The location of the swelling should help your doctor determine if the cause of your angioedema is allergic, or due to another medical condition. For example, swelling of the lips, face or eyelids in many cases is due to an allergic trigger. One of the most common causes of angioedema in these locations is a food allergy. I typically hear a story where a patient has eaten at a restaurant(many times an Asian restaurant with various sauces) and within an hour the allergic reaction involves the lips or tongue, but can also affect the face or eyelids- think of Will Smith after he ate peanut in the movie Hitch.  For these type of allergic reactions that are not obvious, food allergy testing through the blood or simple, non-invasive skin tests can provide the answer to prevent future reactions. Another common cause of swelling in these areas can be a contact dermatitis allergy. This is where a person touches a product that gets transfered from the fingers to the face and can trigger intense swelling. A recent example I just saw in the office was a woman who started coloring her hair to get the grey out. She put the home product of hair color on her scalp on Friday, and by Sunday her eyelids were swollen so badly she could hardly see! This is an example of what we call a delayed allergic reaction- meaning, the allergic swelling doesn’t take full effect until 48 hours after the application. My office does skin patch testing which is safe to determine which chemical in the product caused the reaction. The other main cause of angioedema can be medications themselves. I have seen in my New York allergy practice several cases where common drugs like Aspirin or Advil have caused the reaction. Another well-known cause of facial or neck angioedema can be from the blood pressure medications called ACE-inhibitors. This class includes popular medications, such as Diovan.

The non-allergic causes of angioedema can be Hereditary Angioedema. This can be a dangerous cause of recurrent swelling involving the respiratory tract an cause asphyxiation. It also can be confused with Irritable Bowel Syndrome or Appendicitis, because the stomach pain can be very severe. There are specific blood tests that can be ordered called complement proteins which can diagnose if you have this disorder. The good news is that there is a replacement medication to prevent these attacks today. Non-allergic causes of swelling can be infectious and require antibiotics or autoimmune, such as in inflammatory arthritis.

To go back to my title: “Why Benedryl isn’t the best choice for Allergic Swelling?”: the answer is that oral cortisone in short courses can quickly reverse the deep swelling and make you look normal again. This a safe option because in most cases it is not needed long-term- and for that the key is a complete medical evaluation to determine the cause. I hope if Will Smith reads this article he will remember not to drink the Benedry but call his doctor for some cortisone.

One of my patients came to me with a story that is all too common: she was having a salad, with multiple toppings, and suddenly experienced severe diarrhea. Most of us would associate diarrhea with a stomach or intestinal upset from spoiled food but many patients and doctors don’t realize that diarrhea or vomiting can be the initial sign of a severe food allergy reaction. My patient also described further alarming symptoms: a hot, flush feeling running through her body and blurry vision.  These are also classic signs of anaphylaxis, as histamine and other chemicals begin to flood the body. She was stumbling in the street until a taxi cab picked her up and brought her to the door step of the hospital.

Because she came by taxi, emergency staff didn’t recognize the seriousness of her condition. She was observed for several hours until the allergic reaction finally subsided on its own. In many cases, patients with severe allergic reactions are given an injection of Benedryl, which is unfortunately not the appropriate first line treatment for anaphylaxis.

The patient had had this kind of reaction before, but a previous visit to an allergist hadn’t yielded any results. Currently, I am running tests to figure out if she is allergic to nuts, legumes, or any vegetables that could have been in her salad. The key thing I have emphasized to her is that this could occur again, and that she needs to have an EpiPen to self-treat if she is not near medical help. An EpiPen looks like a big pen, but it contains epinephrine (adrenalin) in an injectable form, which can reverse a severe allergic reaction within minutes. A patient that uses an EpiPen should dial 911 for medical attention and be properly evaluated. The great news is that studies have shown that early, appropriate use saves lives!

This holiday season there will be lots of parties and delicious tantalizing treats – if you have a food allergy, especially a severe one, please be sure to have an EpiPen and know how to properly use it. The boy scout motto, “Be prepared” can save your life.

First, resolved component testing (aka the UKnow Peanut Test), a technique developed by PIRL laboratory in Michigan, a division of Thermofisher Diagnostics, allows for a more precise way to test for the allergy. The UKnow Peanut Test is a blood test, as opposed to a skin test, that isolates specific proteins in the peanut in order to find out which proteins are dangerous for a person to have and which are most likely cross-reactions to another allergen protein, such as pollen. A study published in The Journal of Allergy and Clinical Immunology by Nicholau et al., showed that patients suspected of having a peanut allergy were more likely to have a severe allergic reaction to peanuts if their blood count was elevated for the proteins Ara h1, Ara h2 and Ara h3. The Ara h2, in particular, was linked to severe peanut allergy. I now routinely order this test on patients that are concerned about peanut allergy.

Next, what might be the most exciting news in the allergy field in over 25 years – the successful oral desensitization to peanuts! USA Today profiled a young girl, Kirsten Mahoney, who participated in clinical trials in Iowa for oral desensitization to peanuts. Kirsten completed the study and is now eating the equivalent of 12 peanuts twice a day with no allergic reaction! Kirsten and other peanut allergic children “microdose” with peanut flour, which is added to a food or drink. They start at an extremely low dose under the supervision of their doctor and then continue at home with the same dose. This program takes about 5 months to complete.

Kirsten’s story is truly awe-inspiring. She went from having a potentially fatal peanut allergy to eating peanut M&M’s every day to maintain her tolerance. A great commercial for Hershey’s?

If you have any questions about resolved component testing for peanuts or other foods, please don’t hesitate to contact us on Facebook or Twitter.

This past week the American Academy of Allergy, Asthma and Immunology had their annual meeting in Boston. The Academy estimates that 40 to 50 million Americans suffer from asthma or allergic diseases. Asthma rates alone have more than tripled in 25 years, now affecting 22 million people. A recent article USA Today article titled, “Allergies triggered by ‘things we love’ are rising,” suggests that pets may be having an increased effect on out allergies. It is estimated that 90% of homes have significant levels of dog and cat hair – even in those homes that don’t have a pet! How can that be? Pet dander is easily transfered from pet owner’s clothing to other places they visit. Studies done in Scandinavia and here in the USA have shown that school children without pets still had a measurable amount of pet dander in their home, transferred to them at school from classmates with pets at home.

Allergists that see patients with allergies and asthma caused by their family pet typically recommend removing the pet from the home – this is sensible, but sometimes emotionally very difficult. Dr. Dana Wallace, the president of the American Academy of Allergy, Asthma and Immunology admits that, “in 30 years of practice, I can count on one hand the number who have willingly given up a pet.” I can confirm her experience, but I disagree with Dr. Wallace, who says that allergy shots are the only alternative. I typically see patients that either have a cat or dog that one of the family members is allergic to, or I see patients that are in a relationship with someone that has a pet that is causing tension. For these patients, I feel comfortable offering them the choice of sublingual allergy immunotherapy, more commonly known as Allergy drops. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I describe how children and adults can reverse their allergies by using allergy drops safely at home. A study published in the journal Allergy in 2007 by Alvarez-Cuesta showed how sublingual immunotherapy to cat dander extract reduced nose, eye, and asthma symptoms.

A man in his 30′s once came to see me because his fiancée had 3 cats and every time he went to her apartment he started wheezing and needed to use an inhaler to control his symptoms. His fiancée was also a patient of mine and I knew that it would be difficult for her to give up the three cats she had had for some many years. He tested positive for cat allergens, I treated him with allergy drops, and his symptoms abated. The couple got married and now, even with his increased his exposure to cats, his symptoms are minimal and getting better with time. He did the full course of the allergy drops treatment for 3 years and he was able to stop using any medications to control his allergies. Several years went by after he had finished his treatment and, by chance, I ran into him outside my office one day. We exchanged pleasantries and I asked him how he was doing. He responded, “Good and bad.” The bad news was that he and his wife had divorced, but the good news was that he got to keep the cats… “That’s the good news?”, I asked.  He responded, “Yes, now that I’m no longer allergic to them I didn’t want to lose them…”

I can’t always guarantee results, but I have had a lot of nice outcomes like the one I described above!

Cat and dog allergies don’t have to end badly… Allergy drops can help!

CBS News ran a story today about problems children have with food allergies, particularly tree nuts and peanuts, when they go trick-or-treating on Halloween, and how to take precautions against a reaction.

In our NYC Allergy practice, I see a lot of kids with food allergies, but I have not found a case where a child couldn’t participate in this fun Halloween event if some reasonable ground rules are set before the fun of collecting candy begins. The key ground-rule for Halloween is that while all candy can be collected:

• No candy is eaten until the  child comes home
• Parents must carefully go through the Halloween candy and make sure they don’t contain any nuts
• If the candy is home-made or there is no visible label, then the candy goes into the garbage – no arguments there
• If your child is very young — go with them so they are not tempted to “cheat”

Set firm ground rules for collecting the candy

If a family is throwing a Halloween party and they know that some of the children may have food allergies to nuts, a great place to order nut-free candies and desserts is from Divvies, who specialize in nut-free, great tasting treats. I personally met the owner, Laurie, and her son, who were on The Martha Stewart Show last spring when I appeared.

As a NYC and LI allergist, I have seen numerous children with peanut and tree nut allergies. Peanut and tree nut allergies can cause the most explosive type of allergic reaction - anaphylaxis - if an allergic child ingests a particular nut. It is possible, but unusual, for a child to have a severe reaction by simply coming in contact with the allergenic food. It is possible the child may get a rash in the area of contact with the nut allergen, but that usually does not lead to a more severe reaction.

Exciting breakthrough news in food allergies is that there is now a blood test that can measure which proteins in the peanuts and other foods, such as eggs, soy and wheat, that can help determine how severe a specific food reaction is to that food. The peanut test is called component testing and is done at one particular lab in this country called PIRL labs in Michigan. I send my patient’s blood with concerns about unclear severity to these foods and help determine what foods must be avoided and what can more safely be in their diet.

Happy Halloween!

Dean Mitchell, MD

Twenty years ago, I was a fellow in allergy and immunology at the St.Lukes-Roosevelt Hospital, affiliated with Columbia University. When I wasn’t working in the allergy clinic, I “moon-lighted” in the Ambulatory Walk-In Clinic at the hospital for extra money. I’ll never forget the time that I treated several patients for high fevers and found myself, several days later, with the same high fever and a couch that lasted 3 weeks. I barely dragged myself to work! After that, I vowed never to make the mistake again of not getting my flu shot. Over 2 years ago, I also had the misfortune of getting the “Swine-flu” in June, right before I was to have ankle surgery. That caught me off-guard; it wasn’t flu season. In either case, good nutrition and proper vaccination is your best defense. I especially implore my asthmatic patients, anyone with an immune condition, and the elderly to get their flu shot!

Yesterday’s USA Today helped de-bunk the 4 myths why people sometimes avoid a flu shot:

1. The flu is just a bad cold: Wrong! The flu kills up to 49,000 people a year! 200,000 are hospitalized, according to the CDC. If you have a high fever and generalized body aches get tested immediately for the Influenza virus by your doctor – they can do an instant nasal smear and decide if you need anti-viral medication.

