Monday, August 31, 2009

Cough, Cough

Eh-eh, eh-eh, eh-eh...You have had a cough for 3 months. What type of doctor should you see? Your primary care doctor, a pulmonologist, an allergist or...? Perhaps you have already tried over-the-counter cough medicine. It's time you need a diagnosis! What is a cough? There is no simple answer. Experts still debate the difference between a true "cough" and "throat-clearing" to clear secretions that are dripping down the back of the throat or refluxing up from the stomach. I work closely with my associate, an ENT (otolaryngologist) to address all aspects of this problem. We both start by taking a full history and physical examination to try and find out the origin of your cough. If it is thought to be caused by fluid dripping down the back of your throat or reflux, a quick endoscopic assessment by the ENT with a flexible telescope can often demonstrate signs that lead to specific treatment. If the cough is coming from your lungs, I will give you a pulmonary function (breathing) test to measure lung function. If there are signs of infection you may need to have a chest radiograph (X-ray), sputum cultures, or a TB test. I may recommend that you see a lung expert (pulmonologist). Both lung infections and asthma can present with cough, and allergy testing may help differentiate between the two. Cough can persist for several months after a viral infection such as bronchitis. Also in the last few months, I have seen 8 patients with cough as a side effect of blood pressure medication. Please remember to bring a complete list of your medications, including vitamins, supplements and herbal medicines when you vist the doctor.

Druce den allergolog: En blogg för dem som är intresserade av allergi, allergiska tillstånd och behandlingar allergi

I just added an amazing tool to the blog: Google Translate. Click on the tool, which you will find on the right side of the posts, and the whole blog will be transformed into Spanish, Welsh, Yiddish, Japanese or any one of 51 languages you may speak. The translation may not be perfect, but this certainly a fun tool that you might want to use yourself elsewhere.

Friday, August 28, 2009

The questions I get

I like it when patients ask me questions (no, really, I do!). It shows that we are having a dialog and that's the basis for trust and a better therapeutic result. So what are the most common questions I get asked? Number one must be "Will the allergy tests hurt?" The answer is "only a little" as I do not use conventional needles for general allergy testing, but use special plastic applicators with tiny metal prongs dipped in the allergy extracts. The second most common question is "Where is your accent from?" The answer to that is England, as I was born and raised in the city of Manchester. Which leads to the inevitable third question - "Do you support Manchester United?" For the answer to that, you"ll have to come and ask me in person.

I changed the header

Two of my best critics looked at "Dr.Uce" and thought it was confusing. Patients will be looking for you under "U" they said. So I dropped the Dr.Uce which I took from a series of newsletters I wrote a number of years ago as spoofs in the holiday season. Perhaps, I"ll do that again later in the year.

Thursday, August 27, 2009

Fan of FAAN

I'm a big fan (and a member) of FAAN - the Food Allergy and Anaphylaxis Network. I just added it to my list of favorite websites on the side of this blog. A number of years ago, I worked for a large pharmaceutical company, and we worked closely with FAAN to make chewing gum labeling more user-friendly to milk-allergy sufferers. Who would have thought that some types of chewing gum contained milk protein? If you have a genuine food allergy, you need to look at labels very carefully. The information on the FAAN website is very reliable.

But my dog is not Allergenic

Here is a picture of our dog. She is a beautiful yellow labrador retriever who we trained for "The Seeing Eye". She must take the prize for the most allergenic dog you could have. Her hair is shed everywhere. But so often I hear "My dog is not allergenic, she has hair not fur." If you don't have any symptoms when you are around your dog that's great. It's useful to know that it's not just the shed hair that causes allergy to furry pets. Proteins are spread into the air from the saliva and urine even from dogs with hair that does not shed. If you are positive when tested to dog, you could still get a reaction from another dog, or if you spend enough cuddle time with your own dog. That's why I ask patients how many furry pets they have, and if they are in contact with pets outside the home, for example grandma's dog, or the time the children spend at their friends' homes. The same is true for cats. I find it challenging that some patients with allergic symptoms often share their homes with many cats. The record to date that have open access to the bedroom is fourteen!

It must be Allergy...

At some point I should post an Allergy 101, or point to some good descriptions of what is and what isn't allergy. Many of my patients interpret vague or continuous symptoms that they can't pinpoint as allergy. So the "cold that never goes away" could be an allergy to something that is around in the environment for a long period of time, such as mold or dust mite, but could equally well be a chronic sinus infection, nasal polyps, or the result of a deviated nasal septum (the bone dividing the nostril being crooked) or even the reflux of acid from the stomach up to the upper airway. I'll write more about all of these later. Another common complaint is "I"m tired all the time. I must be allergic to something in the air." That's when I need to be a detective and think about all the causes of fatigue...from thyroid disease to anemia and even depression. Yes, and also allergy, becuse having even just hay fever, or seasonal allergies can wipe you out. Reactions to foods are also commonly blamed on allergy. That's a complicated issue I will tackle separately.

Wednesday, August 19, 2009

About me

If you are going to be reading my blog, you should know something of my background. I am currently in the private practice of allergy and immunology in Somerville, NJ. I am associated with David Bortniker MD who is an experienced otolaryngologist, head and neck surgeon. David's well-established practice - Ear Nose & Throat Care PC is now "Ear Nose & Throat Care PC & Allergy". We are both affiliated with Somerset Medical Center. Our website is

For the last 16 years I have been conducting patient care and teaching at UMDNJ - New Jersey Medical School, in Newark NJ. I am a member of the voluntary teaching faculty and currently hold the title of Clinical Professor of Medicine in the Department of Medicine, Division of Allergy and Immunology. During the same period of time, I worked for several pharmaceutical companies, conducting either clinical research or supporting medical affairs for allergy and other products. My most recent position, up until 2008, was with the McNeil Division of Johnson & Johnson, where I was Senior Director of Medical Affairs. One of my responsibilities was helping get the antihistamine Zyrtec converted from prescription to over-the-counter marketing. Earlier, I was working in academic medicine full-time at Saint Louis University School of Medicine, in St. Louis, Missouri. I left there as Associate Professor of Medicine and Assistant Professor of Otolaryngology. I trained in allergy and immunology at the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health, in Bethesda, Maryland.

Professionally, I am a member of the rhinosinusitis committee of the American Academy of Allergy, Asthma and Immunology (AAAAI), and the respiratory diseases committee of the American College of Allergy, Asthma and Immunology (ACAAI). I will be writing more about these professional organizations later.

Welcome to my Blog!

Hi! I'm Dr. Howard Druce and I have started this blog for my patients, friends, and all those interested in allergy. In this blog you will read about allergy, my medical practice, and a little bit about me and my interests. It's an opportunity to express my opinions in an informal way, get some feedback and perhaps start some new thoughts on allergy and its treatment. So first, two disclaimers! This is not a substitute for medical advice, so I can't be specific on this blog. If you are interested in becoming a patient, I will post links to the practice website later. Second, I am no longer affiliated with any pharmaceutical company, so the views expressed are purely my own.