different cities and different states, but we understood what the other person was going through. We may have been a part, but we were together.”

What do you love most about your job?
“Critical thinking. I really enjoy the process of meeting a patient and getting to put the pieces of the puzzle together to help them. I’m grateful that I get to improve people’s quality of life. Nothing is more rewarding than hearing their success stories.”

Is there anything you want to add about being a doctor?
“You can know all the science but if you can’t explain it to your patient then it all goes out of the window. Rapport with your patients is equally as important as understanding the science. Patients need to feel comfortable with their doctor. At the end of the day, you just need to be good at what you do.”

We’re thankful for the incredible team of compassionate and talented providers that we have here at Charleston Allergy & Asthma! If you think you may be suffering from allergy symptoms or if you’re in need of a local board-certified allergist, schedule an appointment with our team today.

 

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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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Smiling woman using laptop.

Telehealth tips: How to get the most out of your telehealth visit

Due to the COVID-19 pandemic, and in an effort to practice social distancing, many patients are experiencing telehealth visits for the first time. Whether you’re meeting with our team of board-certified allergists or another medical provider, there are some simple and practical steps you can take to make the most out of your visit. 

As our providers have been serving patients via telehealth, we’ve compiled our list of the best tips and tricks so that your visit is smooth sailing and we can provide the best possible care – virtually!

Check your tech

Make sure you have a smartphone or computer with a front-facing camera that is positioned at eye-level. Check that your internet connection is strong prior to your visit and be sure that your camera and microphone is turned on at the start of your call. For the most reliable internet connection, use a wired connection when possible. And don’t forget to make sure your battery is fully charged or that a charger is closeby. 

Quiet is key

Find a private space where your provider will be able to hear you clearly. It can be difficult to hear or distracting when there is lots of background noise. Using headphones can make it easier to keep your conversation private and ensure you can always hear your provider throughout the call.

Bright light

If possible, set up in a well-lit space so that your provider can see you clearly. Try turning on overhead lights and blocking light from windows, which can lead to a bright glare. Try not to sit directly in front of windows, this could cause a “shadow” effect and make it difficult to see your face.

Question cues

Are there symptoms that you’ve been experiencing or particular questions that you know you want to address with your provider? Given that your appointment setting is different than normal, preparing ahead of time and writing those questions down ensures that you don’t forget anything you want to cover. Be ready to share information regarding your symptoms and any questions or concerns you might have.

Practice patience

If you’re new to using telehealth technology, don’t worry! If the call drops, simply follow the original instructions to jump back into the session. Technology can be finicky and unpredictable and our staff is taking that into consideration throughout telehealth appointments.

Telehealth has been an incredible asset during COVID-19. Our team is dedicated to providing you with the best appointment experience possible and we want to be sure you get the most out of it as well. Are you in need of an appointment? Visit our telehealth webpage today to sign up for your visit.

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Girl smiling in front of a bowl of food.

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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FDA approves first peanut allergy treatment graphic.

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 putting lotion on her 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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Family blowing their noses while in bed

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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