2. The flu shot causes the flu: Wrong again! The injectable flu shot is treated so it’s not live and can’t transmit the flu to you. The nasal mist has a weakened live virus given to teenagers and adults under 55 without certain contraindications – on occasion, this can cause a runny nose.

3. Only sick people need a flu shot:  Not true. Any person that is around a lot of other people can contract the flu and spread it to co-workers, family members, or fellow subway or bus riders. “Healthy” people tend to try and fight through an infection, but in the case of the flu you are just adding to your misery, and possibly spreading that misery to others.

4. Flu shots contain Mercury: Partially wrong, partially true. The single dose flu injections that we give in our office at Ocean Allergy and Asthma are thimerosal, preservative free. The FluMist nasal spray given by many pediatricians is also without thimerosal. Only the flu injections from multi-dose vials – check your with your pharmacist if you get your flu shot there – can contain thimerosal but it has not been linked to any specific disease.

Please don’t be one  of the 42% of consumers surveyed that they plan to skip the flu shot – there are some things in medicine we get right, and getting a flu shot is one of them.

I’ve noticed that everyone lately is complaining about Mosquito bites. It seems Hurricane Irene brought with her more than just damaging floods. The excess water everywhere is a breeding ground for mosquitoes. Normally, mosquitoes wouldn’t be a major topic of discussion, but with West Nile virus being reported in our area, and some unusually severe reactions that I have seen in my New York city allergy practice, I think it’s worth being aware of some facts:

1. Mosquitoes come out more in the evening, so if you are taking an after dinner stroll wear long sleeve shirts, pants and socks—don’t give the mosquitoes much skin exposure. Using citronella candles or mosquito coils can help a little to repel the insects.

2. If you are going into a grassy outdoor area like a park, be sure to use insect repellent. The most proven effective repellent is DEET in concentrations of 10-30% and can be used safely in children older than 2 months.

What to use and not use:

If you get some very itchy bites Don’t use Benedryl spray or cream! You are much better off using over-the-counter cortisone cream and applying ice to the area so there is less swelling. You can take an oral antihistamine like Claritin, Allegra or Zyrtec to decrease the itching, and even Ibuprofen (Advil or Motrin) can stop some of the swelling and itching.

Another over-the-counter remedy is to use After Bite. If you use it immediately, it greatly reduces itching and swelling.

Reactions can sometimes be severe

There is allergy testing for Mosquitoes, but it is rarely necessary because most bites aren’t severe and resolve with the above treatments. However, this past year I had 2 cases of severe allergic reactions to mosquito bites. One was in a small child, his mother brought in photos how severe the swelling was in the boy’s leg after the mosquito bite. He couldn’t walk for a few days afterwards. Another strong reaction occurred in a college student who was bitten behind her knee. Her knee swelled up so much she also had difficulty walking. In both of these cases, if I had spoken to the patient early enough (they were both new patients I had not yet seen) I would have prescribed oral prednisone to make sure the swelling didn’t become severe enough to cause inflammation in the deeper tissue. If someone’s job put them in increased exposure to mosquito bites and these kind of reactions, I would consider desensitization with mosquito extract.

And lastly, if you do get several mosquito bites and develop a fever, Call your doctor immediately to be tested for West Nile virus!

The good news: Fall is on the way and the mosquitoes will be leaving town soon!

Dean Mitchell,M.D.

The Allergy Detective

Mold is a type of fungus that grows wherever water and moisture is present along with warm temperatures. As an allergist in New York and Long Island, I have seen many patients over the years suffer from medical problems related to chronic mold exposure. The type of problems range from:

• Respiratory symptoms such as coughing, wheezing or shortness of breath
• Common nasal symptoms such as sinus pressure or pain
• Headaches
• Fatigue

In some cases I’ve seen patients develop rashes from airborne mold. Mold can be very dangerous for a person that is immune compromised, such as after a round of chemotherapy when a patient’s white blood cell count may be low. Mold can be invasive, get into the bloodstream and cause a deadly infection. More commonly, in patients with allergies, mold causes the symptoms described above, along with fatigue.

The most common molds are Alternaria, Cladysporium, Penicillium (similar but not the same as Penicillin) and Aspergillus. As an allergist, I can test for these molds through skin or blood tests to see if a person is allergic. In my experience, mold allergies are sometimes difficult to treat with just antihistamines. My best results seem to occur in patients treated with sublingual allergy immunotherapy (allergy drops). Sublingual allergy immunotherapy builds a person’s natural resistance to specific molds and can usually decrease a persons need for medications.

Meanwhile, I hope all of you are safe back in your own home, and that the electricity is working! The best thing you can do to prevent molds from growing is to clear out the water, use dehumidifiers to suck out the moisture in the air, and check for any unusual green or black spots where water damage occurred.

Dean Mitchell, M.D.

The Allergy Detective

Today, there are many antibiotics that can be used by a physician to treat infections anywhere in the body, in contrast to 50 years ago when Sulphur compounds and Penicillin were the only game in town. Penicillin was so valuable that in the early days of its use in hospitals, the doctors would collect the urine of patients given Penicillin and boil it down to extract the Penicillin and use it for other patients—it sounds horrific, but it did save lives. We are in a much better place today with antibiotics widely available in our country and many choices. However, the new antibiotics are very powerful – sometimes too powerful – and have side effects that are not widely known.

With Quinolones for example, you may recognize the names Cipro or Levaquin, which are new, potent antibiotics that treat a wide array of infections. A side effect not commonly appreciated is that these antibiotics have an enzyme that can cause tears in your tendons. Podiatrists and Orthopedic surgeons are acutely aware of the Quinolones causing these problems – especially Achilles tendon rupture. Another common antibiotic, Zithromax is good for mild respiratory infections, but it doesn’t kill bacteria (the medical term is bacteriocidal) it just slows it down (bacteriostatic). Zithromax is not good enough against the bacteria called anaerobes – the type found in your mouth and gut. Penicillin, as I learned in medical school, has the special properties of killing bacteria’s cell wall and thoroughly clearing an infection. In truth, when Penicillin was used for many years some resistence developed to its use and derivatives of Penicillin were made to add to its potency. The medications like Amoxacillin, Ampicillin and Cephalosphorins took over the place of just giving the original. These medications work very well and have a long history of safe use. If someone is allergic to Penicillin they also may be allergic to these medications, but again allergy testing will help determine if these are safe to use.

The question, “Does it matter if I am Allergic to Penicillin?”, the answer is yes. There are many situations where use of antibiotics are needed prophylactically (before the surgical procedure) and penicillin is still one of the best choices. For example, a patient that has a heart murmur should be treated with antibiotics before dental surgery. The bacteria in the mouth can enter the bloodstream and if heavy enough can lodge on a heart valve that is compromised – this causes a condition called Endocarditis which can be fatal. Another common situation is anyone that has “hardware” in their body – artificial hips, knees, etc. These replacement parts can become infected after a “dirty” procedure like dental work or surgery in another location involving the bowel. Penicillin and Cephalosporins are excellent antibiotic coverage to keep the bloodstream clean.

There is an appropriate place for some of the new antibiotics that are very powerful – especially in the hospital where bacterial resistant infections are more common. However, good ol’ Penicillin still has its place in the doctor’s black bag (I still have one) and knowing if you are allergic can make a difference in your care. Contact one of our allergists of New York today for more information or to be tested.

Here are a few key points:

• Sunscreen products that pass FDA’s test for protection against UVA/UVB rays will be labeled as Broad Spectrum.
• Products with SPF values of 15 or higher may state they reduce the risk of skin cancer and early skin aging when used with other sun protection measures, and when used as directed.
• Products with SPF values between 2 and 14 may be labeled as Broad Spectrum if they meet the requirements, but can only say they help prevent sunburn.
• Sunscreen products that do not meet the Broad Spectrum guidelines, or have an SPF of 2 to 14 must include a warning that the product has not been shown to help prevent skin cancer or early skin aging.
• The terms waterproof, sweat-proof and sunblock are not permitted on packaging.
• Labels may state a sunscreen product is water-resistant, but it must include the amount of time before reapplication (40 or 80 minutes).
• All sunscreens must have a Drug Facts section on the back and/or side of the package that includes Active Ingredients and Use Claims.

These changes will take place over the next 12 months, and you can call the FDA (800) 299-4786 for more info.

Generally, an SPF rating over 30 will block 97% of UVB radiation. However, UVA  radiation, which is not currently labeled in sunscreens, may be the reason for the increase in skin cancers, especially melanoma. Prolonged exposure to the sun, even if the person doesn’t burn, can still cause photo damage to the skin that has lasting consequences. The new Food and Drug Administration guidelines will take into account the sunscreen’s ability to protect against UVA radiation.

Sunscreen allergies and the effect of medications

Many patients come to my office because they developed a severe rash after being in the sun. Some patients develop a rash or itching almost immediately after even a few minutes of sun exposure. My job as a NYC Allergist is to determine if the patient has a sunscreen allergy to chemicals in the product, such as PABA, or if the patient has an underlying medical problem that is causing a photo-sensitive reaction. In some cases a patient may be taking a common medication that can be causing a photosensitive reaction. You would be surprised at some of the medications on that list: non-steroidal anti-inflammatory drugs like Motrin or Advil, thiazide diuretics used in many blood pressure pills and even antibiotics, such as tetracycline and ciprofloxacin have been associated with severe reactions.

Additionally, certain foods, if handled in the sun, can cause a contact photosensitivity. This happened to me several years ago: I was on vacation in Florida and it was very hot. I was drinking bottled water and squeezing lemons in the water for flavor. A few days later I came back to New York and I discovered this creeping red rash on my right forearm. It was strange – it didn’t itch but it looked terrible. Despite being an NYC Allergy Doctor, I sought out another medical professional who astutely figured out that the rash was do to my using the lemons in the sun. Lemons contain psoralen and this natural photosensitizing chemical can cause ugly rashes. This can also occur with celery, so watch out if you are drinking those Bloody Marys at the beach!

The Effect of Perfume

Another area of contact photosensitivity can be from perfumes or colognes. These products can contain parabens and other chemicals that when exposed to sunlight cause rashes. I would strongly advise against putting anything but sunscreen on your skin when going into the sun for several hours. Unfortunately, the sunscreen itself can be another culprit for a photosensitive reaction. The higher the SPF the more likely the more chemicals in the sunscreen. The common chemicals that can cause allergic reactions are: PABA, oxybenzone and cinnoxate. In my opinion, the ideal sunscreen with the least allergic potential and the best sun protection are products containing only zinc and titanium dioxide. Many companies make skin tone products with zinc and titanium dioxide and they can match your skin color. My key caveat is to wear old clothing when you use this sunblock because it is messy and I have stained many white shorts with tan-colored sunblock.

Detective work

My final job as the Allergy Detective is to make sure my patients don’t have an underlying medical problem that is making them sun-sensitive. These conditions may include vitamin deficiencies, such B6, which can cause skin rashes. Certain liver diseases allow for the accumulation of toxins in the blood and these will be more pronounced after sun exposure.  Auto-immune conditions should be checked in anyone with chronic rashes after even mild sun exposure.

The good news is that some sun exposure can be a good thing. Vitamin D deficient patients are recommended to get 20 minutes of sun on their arms and legs without sunscreen to boost their levels of this important vitamin.

I wish you all a wonderful, fun and rash free summer!

The Allergy Detective

The thyroid is  an internal organ that has been linked to chronic hives. It’s not well understood, but when the thyroid is over or under active the dysfunction can manifest itself with skin rashes, such as hives. I order special antibody tests for the thyroid to determine if there is a connection between the hives and the thyroid. If the tests are positive, I will then order a thyroid Ultrasound to see if any nodules are present. This a simple, painless test that only takes a few minutes, but offers clues to the condition.

I read some interesting reports linking Celiac Disease and chronic urticaria. I have seen several Celiac disease cases in my career as an allergist. Patients present with stomach problems and think it is a food allergy. Instead, after careful testing, I discover there are no specific food allergies, but the patient have an immune reaction to gluten products. Celiac disease today is even more common than we realize: 1 in 300 people suffer with this condition. The most deceptive part of this disease today is that many patients don’t have any gastrointestinal symptoms, and instead present with sinus disease, arthritis, anemia and rashes. I am an avid tennis fan, and I suspect Novak Djokovitz, the number 2 player in the world, may have Celiac disease. He mentioned in  Sports Illustrated that he now eats a gluten-free diet and feels his energy is much better. The gluten-free diet is not an easy diet to follow in our society, but there are many supermarkets that now have an array of gluten-free products which offer many new options.

Going back to the flat, red rashes,  good allergy medical detective work is needed. I recently treated a patient with severe redness on his face and all over his hands. Allergy Patch testing (without needles) was done and revealed he was allergic to his hair dye. Another patient developed a painful rash on her legs. A painful rash is usually not allergic – it turns out she had a cellulitis (an infection with bacteria of the skin).

The summer is upon us – with a lot more skin exposure. My advice to all: get 45 minutes of sun exposure to raise your Vitamin D levels, wear sunscreen after that and especially on your face. If you do get a rash which persists more than a day or two, make sure to see a physician.

USA Today, using data collected from Quest Diagnostics, reported the worst cities for ragweed pollen (the late summer pollen usually referred to as “hay fever”) are:

1. Phoenix

2. Las Vegas

3. Kansas City

4. Riverside, CA

5. Dallas

6. Chicago

7. Sacramento

8. Philadelphia

9. Denver

10. Washington and Minneapolis (tie)

The report published in AllergyCapitals 2011, in cooperation with the Asthma and Allergy Foundation of America, had a very different list:

1. Knoxville

2. Louisville

3. Charlotte

4. Jackson

5. Chattanooga

6. Birmingham

7. Dayton

8. Richmond

9. McAllen, TX

10. Madison, WI

Clearly these reports are not compatible. This is easily explained by the different ways they assessed being allergic. The USA Today report measured the results of allergy blood tests that were reported positive. This requires careful insight: to have the blood tests the patients had to see a doctor to order the tests, and it’s assumed because these tests were positive these individuals had allergies – this is not always correct. They did notice over the 4 year study that Sensitization (antibodies showing allergic potential) did increase 5.8% during the study period. Again, the drawback of this study is that patients had to have the finances to see a doctor and have the blood testing done. I think that many patients with allergies unfortunately have never even see a doctor and rely on over-the-counter medicines.

AllergyCapitals 2011 took a different approach: They did measure the pollen counts in the different cities (very important), and measured prescription medication use, another important variable. But of course many allergy meds don’t need a prescription anymore, and the number of Board Certified Allergists in the populated area. I tend to give more credence to this report because of the multiple factors evaluated, compared to the 1st report which just used blood studies.

Interestingly, the USA Today report seems to be dominated by Western cities and the AllergyCapitals 2011 report seems to favor the Southeast. The Southeast, with its longer periods of hot, humid weather is a prime breeding ground for heavy pollen and mold counts, and is more likely to have more allergens. I have had patients fly up to see me in my office from Washington to Chattanooga who have found this year’s allergy season unbearable.

The local good news: in the realm of allergies NYC ranked 23rd! I don’t know how much relief that gives to many patients I saw this past month with severe allergies from tree pollen. The most challenging place to live with allergies is wherever you are and the pollen is making you miserable. The best advice I can give you is as an allergy doctor in NY: find out what specific pollens you are allergic to and get treated ahead of the season! Contact us today for an evaluation.

Dean Mitchell, M.D.

“The Allergy Detective”

Transfusion reactions are rare, and are usually avoided with careful screening of ABO blood compatibility. The mother made the keen observation that the only time her son had a similar reaction was at age 1 when he ate some peanuts, and the family had since been very careful to avoid any peanut ingestion by their son. The physicians were astute in locating the multiple blood donors of the platelets (blood clotting  particles) in this case.

With careful questioning the donors did recall eating peanuts the night before they gave their blood! How could this affect the young boy with Leukemia? It turns out peanut proteins can stay in the blood for 24 hours after ingested. The blood donated by these individuals was measured and found to have circulating peanut proteins. The young boy’s blood was tested and showed he had high levels of IgE (the allergy) antibody to peanut protein. This is the first time a reaction like this has ever been reported and linked to a food allergen.

The take home message: Peanut allergy is clearly on the rise, and to anyone generous enough to donate blood to help save another person, please avoid eating peanuts for at least a week before the donation.

As an NY allergist, I know that peanut allergic parents don’t need one more thing to worry about, but I think this information is useful and if there is a concern, they may want to ask donors, family and friends if they have avoided peanuts before donating blood. Contact us with any questions you may have, or to have a food allergy treatment in NY.

Now a company, Pure Solutions, is doing something about this problem. I called the CEO, Brian Brault, because I wanted to find out what their company was doing that protected allergy sufferers from the common airborne allergens encountered in many hotel rooms. These are the steps his company takes to make the air in hotel rooms more amenable to allergy patients.

• Tea tree oil enzyme tablets are placed on the coils of the beds to prevent bacterial build up
• Ozone treatments are done in the rooms to remove viruses and bacteria
• A air quality check is done to make sure once the room is treated there is no ozone detected in the air.
• Air Purifies are installed to circulate and clean the air of over 90% of mold and viruses.

The bottom line: the Pure Rooms have 90% less particle counts than comparable hotel rooms. This is impressive.. even to an allergy doctor of NY. Inside the rooms, they use fragrance and chemical free products certified by Green Seal. They also have fragrance-free soaps, shampoos and lotions on request. At this point, you are probably thinking, why don’t hotels do this to all the rooms – the answer, cost. However, the cost to the consumer is not exorbitant. for an extra twenty-five dollars you can get a hypoallergenic room, and hopefully sleep with more confidence and more comfortably. There are now 5,000 rooms in 200 hotels worldwide including the Hyatt, Hilton and several other chain hotels.

Next on my wish list: Allergy Safe Airplanes. I’ll have to talk to Mr. Brault if they can expand into this market.

So, if you are concerned about the hygiene in your room, ask if they have Pure rooms available.

The other cause for oral itching in the spring for tree pollen allergy sufferers can be foods. There are several fruits and nuts that cross-react with specific tree pollen and by eating these fruits you can worsen the oral itching. The foods that cross-react with Birch pollen include: apples, cherries, kiwi, soybean products, almonds, carrots and celery. These foods when consumed raw can trigger the intense oral itching. I have some patients that can’t even peel an apple or carrots during this time of year. Interestingly, many of these foods can be consumed if they are cooked, so you can have your apple pie for dessert. There are now special tests that can be done to differentiate these milder food allergies from the serious food allergies that can cause anaphylaxis (allergic shock). As an NY allergist,  I use Component Testing which is the newest and most specific blood testing to evaluate the proteins causing the food allergy.

My patient’s rightfully complain: “This is unfair – I love these fruits and vegetables and they are supposed to be healthy for you, right?” It is unfair, but the good news is that they are not the severe type of food allergy in most cases. For now, I can use the allergy drops (sublingual allergy immunotherapy) to desensitize patients to the tree pollen allergy and make their eyes, nose and chest symptoms less severe. I believe this has a big advantage over allergy shots, in which the doses have to be decreased in the season to avoid an allergic reaction from the allergy shots themselves. I have been pleased so far this season that my patients that are on maintenance levels of allergy drops have had much less intense symptoms than the new patients I’m seeing these past few weeks.

If food allergy treatment in NY is something you’re considering, be assured that our experts are there to help.

Fight back! Photo from LHJ

I just picked up the May issue of Ladies Home Journal off the newsstand. The title of the article on page 152: Allergies Suck! The picture shows a woman vacuuming in a bright orange Hazmat suit…

My response: Fight back with proper treatment!

The writer, Laurie Tarkin, interviewed me a few weeks before about why so many people suffer with allergies despite all the readily available over-the-counter treatments. My gut reaction: allergy sufferers that take medications like Claritin, Allergra or Zyrtec can expect mild to moderate relief, but finding the cause of your allergies is the key to staying healthier and being symptom-free. The only way to find this out is to get tested!

Testing is not as onerous as it used to be. In our office, we typically do a simple blood test called the ImmunoCap and send it to the lab. Usually within a week or two we get the results and I can advise my patient as to the specific allergens that may be causing symptoms. If the blood test doesn’t show a clear cut answer, we can do painless prick tests (similar to a plastic tooth pick) to get additional information. This time of year the tree pollen is on the rise and I’m seeing new patients who have nasal congestion, eye itching and throat itching. By the time May rolls around both the tree and the grass pollen are packing a one-two punch making allergy sufferers miserable.

The article quotes myself and several other prominent allergists: Linda Cox, Gary Rachelefsky and Mark Dyskewicz, and discusses the range of symptoms that a patient with allergies can have. Surprisingly, not all allergy symptoms are the classic ones, such as sneezing and runny nose, itchy eyes and asthma. Symptoms that sometimes get overlooked are: headaches, sinus pressure and, more recently, stomach pains. Allergy patients are 14 times more likely to have migraines.

My interview focused on one of my patients who was having a combination of stomach pains and throat tightening. She saw a gastroenterologist who diagnosed that her stomach pain wasn’t the typical acid reflux, but the acid was due to allergy cells called eosinophils. The eosinophils are activated by airborne or food allergies. A food allergy can cause an acute severe reaction, such as difficulty breathing or a dangerous drop in blood pressure. However, a relatively new condition called Eosinophilic esophagitis or gastritis, has been found to cause acid reflux that doesn’t respond well to even the strongest acid blockers.

The key allergy testing and treatment for some of these patients is to test them for food allergies and if a positive test is found, try and eliminate this food from the diet. In this case, it was interesting that my patient was worried that she had Celiac disease, a condition where you are immunologically intolerant  to wheat. My testing showed that she wasn’t allergic to wheat, but to barley, which is used in many wraps and sandwiches today. She was also allergic to mustard which surprised both of us. Her symptoms have improved greatly since she has avoided these foods.

Fortunately, as an allergist in NYC, I have yet to recommend a Hazmat suit for any of my patients. I have a better weapon for the outdoor and indoor allergens – Allergy drops. The last page of the article mentions: Try The New Drops. Although it mentions only 6% of the allergy doctors are prescribing it, I have been doing it for 13 years and have seen incredible results. If you want to read further about allergy drops, you can find my book: Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006) on Amazon.com or through Barnes and Noble’s e-reader.

If you see anyone walking around New York on a sunny, spring day when the pollen is high, and they are wearing a bright, orange Hazmut suit – I know you won’t find my business card in their pocket.

There may be a brighter future for peanut allergy sufferers

I received my allergy medical journal a little late this month, but it has a special surprise: a great article showing that sublingual allergy drops can protect children from peanut allergy. This is major headline news, and yet I didn’t hear anything in the lay press newspapers about this exciting breakthrough. Sublingual allergy drops have been successfully done for hazelnut and kiwi, but to protect against peanut allergy is a tremendous accomplishment.

The article appears in The Journal of Allergy and Clinical Immunology, March 2011. The research was conducted at Duke’s Department of Pediatric Allergy and at the Food Allergy Center at Massachusetts General Hospital- two highly reputable centers. The study was done on 18 children, ages 1 to 11, who had a diagnosed peanut allergy. It was a double-blind placebo controlled study — the highest quality. 11 children received sublingual allergy drops and the other 7 children received placebo drops. The study had a 6 month build-up phase and a 6 month maintenance phase.

The key results: the group treated with the peanut allergy drops were able to ingest 20 times more peanuts (equivalent to 6-7 peanuts) than the control group (who tolerated less than 1 peanut at the end of the year study). The exciting part to me as a physician is that not only was the desensitization successful, but in the process of the treatment no patients required epinephrine (adrenalin) to reverse a severe allergic reactions — indicating the treatment can be done safely!

Unfortunately, I don’t think the treatment will be available in the next few months, but I would hope in the next year or two this treatment will be approved and available to help protect all those children and adults who fear an anaphylactic (severe allergic) reaction to ingesting peanuts. I wrote in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, that I hoped in the future sublingual allergy drops would make a difference in reversing food allergy—The time has come sooner than I expected.

Meanwhile, if you suspect your child or you have a peanut or other food allergy, it is imperative to get tested and know the emergency treatments available. Contact us today for an evaluation.

Dr Mitchell on Martha Stewart—click here to view the video

Two weeks ago I was in a whirlwind of activity. My office was moving to its new location on 57 West 57th street and I was contacted by The Martha Stewart Show to come and discuss the problem of indoor allergens. I was excited at the opportunity to be on the show, however with the move and all that it entails, I wasn’t sure if I was juggling to many balls in the air.

I was impressed that Barbara, the producer at The Martha Stewart Show, was very intent on the quality of the material being interesting and factual – no hype -  just the real deal. She spent the entire week getting me ready with my material and her assistant Sara was busy tracking down good pictures to use for the television audience. The preparation for the show was a good review for me: I worked with Allergy Control Products, a company that specializes in products for the home to decrease indoor allergens. All the facts mentioned on the show to reduce dust mites are well-documented in the medical literature: use of encasements for mattress and pillow covers, using HEPA vacuum cleaners and keeping humidity in the home under 50%. The Martha Stewart line of bedding : Allergy Wise bedding at Macy’s was new to me, but it was made from comfortable materials and hypoallergenic synthetic fabrics – and affordably priced.

I was excited that the show started with a zoom in of my book, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006).  Then I was sitting next to Martha – live on the air getting ready to take her questions. I will admit I was nervous for a half-hour before I was to go on the air, but I was lucky that the guests for the day - Joan and Melissa Rivers - got me laughing minutes before I went on the air.

Joan took a question from a young female audience member just before I was to go on. The question was from a 20 year old female: “Mrs. Rivers, if you were my age, what would you recommend I do with my life? Joans answer: “Honey, my advice is to get married, make sure he’s rich – and very old and in need of a a pacemaker.”  Joan Rivers, like Don Rickles, is still on top of her game.

Finally, the spotlight was on me and I knew I had to remember all the facts floating in my head. Martha asked me “Why are allergies are so common today?” My answer was the same as I wrote in an earlier blog: New studies are confirming that city children are more likely than rural children to develop allergies. The findings are pointing to the early exposure to bacteria found on farms with animals that strengthen a child’s immunity to allergies and asthma. The key seems to be exposure in the first year in life, when the immune system is very influenced by external surroundings. A prior study showed similarly that children exposed to dogs in the first year of life were less likely to develop animal allergies to dogs.

Joan Rivers—still on top of her game

When I was in the dressing room I had the pleasure to meet Lori Sandler and her son Benjamin. Lori is the owner and founder of Divvies, a company that makes desserts and other treats for allergic children and adults. I spoke with Lori and said there is a great need for these products. I’ve seen so many parents try hard to make sure their child with a peanut or a tree nut allergy finds desirable and safe treats for birthday parties and other events. Even an everyday chocolate bar can be dangerous to some of these children if contaminated at the processing plant with nuts.

Well, my fifteen minutes of fame (actually it was nine minutes) is over, and I’m glad to be back at my regular job as an NYC allergist helping my patients with allergies and asthma.

Our new Manhattan, NYC address, starting on Tuesday, March 8th

57 West 57^th St
Suite 601
NYC NY 10019

But don’t think for a minute that farm life is all that easy. The take home message from the European researchers who conducted this study was that while growing up on farms, children were exposed to multiple different bacteria and fungi (molds) that actually stimulated their immune system in a good way to prevent later development of asthma. This news is not actually new: in my book, Dr. Dean Mitchell’s Allergy Solution (Marlowe 2006), I have a chapter devoted to, ” Why Allergies are so Prevalent Today”.

The best explanation for the lower incidence of asthma and allergies in rural and 3rd world countries vs. urban and Western countries is called ” The Hygiene Hypothesis“.  The Hygiene Hypothesis makes the case that our  ”cleaner”, more antiseptic environment makes the immune system tilt in favor of  developing allergic inflammation. The hypothesis attributes vaccines, antibiotics and our diets to causing allergic diseases. There has been great discourse as to whether frequent use of antibiotics and multiple vaccines are more harmful than beneficial to infants – and the debate will probably not be answered for quite some time. Meanwhile, what can we do to prevent childhood asthma, which has doubled in the past 30 years?

My answer for those of us who are not ready to ” buy the farm”, is to go back to nature. We are all in agreement that processed foods are not as healthy for us as fresh grown foods. This is common sense. The same thing applies to the air our infants breathe. Even an infant is much better off getting several hours a day of fresh air at a park or schoolyard than being stuck indoors watching videos and breathing in forced air – hot or cold – and breathing in dust mites from the carpeting. The studies continually show that in the first year of life, an infant’s immune system is highly influenced by its environment. I have read several studies by asthma doctors showing that an infant exposed to a cat or dog in their first year of life was less likely to become allergic to these animals.

Well, we can’t turn back time, but we still have some good options. For future parents with a history of allergies or asthma, make sure your infant gets lots of fresh air and exposure to animals – take him frequently to a petting zoo. For the grown-ups, the other good option is sublingual allergy immunotherapy  (allergy drops). I have been able to help so many patients with nasal, eye  allergies and asthma by using the home program of allergy drops and restore the immune balance…that not growing up on a farm lacks.

Oh, one last thing: our new NC office at 57 West 57th street and the corner of 6th avenue is just 2 blocks from Central Park – in the nice weather I expect to see all of you getting some fresh air on your way to the office.

1) use a scarf to cover your mouth when outside: breathing in cold air through your mouth can immediately trigger an asthma attack; your nose is supposed to be doing the breathing , because it warms and humidifies the air before it gets to your lungs.

2) if  you are going to be walking outside many blocks or for an extended time use your inhaler at least an hour before you go outside to open the airways and give you extra protection.

3) Make sure you know how to use your inhaler (s) correctly.

My nurse, Mildred, is an avid sports fan. She was watching the Australian Tennis Open on TV, and she happen to see Venus Williams struggling to breathe. She saw Venus use an asthma inhaler on the change-over to help her breathing. However, Mildred, who has worked with me for many years and knows how to use an asthma inhaler correctly, quickly told me: she was shocked that Venus Williams appeared to be using her asthma inhaler incorrectly! Venus is not alone. I frequently see patients that have asthma, who before coming to my office were never shown the correct way to use an inhaler. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006), a chapter called, ” The Asthma Action Plan“, discusses and illustrates the correct way to use an asthma inhaler.

“The Asthma Action Plan” shows you the proper technique and strongly encourages anyone using a rescue inhaler, like Ventolin or ProAir, to use a spacer device. A spacer device is essentially a holding chamber so that the aerosolized medicated particles can be inhaled deeply into the small air tubules where the spasm is taking place. There are studies that show a spacer device is as good or even better than the nebulizer machine many asthma patients rely on. I also discuss in this chapter the common mistakes patients make when using their inhalers. One important tip: Wait a few minutes if possible between puffs of your inhaler. Many patients rush to get it done. By waiting a few minutes (2-3) between puffs, you are allowing the larger bronchioles to more fully open, and then the 2nd puff can go deeper to open the small bronchi where the blockage is occurring.

In the meantime, Stay Warm! Spring is only a month away.

I just read a great article in The New Yorker magazine by one of my favorite science writers, Dr. Jerome Groopman. The February 7th issue, is titled: The Peanut Puzzle. The article discusses what has baffled Food Allergy researchers for the past twenty years: Why are food allergies, particularly peanut allergies, on the rise when more and more mothers aware of this problem are taking specific precautions to try and decrease the risk that their child will have a food allergy? For years, mothers were told to breast feed their child, and avoid peanuts during pregnancy and breast feeding. None of this now seems to make a difference. And in fact, in the future the opposite advice might be given. Why?

The first theory  – Play with dirt

There are a few interesting and plausible theories now circulating that may explain this conundrum: First, The Hygiene Hypothesis, which I discuss in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006). The hypothesis makes the case that with advances in medical practice, such as vaccinations and increased use of antibiotics in the first year or two of an infant’s life, that we are re-directing the immune system away from the infection fighting mode and resetting it to battle against allergies. Their data shows that children growing up on farms, surrounded by dirt and animal manure, seemed to have less allergies. It was part of the “play with dirt” theory of exposing children to certain endotoxins that may actually strengthen the immune system.

The second theory – The sunshine vitamin

The 2nd and newer theory revolves around the “Sunshine Vitamin”, Vitamin D. Researchers are finding that geographical areas – typically in the U.S. below Atlanta on the east coast and out west in Arizona and Southern California that allergies are less prevalent. Studies have shown that Epinephrine, the injectable medication for a severe allergy attack, (anaphylaxis) is more commonly written in these areas of the country. Vitamin D is also being found to help decrease allergic dermatitis, specifically atopic dermatitis (eczema) because it blocks certain proteins in the skin that cause the inflammation. I am now routinely recommending Vitamin D to my patients with eczema.

The third theory – Give babies peanuts

The 3rd and final new theory is fascinating because it goes against everything we think is logical. An infant at risk for food allergies, specifically peanut allergy, should be given peanuts early in life. Dr. Gideon Lack, a pediatric allergist at St. Mary’s Hospital in London, has published letters in British medical journals drawing attention to the disparity between peanut allergy in the U.K. and U.S.A vs. Israel. He found that the risk in the U.K. among Jewish children was 11X higher than the Jewish children in Israel – this was astonishing. I know families in my New York practice that have children with peanut allergy and have cousins in Israel without any food allergies. One interesting, but not proven theory, is that Israeli infants are given Bamba, a peanut concoction early in life, which may cause the immune system to build an early tolerance from the exposure.

Hopefully, over the next few years we physicians will better understand the causes of peanut and other food allergies. In the meantime, our best options are careful avoidance through education, being prepared with an EpiPen and awaiting new desensitization treatments.

I read a disturbing story in Newsday last week about a teenage boy playing basketball in Long Beach, N.Y. (my hometown) who collapsed and died while playing a basketball game with his friends. The details are scant at this time as to the exact cause of death, but he did have a known history of asthma. The article said that he had been diagnosed with asthma in the past, but wasn’t on any current medications because he hadn’t had an asthma attack in a while. It is unusual for a teenager or adult to get a sudden asthma attack without some prodrome (early warning signs) such as shortness of breath, wheezing, or constant coughing, unless it’s from a food allergy, which triggers anaphylaxis (the most dangerous type of food allergic reaction).

Keep your inhaler fresh and ready

As a NYC asthma doctor, my main concern in this case is to remind all patients with a history of asthma to carry an updated rescue inhaler, like Ventolin or ProAir, to have on hand if you develop any acute symptoms that may be related to asthma. I often find a patient who is doing well is doing well has an inhaler that is expired. Asthma can be brought on by many factors: cold air (like the frigid weather we have now), exercise (it may happen a few minutes or even an hour after finishing a vigorous workout), emotions (nothing like a nasty argument to cause tension and bronchospasm), and of course, air-borne allergies like cat or dog dander, dust, mold or pollen (in the spring or fall). Periodic checkups to measure your breathing status with a peak flow meter or a spirometry (lung function test in the office) is good way to keep tabs on how strong your breathing really is.

Rethinking a diagnosis

The other important point in cases like this is for the physician who takes care of any patient diagnosed with asthma to occasionally re-think the diagnosis. I discuss this in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006) that other conditions can masquerade as asthma, and require a totally different treatment. In young teens or adults, a condition called Hypertrophic Cardiomyopathy can exist that can cause episodes of shortness of breath, because the heart is too thick and can cause irregular heart beats and rhythms. This can lead to fatal arrythmias (irregular heart rhythms). A doctor needs a high suspicion because a heart murmur is not always heard, and an ECHO cardiogram is needed to help make the diagnosis. As a New York Asthma Specialist, I use a detailed history to guide me whether a person’s asthma is authentic. I also find allergy tests help support the diagnosis of asthma, since 70% of asthmatics tend to have a positive allergy test.

The key is with a proper diagnosis and proper education on which inhalers to use and when to use them, any patient with asthma should feel confident to reverse and control his symptoms.

Do antibiotics make allergy symptoms worse?

Antibiotics and Asthma

There is a growing body of literature supporting the concept that the overuse of antibiotics among children is related to the increase in allergic asthma. Frequently, a medical research article seems to contradict everything that is logical about medical care. It is important to not let one or even several articles change your mind about medicines or vitamins.

A New Theory

A theory called “The Hygeine Hypothesis” is mentioned in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe 2006). The gist of The Hygeine Hypothesis is that frequent doses of antibiotics in children can alter the immune system away from fighting infections, and direct the immune system to go in the direction of allergic inflammation.

This can result in a greater incidence of allergic conditions, such as asthma, skin allergies and nasal diseases. In the American Journal of Epidemiology on December 29th, 2010, researchers at the Yale Public School of Health studied 1401 children between the years 2003 and 2007. They found that children with early antibiotic exposure had an increased risk for asthma – even in children where there was no family history of asthma.

The main recommendation of the researchers is a more “judicious use of antibiotics in infants, especially the broader spectrum antibiotics.” This makes sense. Of course, all parents are distraught when their child is sick, especially with ear infections that can be extremely painful. However, in many cases, the cause is viral and the antibiotics are not truly effective. The mainstay is supportive care and careful observation.

This winter many children will experience runny noses, coughing and sometimes more painful sore throats and ear infections. Please see your doctor for a careful examination – don’t just call up and ask for antibiotics, even if you are the patient.

An infection or something else?

And please remember, if your child is constantly coughing, it may not be recurrent infections, but more likely bronchospasm. Bronchospasm is an early sign of asthma and is treated totally different than a cold. In fact, I just had a patient that has asthma and self-treated with an over-the-counter cough medicine for colds and got worse: the medicine had an expectorant component, which actually makes you cough more. This is the worst thing for someone with bronchospasm or asthma. As an Asthma specialist, I devote a whole chapter in my book on the two components of asthma: bronchospasm and inflammation – and how they should be treated.

My last key point, if you or your child has repeated colds or coughing, is to see a specialist. In my office we do allergy testing to make sure a common allergen, such as dust or your pet, is not the cause of your asthma. The good news with allergies is that they are reversible in many cases. There are certain environmental controls that can be applied: air purifiers, encasing mattresses and pillows in hypoallergenic covers… and for those allergic children or adults who suffer, we use allergy drops, instead of shots, to build up your immune system to be more resistant to developing chronic symptoms.

Call us for more information.

Allergy testing can confirm a diagnosis, not make one

They mention that skin prick tests and blood tests can be misleading. I do agree any test can be misinterpreted if the reviewer is not experienced in diagnosing the medical condition in question, and that testing should clarify or confirm a diagnosis - not make a diagnosis. However, I’m also concerned that the report didn’t address issues I mentioned in my prior post on the dangers of not adequately preparing for a serious food allergy.

Making the connection with meals

My experience has been that patients who suspect they have food allergies as the cause of their symptoms need a very careful history: noting when the possible food reaction occurs in relation to meals, what is the exact reaction (skin, respiratory or, most likely, gastrointestinal) and what foods are safe to eat. There are many patients that have food related reactions that can be labeled adverse reactions because they don’t always cause the same problem, but patients who are aware can see a pattern.

The most common food intolerance

The classic food intolerance is lactose intolerance, which is the result of lacking adequate enzymes to digest milk products. This can develop after many years of drinking milk. We can lose the amount of enzyme in our bodies that we once produced. The other classic intolerance is to wheat, but is more serious in those patients with a diagnosis of Celiac disease. This is an autoimmune disease triggered by the ingestion of wheat products. The danger with Celiac disease from patients I have seen is that they don’t always recognize that wheat products like bread are making them sick. They just don’t feel well and many times can be anemic or have rashes or arthritis. There are blood tests available that can help establish the diagnosis. A blood test called anti-tissue transglutaminase IgA and anti-endomyosomal IgA antibodies are the non-invasive tests to ask for.

The most important question you have to ask yourself, or as a parent regarding your child is: does there seem to be a relationship between the symptoms and eating meals. Patients without food allergies have symptoms even when they don’t eat. A food allergy in most cases occurs within minutes or up to an hour after eating the allergic food. I strongly believe that if your symptoms have a temporal relationship to your meals or snacks then  food allergy testing can be beneficial. The studies cite that only a few foods cause most of the food allergies: milk, eggs, peanuts, tree nuts, soy, shellfish and regular fish. In reality, there are many foods that can cause a serious food allergy. I’ve had a patient that is allergic to chocolate- she can’t even go into a room where someone has been eating a chocolate candy bar. I have a patient that is also so allergic to tuna that she couldn’t go into a restaurant because the smell of tuna gave her an asthma attack. These are the real food allergies - and testing and educating my patients how to be prepared to treat a reaction is my job!

Component testing

For serious food allergies, you don’t need to challenge the patient with the food – that could be dangerous. There are new blood tests that measure the specific proteins a person may be allergic to which is helpful in assessing how serious the food allergy is, and if it must be avoided. It’s called Component testing and right now it is the best test to assess the potential danger in a peanut allergic patient. The peanut has 9 different proteins that can be tested, and one of them has been identified with severe peanut reactions called Ara h 2. This test can be specially ordered by your doctor from PIRL labs in Michigan.

The future is promising

The treatment for food allergies right now is frustrating – just avoid eating the food. However, in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I devote a whole chapter to food allergies and mention the different treatments being evaluated in clinical trials now. The future does look promising, but for now, if you think you have a food allergy, please see an allergist. If you have a food allergy, always have your EpiPen on hand.

Be prepared

As a NYC allergist, my concern is two-fold: that children and adults be properly evaluated and diagnosed for a true food allergy, and if they do have a food allergy that they be prepared to treat the unexpected emergency situation. The Food Allergy News (a newsletter from The Food Allergy & Anaphylaxis Network) in December 2010 had a lead article on a survey done at the University of Michigan to try and categorize the scope of the problem of food allergies on its undergraduate student population. Specifically, they were most interested in the food allergy preparedness of the student and the campus health facilities. 513 students responded to the survey and 293 reported they had a known food allergy. Almost 48% said they had emergency medication with them in case of a food allergy reaction. However, in most cases(41%) it was Benedryl, not the more powerful and effective self-injectable epinephrine (just 21%).

What’s baffling is that 24% of the students that had a life-threatening allergic reaction (anaphylaxis) had never been prescribed epinephrine. This problem is close to my heart as both an doctor and a parent. My alma mater, Brown University, had a tragedy occur a few years after I attended. A young man with a known peanut allergy had a bowl of chili at a restaurant, not knowing it was made in a peanut base; he went into anaphylaxis and died. I don’t know if he had an injectable epinephrine device, but I do know that studies done at Mount Sinai have shown that patients that use the epinephrine injectable device within minutes have much better outcomes – and a much lower risk of death. I try to teach my patients with severe food allergies to not only carry their EpiPen with them at all times, but to know how to use it properly, so they are ready and not afraid if the situation arises.

If someone has a severe allergic reaction, especially if it requires emergency room attention, I believe it is critical to see an allergy specialist to be tested to see which specific food caused the reaction – and to make sure there are no other related foods that may trigger a future reaction. The testing is highly accurate and safe. In my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, I have a whole chapter on this topic and discuss some of the therapies that are being investigated.

Along with many travelers this holiday season, I passed through busy airports. There was no shortage of  Kleenex packets being bought at the convenient shops, and many travelers had their stash of cough drops. In my opinion, the “cough drop” is one of the least effective treatments for a chronic cough. Yet why are so many millions of these products sold?

Chicken soup: A better alternative

The Pharmacies have done a good job in making us believe that cough drops are a safe and effective remedy for a cough. Of course, for a simple viral illness, like the common cold, a cough drop with Eucalyptus will make you feel better. It will soothe some of the throat irritation which can trigger a cough or throat clearing mechanism. A good bowl of homemade chicken soup is a better alternative. The warm water combined with salt is even more soothing on the throat, and the chicken stock has been shown in some studies to improve white blood cells in fighting off infections. I see too many individuals who are “popping” cough drops like breath mints – they are doing it for survival. They don’t want to create a spectacle in a public place where a loud, hacking cough brings stares of disdain or worse – isolation.

Getting to the root of the problem

As an allergist, I see many patients that have battled with a chronic cough for years. It can be debilitating and frustrating. I focus on the underlying cause, which I have mentioned in prior posts, that can come from different sources: the nose, the chest or the stomach. In each case, the chronic cough will be alleviated much faster if the primary cause is treated.

Using an Inhaler

To wean a patient off cough drops I have to give them some confidence in an alternative treatment that will do the job. I usually start with an inhaler. Inhaler’s by definition are bronchodilators, which open up the airways which are spasming – that’s why you are coughing. An inhaler that combines a bronchodilator with a corticosteroid is even better, because the mild cortisone component is a ” mucus buster”, much more effective at breaking up mucus than over-the-counter decongestants, which essentially dry the mucus but don’t remove it.

Survival tips to get relief from a chronic cough:

If you can’t get to your doctor immediately:

1. Drink a caffeinated beverage. Coffee or tea will give you some bronchodilation – but use it in moderation.

2. Use saline or just a few days of Afrin to make sure your nose is opened and mucus doesn’t build up, causing post-nasal drip.

3. Old medical trick: if the coughing is non-stop, place a small piece of paper just between your lips – just for a minute or two – this is just enough time to break the cough reflex, and sometimes gives temporary relief.

These are temporary solutions… the real key is to seek medical attention and not be your own doctor. The cost in the long run is well worth the relief.

Christmas and New Year’s Day are literally  around the corner…. I’ve spoken to many of you who are excited to get out of town and visit friends and family. One concern many of my patients have expressed to me is: How can I avoid getting sick, from either my allergies or infections, on my trip? I’ve done some research over the years and I think have come up with some good tips to ensure a healthier travel experience.

Tip #1:

If you are traveling to a friend or family that has a pet, cat or dog, and you are allergic, there are some sensible things to do. First, if you are on allergy drops, continue to take them while on your trip to maintain protection – unless you get very sick. Second, make sure to take preventive medications a few days before you travel. Topical medications  like nasal sprays (ex. Flonase, Nasonex), eye drops (Elestat or Pataday) or inhalers (Advair, Flovent) are the best way to add extra protection before you get the exposure.

Also, if possible ask your host if they can make sure the room where you are sleeping is off-limits to the pet- this is critical: the worst reactions I see is when a person sleeps in a room where the pet has been staying for long periods of time- even if it’s not when they are sleeping there. The cat dander especially stays airborne for up to 4 months! If you develop symptoms while you are there, you should use antihistamines, such as Zyrtec or Claritin (both are over-the-counter) which will give added relief. Try to get out of the house during the day to get some periods of fresh air.

Tip#2:

If you are staying at a hotel, dust mites – and possibly mold – are the allergens to be concerned about. This is especially true if you are travelling to a warm, humid climate (Florida or the Caribbean). What can you do realistically? You can tell the hotel management that you are allergic to dust and mold, and would appreciate a thorough cleaning of the room – especially the headboard area. This area gets overlooked in cleaning and is literally right by your head, where you are breathing in all that dust. This may sound obvious, but ask them to make sure the sheets were changed from the prior guests and if possible washed in hot water (over 135 degrees) which kills the dust mites. If you want to be fanatical (but to me not unreasonable) bring your dust mite covers, at least for your pillows- and see what a difference this can make. If you smell mold in your room, pump up the AC. Mold spores don’t like cold temperatures.

Tip#3:

This one’s simple but overlooked: ask for a smoke-free room. You probably think most people don’t smoke anymore, but there are many European travellers to the U.S. with the weak dollar and they are smokers. The chemicals in the smoke last in the room for days. The hotel staff will try to spray air-freshener all over the room, but the smoke fumes linger and are damaging to your sinuses and respiratiory tract- making you more prone to an infection.

Tip#4:

Don’t use the bathrooms on the plane! Of course, unless you have to. The bathrooms on the plane are germ infested! I have gotten sick several times before I read an article explaining what is going on in these bathrooms. My advice is to put on rubber gloves. I do this all the time. I have my lavender or blue latex-free gloves in my carrying-on bag and if the urge to go to bathroom gets too much, I put on my gloves and take my chances. So far, over the last 8 years I haven’t gotten sick on a trip. If you forget a pair of  rubber gloves, no problem- the TSA security has plenty of those gloves as they examine your bags: ask politely if you can have a pair or two.

Tip#5:

Get some sun if you are going to a warm climate. Do it safely and try not to burn on your first day or two. In the Northeast, all of us get a paucity of Vitamin D during the cold, dark winter months. There is no substitute for good old sunshine. Start out with at least an hour a day, and slowly build up an extra half-an hour on top of that. It is good idea to use sunscreen on your face, but let your arms and legs go sunscreen free to soak up the Vitamin D. Many of the new studies clearly show Vitamin D stengthens our immune system- and many new allergy articles show it helps decrease allergies- it’s also great to clear up your eczema.

I hope these tips make your holiday allergy and infection-free. Have a great time!

The studies keep pouring in: at the American College of Allergy, Asthma and Immunology meeting in Phoenix, researchers presented data showing that sublingual allergy tablets to grass pollen was safe and effective in children. This was the first study done in North America. Prior studies were done in England and Europe. The exciting part is that the therapy appears to work within 16 weeks and gave significant protection against grass pollen allergy compared to placebo (water tablet). It is also easy for kids to use.

I’ve been using the sublingual method to treat my patients for the past decade and have seen the dramatic improvement in children and adults. Dr. Blaiss, a former president of the Allergy society, mentioned that the great thing about this therapy is that it changes the immune system to protect against the allergen, unlike drugs which can only try and mask symptoms. I wrote in my book, The Allergy and Asthma Solution, that this unique therapy which has been around for over twenty years in Europe can change the lives of millions of allergy and asthma sufferers.

Mike’s Story

I had a patient I’ll call Mike, who couldn’t go outside during the months of May and June, because his grass allergy was so bad. He was an avid golfer, but was getting ready to sell his clubs because the misery just wasn’t worth it. Mike was a great patient: he stayed on the program and within a year he felt much better but still needed some medications. The following year he got through the spring season without any medications, just using his drops. It has been over 5 years since Mike finished the program, and I know how great he is doing by the many friends and family he has referred to our office to become allergy-free.

Journal of Allergy Study

One more important recent study: in the The Journal of Allergy, Asthma and Immunology in November this year, a team of top Italian allergy researchers showed that if patients continued their allergy drops for the proper maintenance period of 3 years, they kept their protection for over 8 years and beyond. This again goes to prove that immunotherapy is an immune changing treatment that can give long-lasting protection. The most striking other fact is that patients receiving the drops developed no new allergies during the therapy, whereas the control group (just meds, no drops) had a 24% increase in developing new allergies.

Allergy Drops: A no-brainer

It’s really a no-brainer anymore: for environmental allergens (cats and dogs, tree and grass pollens, dust mites and molds) allergy drops are the way to go. I just can’t wait until the food allergy studies that are currently underway come out. Allergists and their food allergic patients so desperately need a safe treatment option.

Many of my patients find their sinuses become more inflamed as soon as their offices or their apartments turn on forced hot air. This is not surprising, as the sinuses must adapt from the cold weather outside and then respond to the dramatic change of the warmer air. The problem is that hot, dry air makes the sinuses too dry and causes them to swell up.

What You Can Do

The best thing a person can do is to keep the sinuses lubricated with saline sprays several times a day. The other recommendation is a cool, mist humidifier to keep in the bedroom to increase the moisture in the bedroom air. Keeping the windows open if possible, is not a bad idea during the day if possible, but at night while you are sleeping that also can be too drying- and lead to sore throats.

Caution:

Do not use Vicks vapor rub in your sinuses, no matter what you’ve heard: this is not meant to go into the nose or sinus cavity and can cause a problem in the lungs.

When to see a Doctor

If you are experiencing persistent nasal congestion or sinus pressure you should be examined by a physician. ENTs and allergists are sinus specialists, and can do nasal and sinus endoscopy to view the sinuses and decide if there is an allergic inflammation, cysts, polyps or an infection. As an allergist, I also can perform allergy testing to see if their is an environmental allergen, such as dust mites or mold, that are contributing to the sinus inflammation. Unfortunately, pet dander is more intense in the winter months, as their owners spend more time inside and as a result get more exposure.

The key to getting through the cold weather winter months for your sinuses is being prepared and use a humidifier.

Prevention: Cover your mouth

The first thing I warn my asthmatic patients in the freezing weather is: cover your mouth outside! Why? When you breathe in the cold air directly through your mouth instead of allowing it to flow through your nose, where it gets warmed up, you can get  bronchospasm. Bronchospasm, is a medical term where the lung’s air tubules constrict and make it harder to breathe. On his show, Dr. Oz provided the example of trying to suck in air with a smaller and smaller straw. I see many patients that forget to have some type of garment to cover their mouth, and then they get wheezing and chest tightness. This is preventable in many cases with a good scarf or a ski mask that covers the mouth.

Use your inhaler

Another preventive strategy if you have asthma is to use your inhaler about half-an-hour before you go outside. For example, when you are rushing in the morning to get ready, use your bronchodilator inhaler, such as albuterol or your combined controller inhaler like Advair, the first thing when you get up. Then, eat, shower, etc, and by the time you are out the door the medicine is maximizing your bronchial protection.

Stay Hydrated

Another way to protect yourself form respiratory issues in the winter is to keep your airways well-hydrated. We all lose water in keeping ourselves warm by raising our body temperature – only we don’t notice this by getting thirsty. Drink hot beverages throughout the day- they will warm you up, and make sure your airways stay moist and don’t let sticky, or dry mucus develop.

Humidify the air

In the winter, it’s not a bad idea to have a good humidifier in the bedroom. The extra moisture in the air will make your breathing more comfortable. Most people don’t have to worry about a humidifier causing mold problems, because the reason you are using it in the first place is because the environment is so dry. Just keep the humidifier clean by rinsing it with a teaspoon of vinegar and a few cups of hot water regularly.

Final Tip of the Day:

Wear Hats and Gloves on these frigid days. It’s not only fashionable, but did you know that you lose most of the heat in your body through your scalp? The fingers are very sensitive to cold in most of us.

This fall on the east coast has been a classic mold season. We’ve had unusual amounts of warm weather, mixed with heavy rains. If you see the beautiful colored leaves that have fallen to the ground, you can be sure lots of mold is spewing off those dead leaves. Mold allergy season typically starts in the hot, humid summer when mold grows on the patches of brown grass, then continues into the fall. This outdoor mold can cause respiratory problems like allergic sinusitis and asthma. Some patient’s eczema rashes get worse around this time as well. Indoor mold can be a problem anytime of the year, wherever there is water damage in a home. I recommend dehumidifiers to decrease the water content in the home.

Recent research

In this month’s issue of the Annals of Allergy, Asthma and Immunology, a great team of researchers showed that sublingual allergy immunotherapy (allergy drops) were effective compared to placebo in reversing the effects of a specific mold, Alternaria, in patients with rhinitis (nasal), eye and chest symptoms. The doctors, Canonica and Passalacqua, are both world leaders in sublingual research. Dr. Canonica was kind enough to endorse my book, Dr. Dean Mitchell’s Allergy and Asthma Solution, back in 2006, when I was trying to educate the public on the benefit of  the sublingual method- which had been around in Europe for over 20 years.

When will it end?

I have been seeing a lot of patients the past 2 months who have been complaining of sinus and chest symptoms. They thought the pollen season was over. It was, but the mold season just kept on going. Usually, once the ground frosts over, mold dies off and the symptoms subside. I’ve been treating patients with this type of mold allergy with sublingual allergy drops in my Long Island practice for over a decade. In this particular area, we are surrounded by water and can get especially high mold spore counts from June through November.

The good news is that winter is around the corner. Less allergies, more time to celebrate the Holidays.

Happy Thanksgiving to all.

The conference at Mount Sinai presented exciting new data that hope for children and adults with food allergies is on the near horizon. Several studies were presented that showed effectiveness using oral immunotherapy to treat milk, egg and peanut allergy. The treatments worked in many of the patients, however there were common adverse reactions(45%) in doing the immunotherapy.In contrast to the oral immunotherapy(the product is swallowed), sublingual immunotherapy was used in a peanut, hazelnut and peach study. These studies did show varying degrees of  effectiveness. Dr. Hugh Sampson also presented data on a Chinese Herbal Formula his group is working on to prevent food allergy reactions and this looks very exciting; they have had success in animal models and are now starting to recruit for human trials. It seems to be a very safe treatment and I would encourage any one interested in participating in the research to contact Dr. Julie Wang who is involved in the study.

One last thought, there is a medication that is available now that might be an effective treatment for food allergies- it’s called Xolair. It is presently only indicated for severe asthma, and  it is an expensive drug only covered for this reason. However, I have used this for a few asthmatic patients and seen that they were more protected against their food allergies. The most dramatic case I had was a patient who had asthma and was highly allergic to salmon and tuna. She was so allergic she couldn’t even be in the same room as someone eating the food- it would cause an asthma attack. She hadn’t been to a restaurant in years because of this severe food allergy. She was treated with the xolair injections once a month and not only did her asthma get better,but she noticed she didn’t have those severe reactions if she was near salmon or tuna, or if someone she was with had eaten either of these fish. I wasn’t recommending she eat these foods, but having more confidence that she was more protected did improve the quality of her life. Using Xolair for food allergies would be off’-label use of the product and expensive( around 1,000 per injection), but I can’t help thinking how many patients might benefit from it’s use.

Allergy specialists have known for a long time that there were patients who complained that they developed allergic reactions to many different medications-especially antibiotics. As allergists, until recently, we had limited allergy testing to evaluate these patients. Penicillin allergy skin testing has been around for decades, and is a valuable test to see if a person is allergic to penicillin, and more importantly has a 99% negative predictive value that you won’t have a reaction to it if your skin test is negative.

The most clinically useful markers right now for prevention of an allergic reaction to a drug are the following:

1) Patients with HIV/AIDS who require Abacavir should be pre-tested if possible for HLA-B5701 marker. 4% of patients with this marker can develop a fever, rash, gastrointestinal and respiratory illnesses. HIV patients are also at a much higher likelihood(44-70%) to have an allergic skin reaction to Sulfonamide medication.

2) Diabetic patients that require Insulin need to be aware that Insulin allergy can develop in those patients with HLA-DR3 marker.

3) Infectious Mononucleosis is classically associated with  a generalized rash if the patient is given Amoxacillin; this can occur when initially the physician sees the severe sore throat and treats it as a Strep infection. This type of reaction with Amoxacillin can also occur with a patient with Chronic Lymphocytic Leukemia.

On a different note, there has been no recent scientific evidence that shows a seafood allergy makes a person more likely to get a Radiocontrast dye reaction; the best thing for a patient with a prior reaction to a diagnostic test with dye is to be pre-treated with oral cortisone and antihistamines in advance of the test.

The exciting research from Harvard’s affiliated medical school, Dr. Maryanne Castells has shown patients allergic to chemotherapy medications can be successfully desensitized and receive the appropriate treatment for their cancers.

This weekend I found myself recuperating from a mild viral illness. I self-made the diagnosis (using my medical skills) because what started as a scratchy throat- which I thought was due to lecturing for 3 hours to my medical students this week- actually evolved into a low grade fever with some chills and sweats. Fortunately, it doesn’t appear to be one of the Influenza strains- I’ve had that 2 years ago (H1N1) and I was much more ill. So, I thought it was a good time to remind myself and others why it would be a very good idea to get your flu shot in the next few weeks.

The flu shot comes in 3 general varieties: regular flu vaccine given from multi-dose vials that due contain the preservative thiomerosal, preservative-free single dose vials(which we give in our office) and the Flu-Mist(the intranasal spray). The regular flu vaccine is usually safe and minimal reactions are observed. It is widely given in doctor’s offices and pharmacies. The preservative-free vaccine is less widely used and I offer to patients who want a little more piece of mind that the vaccine they are getting doesn’t have thiomerosal, which contains about 25 micrograms of mercury. These are both given as injections. The other alternative is the intranasal Flu-Mist. This is a live-virus preparation which is safe, but should not be used in children or adults with asthma, immune deficiencies or the very young or elderly, who might have compromised immune systems, pregnant women or patients with underlying heart disease or diabetes.

October and early November are a good time to get your flu shots or sprays because the Influenza virus typically peaks in December, January and February. The immunizations takes 2 to 3 weeks to start to be effective and should last through these high peak months.

I also stongly recommend that patients that have sore throats and fevers go to your doctor to get a throat culture for Strep or a nasal swab for Influenza- that is what we do in our office, because antibiotics are not effective for viral illnesses and for severe viral illnesses, if the patient is seen early anti-viral medications can lessen the severity.

A medical pearl of advice: Don’t rely on the over-the-counter meds for relief. They can mask the severity of symptoms. The zinc nasal sprays can permanently cause loss of smell, and over use of decongestants can raise blood pressure and cause heart arrythmias.

I am not against a well-made chicken soup like my grandmother used to make- it provides relief to a sore throat(that’s the hot salt effect) and good old comfort food.

If you haven’t been diagnosed, an allergist can do a simple test to see if you’re positive to Ragweed, or some of the common mold spores that are also floating around in the cooler, drier air. Over-the-counter antihistamines can take some of the edge off the symptoms, but the prescription sprays work faster and are less sedating.

I have been so pleased that my patients who have had prior problems with ragweed or mold are doing so well on the allergy drops (sublingual immunotherapy).

The good news is that the season should be over by October… the bad news it will be back next year without fail.

As a physician, I am so impressed with Dr. Mehmet Oz. He is truly a great surgeon, and I have patients that have used him. He is also an incredible communicator on health issues. The latest issue, his own health, got the attention of the whole country. The colonoscopy seen all over the country showed he had a pre-cancerous polyp, which caught so early most likely saved his life. The take home message from Dr. Oz was: be proactive when it comes to your health. Your insurance company isn’t going to send you reminders when you should get certain check-ups.

In my area of expertise, as an allergist, asthma specialist and immunologist, I have a few recommendations for my patients to be proactive with their health. First, make time to get your flu shot. It really saves lives. You hear the rare, but occasional horror stories of someone who died from the H1N1 virus last year. This year’s flu shot covers this virus, plus two other strains. The best time to get the shot is now through the end of  October before the flu season arrives- typically December through March. The shot does take a few weeks to gain maximum immunity. We have in the office the preservative-free vaccine, but all the other vaccines are highly safe as well.

I also want to stress again to parents with children who have asthma: please have your child checked for allergies. It’s estimated 50 to 70% of children with asthma have underlying allergies. The allergies cause inflammation in the lung tissue and can require inhaled cortisone to control it. By identifying the allergens and possibly avoiding them, or if that is not possible, then we use sublingual immunotherapy (allergy drops) to protect the child and boost their immunity to the specific allergen. A child’s lungs grow to until their about 12, if chronic inflammation goes unchecked their lungs may never reach full capacity.

Also, children with eczema- the red, scaly rashes that go with dry skin and itch like crazy. These children should also be checked for allergies- especially food allergies. In up to 40% of cases, these children may be allergic to a food that is worsening their rash. I also am finding that proper doses of Vitamin D is key to improving their skin and immunity.

So remember, as we head back to work, and the kids back to school- find time to be proactive about your health.

The first question most patients as is: Do bioidentical hormones cause cancer? The answer is no. But many doctors and patients simply do not understand the difference between bioidentical and synthetic hormones. It is time they do.

It is now known that synthetic estrogens like Premarin and  progestins like Provera, increase the risk of breast cancer. Multiple studies have shown that natural estrogens and natural progesterone are protective against breast cancer as well as some other types of cancer. But mention that to traditional physicians and they will undoubtedly say that’s not true. Tell them to read the literature and take their heads out of the sand!

Most bioidentical estrogens contains estriol which is much safer than synthetic estrogen. Studies have shown that women with high estriol levels have a lower incidence of breast cancer. Not only that, but one study showed that when giving estriol to postmenopausal women with a history of breast cancer, some women demonstrated a halting of the cancer. In addition, many studies have shown that giving women estriol had a protective effect on breast cancer while synthetic estrogens were shown to increase breast cancer risk.

The same can be said of natural, bioidentical progesterone; it inhibits the growth of breast cancer cells. Synthetic progesterone has time after time been shown to increase the growth of breast cancer cells.

Now would be a good time to discuss the WHI or Women’s Health Initiative. The WHI studied synthetic Premarin and Provera. It concluded that the two hormones increased the risk of heart attack and stroke. As a result, millions of women went off  hormone replacement therapy, suffered, and continued to suffer tremendously. Many of these women were not offered bioidentical hormones.

Provera has been shown to inhibit the heart protective benefits of estrogen and therefore increase the risk of heart disease. On the other hand, natural progesterone has also been shown to increase HDL or good cholesterol.

As mentioned in Part I of this series, synthetic hormones are significantly more potent than natural hormones. This goes to show that stronger is NOT necessarily better.

The take home message here? For women who want to try hormone replacement therapy – bioidentical is the way to go. Bear in mind that topical hormone replacement therapy is NOT the same as bioidentical. Many pharmaceutical companies have jumped on the bandwagon and are trying to cash in on bioidentical hormones. They are hoping that patients and doctors won’t know the difference. But these prescription creams are not tailored to the individual and true bioidenticals do just that. So keep informed, read and question your physician about bioidentical and if he or she does not know about them, find one who does.

When should you seek medical attention for a sting: if at any time you develop hives all over your body(away from the sting site), or you are short of breath or wheezing; if you feel faint or feel confused- these are all signs of a general reaction which require immediate medical attention. This smartest move would be to go to your closest ER and tell them you’ve been stung. After assessing you, they should give you an injection of epinephrine(adrenalin) which in over 90% of the time will reverse the reaction. After you been stabilized and sent home, you should make an appointment with an allergist to find out if you are allergic to any bees, hornets or wasps. The testing is important because in people highly allergic to insect stings a future sting could be worse or fatal. There is proven allergy immunotherapy that does protect against insect stings.

My approach to find out what is causing the hives is a good history: I find out what you are eating and drinking and see if their are any potential allergens. I will ask any medications that you may be taking- any medication, an antibiotic or common pain reliever like aspirin or motrin can be a cause. And of course, I will try to see if you have had any unusual exposure by an environmental or contact allergen. After the history, I will usually do some form of testing either simple skin tests(which are like plastic toothpicks) or with a blood test to investigate for any internal problems. Finding the cause in chronic hives takes a good medical detective, and a good patient to give the clues.

Interesting case: Several years ago, a man in his 50′s came to me suffering terribly from chronic hives. He brought in a bagful of medicines that he was given by other doctors. He still wasn’t better. He was on cortisone pills and antihistamines, but still had daily hives. After a few visits, and carefully reviewing all his medicines I had the answer: he was taking aspirin for prevention of heart disease and I had him stop the aspirin and within a week the hives disappeared. The funny part was he was great for several years, when I got a phone call from him that the hives had come back- he was panic stricken. I carefully reviewed with him if anything was different. He mentioned his stomach was upset recently and he took Alka-seltzer for relief.

I asked him to check the ingredients on the Alka-seltzer- sure enough, it contained aspirin. My advice to him, next time he has stomache upset, choose Mylanta.

If you are concerned you can read more about this in my book, Dr.Dean Mitchell’s Allergy and Asthma Solution(Marlowe 2006). Meantime, if you feel good, just go out there and hit the road…..

What exactly are bioidentical hormones? They are hormones that have the exact same structure as the hormones made by the human body.Premarin, Provera and Prempro are synthetic hormones made by a pharmaceutical company. These are NOT exactly identical to the hormones made by the body because a drug company, by law, is not allowed to patent a bioidentical substance. Therefore, in order to get a patent and sell a substance, they must change its structure.

Many people question “why replace hormones that are supposed to decrease with age?” That is like saying why take care of our teeth. As we age, without proper dental hygiene, most people would lose their teeth. Modern medicine has allowed the aged to keep their teeth. So why not take hormones to offset some of the signs and symptoms of aging? Modern medicine has prolonged the human life. It makes sense to improve the QUALITY of that life.

As a result of patient demand, pharmaceutical companies have developed topical hormone replacement therapy. Most patients equate topical creams to being bioidentical. That is not true. These hormone replacement therapies are not individualized and the key to successfully using hormones is to treat the individual. Before taking any hormone replacement, it is important to take a series of blood tests that include estrogens, progesterone, testosterone (yes women need some!!), DHEA and pregnenolone. Once starting therapy, careful monitoring of bloods and symptoms allows the patient to be on the lowest dose required to alleviate symptoms.

The question most people ask is :are bioidentical hormones better than synthetic? Bioidentical hormones are better but they are still drugs. As we know, no drug is one hundred percent safe. However, bioidentical hormones are natural and mimic the body’s own rhythm. Synthetic hormones are much more potent and can have many more side effects.

Stay tuned: Part II- Bioidentical Hormones and Cancer

The over-the-counter antihistamines can be helpful, but they are definitely not as effective as prescription nasal sprays or prescription eye drops. The question I get from patients is: will this problem ever go away? Do I always have to be dependent on nasal sprays and medications to control my symptoms? There is a more natural and long-term solution to Hay fever problem, as well as other air-borne allergens- it’s called immunotherapy. If you are not sure what immunotherapy is, you probably recognize when someone with allergies says,” I go for allergy shots”. Allergy shots work but they can be painful and inconvenient- and sometimes dangerous. The good news is that you can now get that same benefit in a natural way by doing allergy drops. It’s fancy name is Sublingual allergy immunotherapy. It’s been done all over the world for two decades- mainly in Southern Europe,but also in Canada and England. I’ve been doing it in my office the past 12 years with very good success. Many of my patients need minimal or no medications while they are taking the natural drops under their tongue- and the better news is that even after stopping patients in most cases retain this immune protection. Why haven’t you heard more about this therapy? Well, in 2006, my book- Dr. Dean Mitchell’s Allergy and Asthma Solution tried to get it to the masses, but since Oprah or Dr. Oz hasn’t invited me on, the work lingers in semi-obscurity. But I have faith, that in the next two years this therapy will be widely available to allergy patients all over the country.

In the meantime, keep an eye on those pollen counts and have your medicine ready- don’t wait until your miserable. The best part of being an allergist/immunologist is that we can get people better- and keep suffering to a minimum, or get rid of it completely.

Yes, the stomach can cause a chronic cough. Many of you are familiar with the term, ” reflux”, and you see enough ads on TV for heartburn medications. However, interestingly, the patients with chronic cough that have reflux many times have no heartburn symptoms, like burning in the stomache area or chest tightness. These patients may have a form of  laryngeal reflux- meaning, the acid from the stomach flows back up the esophagus and irritates the layrnx(your voice box area). Sometimes, the only symptom a patient may have is constant throat clearing- it is very annoying to them and others.

To literally, put the “fire out of the belly” involves a few steps. First, dietary changes are critical. Unfortunately, if you like the heavy tomato sauces with pasta dishes- look out- this is a key culprit for reflux. If you  like having those few glasses of wine each night with dinner- beware, you will be coughing the rest of the night. There are other foods that may cause the reflux as well, and you find lists of foods on-line, but you should review this with your doctor or a nutrionist. Taking acid blocker medications may  give you temporary relief, but it’s best to try natural ways to reverse this condition, because many new studies are showing that these acid blocker medications have side-effects if used long-term: softening of the bones(osteoporosis), increased risk of infection(because the stomach acid doesn’t kill the bacteria in foods) and depletion of other paritally absorbed nutrients.

My other strong belief in reversing reflux is to use breathing exercises. Why breathing exercises? I learned from an excellent osteopath that the diaphram(the muscle in our abdomen that separates the chest from the stomach) if tense and in spasm squeezes the junction where the stomach and esophagus meet, and this is an anatomical cause of the reflux- usually from stress, but totally reversible. I discuss examples of these breathing exercises in my book, Dr. Dean Mitchell’s Allergy and Asthma Solution(Marlowe 2006) which are very helpful.

The classical signs of dark green sputum and a fever point to a bronchitis or pnuemonia; however, some infections like Mycoplasma pnuemonia, so called ” walking pneumonia”, typically have a high fever for just a day or two, but the hacking cough can last for weeks. I remember catching this infection after coming off a plane during a medical school break- I was coughing for weeks until I went to a physician who made the diagnosis and treated me with antibiotics- specifically the group of meds in the erythromycin class, which are more effective than penicillins for Mycoplasma.

The other category in the chest that can cause a chronic cough is bronchospasm. Patients that have increased bronchial reactivity(meaning their lungs “twitch” very easily to allergens and infections) often present with a chronic cough. As an NYC allergist/asthma specialist I have special breathing tests that allow me to assess the nature of the cough and it’s effect on the lungs. I do in my office a test called the Nioxmino, which is a simple breath test(you just blow into a small device) and it gives me a reading of the nitrous oxide in your breath. This simple and safe test can show if you have evidence of allergic inflammation in your lungs. I frequently see patients that have cats and dogs or rabbits in their homes and if they are allergic to them and have a cough I usually see a high nitrous oxide level. This can be easily treated with a mild cortisone inhaler, and stops me from thinking the patient has an infection and needs antibiotics.

A good patient definition of a chronic cough is when your family, friends or loved ones strongly recommend you see a doctor about your cough. A cough is not usually deadly, but it is annoying and exhausting to the patients who can’t seem to shake it. This time of year it’s unusual for an infection to be the main cause of a chronic cough. The reason being: less crowding on subways and buses, people are outdoor more.

My job, as an NYC Allergist, is to explain to new patients with a chronic cough what is the underlying cause for their cough, so we can treat the problem and not just suppress the symptom itself. I sometimes see, unfortunately, a physician will use codeine products to give their patients relief from the severe, chronic cough- this can be problematic. I’ve rarely seen it work long-term and the side-effects are usually intolerable for the patient.

My approach with the patient is to look at 3 systems: the nose, the lung and the stomach. These are frequently the areas where the cough is emanating from. My job as an Allergist and Sinus specialist is to determine if nasal blockage due to airborne allergies or due to anatomical problems(deviated septum or polyps). I specifically test for common outdoor and indoor allergens, such as pollen, pets, dust and mold,which can cause swelling of the nasal passages and ultimately cause post-nasal drip into the back of the throat and lungs- causing the incessant cough.

I find the short-term solution in these patients is to decongest the nose, but without oral decongestants. I use topical decongestants that must be used with a mild prescription spray- so you don’t get the rebound effect from the decongestant spray. I then wean the patient off the decongestant spray and just use the prescription spray. This can be very effective. If the patient has positive allergy tests that indicate this as the cause of the nasal congestion, I will present to the individual the option of sublingual allergy immunotherapy(allergy drops) for a more natural and long-term solution to the chronic cough.

The next installment will be about the lung causes of chronic cough…

Be aware of the climate you are heading back to at school. Regardless of the temperature, the ragweed pollen counts will climb higher through the end of August until about mid-September. If you know you are allergic to ragweed, be prepared.

It’s important to have your medications available, such as antihistamines, nasal sprays, eye drops and asthma inhalers. The ragweed season is typically a short one, but you don’t want to be suffering your first few weeks at school.

If your heading southeast, be prepared for high humidity which is usually accompanied by high mold counts. Colleges in the Carolinas, Florida, Louisiana and Alabama can be particularly tough. Again, the same medications used for ragweed allergy can be used for mold allergy.

The other culprit to be aware of in the hot, humid early fall weather are dust mites.  Dust mites multiply the most in the fall, so it’s important to do everything possible to decrease exposures. It is helpful to obtain allergy-free covers for your mattress and pillows—90% of your exposure occurs in the bed and bedroom. If you have access to air-conditioning, it would help cool the temperature and reduce humidity.

Check the pollen count— it can be an excellent guide to know when you need your medicines. Click here to check the pollen count