Your New Year's Celebration can cause more than a Hangover

Press release from the American Academy of Allergy Asthma and Immunology

MILWAUKEE – Toasting the New Year is a tradition that can cause more than a headache the next day. For some people, drinking may also trigger allergy and asthma symptoms, according to the American Academy of Allergy, Asthma & Immunology (AAAAI). “It is usually not the alcohol itself that produces the reaction. It is most likely ingredients, such as sulfur dioxide (metabisulfite), yeast and additives,” according to Clifford W. Bassett, MD, FAAAAI, Chair of the Public Education Committee of the AAAAI.

The key preservative in wine is sulfur dioxide. It is naturally produced by wine yeast in small quantities during fermentation. Sulfur dioxide is also used as a preservative in foods such as dried fruits, baked goods, condiments, canned foods, shellfish, frozen shrimp, canned tomatoes, frozen potatoes and fruit juices. If you tend to have a reaction to these foods, you may also experience it with wine.

Histamine can be another culprit. Bacteria and yeast in the alcohol generate it. Histamine is naturally released by the body during an allergic reaction so even if you don’t have an actual allergy, drinking alcoholic beverages may cause a runny or stuffy nose, itchy, runny eyes or worsening of asthma symptoms. Red wines often have a larger amount of histamines than white wines.

If you think you are allergic to beer, it is most likely the barley, corn, wheat or rye in beer that may cause similar allergic reactions.

If you suffer from allergies or asthma, visit www.aaaai.org for more tips and information that can help you have a happy, healthy new year.

The AAAAI (www.aaaai.org) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 6,500 members in the United States, Canada and 60 other countries. To locate an allergist/immunologist, visit the AAAAI Physician Referral Directory at www.aaaai.org/physref.

Dr. Druce is a Fellow of the Academy and member of the Rhinosinusitis Committee.

Coping with Allergies During the Holidays

For asthma and allergy patients, the holidays present a variety of challenges to maintaining good health. Enjoying the holidays is easier when you plan ahead so you can look back on this special time with joy. These tips are from the Allergy and Asthma Foundation of America.

• Clean your chimney before the first holiday fire
• Check fireplace vents and secure fireplace doors to reduce smoke entering the room
• Use doors instead of screens
• Decorations stored since last year can become coated with dust and mold
• Thoroughly clean and dry all decor, seal in plastic bags, and store in airtight containers
• If you are sensitive to dust or mold, wear a face mask while unpacking and decorating
• Clean and replace filters in your furnace before turning on the heat
• Use a filter over vents to catch dust particles
• Clean or replace filters in any portable air cleaners
• Run units at the highest setting during winter months
• Check humidity levels in rooms where you spend most of your time
• Keep humidity below 50%, as long as you are comfortable and allergy symptoms are minimal
• Limit use of air fresheners such as candles, oils and potpourri

If you bring a live tree into your home, use the following guidelines to help reduce problems:

• Thoroughly wipe the trunk with a solution of lukewarm water and diluted bleach (1 part bleach/ 20 parts water) to kill mold.
• Use a leaf blower (away from the house or garage) to remove pollen grains.
• Artificial trees are great substitutes as long as they are not coated with sprayed-on "snow."

Outdoor allergens can also be potential triggers for asthma and allergies. Here are some suggestions for preparing your home and family for the holidays:

• Remove wet dirt and leaves from the foundation and gutters to prevent mold growth near windows and doors
• Stack firewood outside, bringing in new logs only for immediate use in your fireplace.
• Wear protective clothing when exposure to mold is likely (gloves, long sleeves, pants, face mask, etc.)
• While outdoors, wear a scarf over your face to warm winter winds that enter your lungs. If this is inadequate, consider a warming mask - available at most medical supply stores
  

Happy Holidays

It's quiet here in the office, and we will be closing until next week, when we will be open every day. Have a safe and joyous holiday!

Nickel Allergy from your Ring?

Yesterday, there was an interesting article in the Wall Street journal on nickel allergy. Check it out at www.wsj.com

Nickel allergies have been on the rise in North America in recent years and now affect 24% to 36% of women and
7% to 15% of men, according to the North American Contact Dermatitis Group, which named nickel the 2008 "Allergen of the Year." Women are more likely to have pierced ears, which can facilitate a sensitivity to nickel if earrings containing the metal contact broken skin. But men are closing the gap due to the popularity of body piercing.

As with other allergies, a reaction to nickel can develop seemingly out of the blue, even years after a person's first exposure. Once the allergy is triggered, it will persist lifelong. A reaction to a particular piece of jewelry may occur suddenly because nickel salts tend to come to the surface years later, or after protective coating has worn away. "You get more exposure to nickel the older the piece of jewelry is," says Jeffrey Benabio, a dermatologist with Kaiser Permanente in San Diego. "That's why you can wear a ring for 20 years and suddenly it starts
causing problems."

More from Mr. Whiskers.....

Question of the week from the American Academy of Allergy, Asthma and Imunology website:

My Allergist tells me I am allergic to dogs and cats, but I have both at home and do not notice any increased symptoms there. Why is that?

Pets, particularly dogs and cats, tend to cause a lot of allergies. The pet allergens are found in the dander, urine and the saliva. Typical symptoms of hay fever include sneeze, runny nose, nasal congestion and itchy watery eyes. Asthma symptoms from allergens include wheeze, cough, shortness of breath and chest tightness. These symptoms are called the “early phase” of an allergic reaction. 

Several hours later the “late phase” of an allergic reaction may occur, with increased inflammation in the nose for hay fever and in the lungs for asthma. Hay fever symptoms in the late phase may be more nasal congestion and drainage. Asthma symptoms in the late phase reaction may be more mucous production and chest tightness. 

When a pet owner is exposed to a cat and/or dog on an ongoing basis, they may have an ongoing late phase reaction. While these symptoms may be more subtle, they are still important and should be taken seriously. Your Allergist will likely discuss avoidance measures with you, may prescribe medicines and may consider allergy shots, or immunotherapy. Just because you don’t notice increased symptoms around your pets, don’t be fooled into thinking they are not causing problems for you. 

It's Lonely Out Here

I have been writing this blog for a few months and would welcome ideas on how to make it more useful and feedback in general.  Please feel free to leave comments at drdruce@entcarepc.com. I am currently posting about one new item a week.

Happy Thanksgiving

It's holiday time again - the last thing you want to think about is allergy.  So here is another picture of Eartha, our yellow lab. The most allergenic dog in town!  Happy holidays!

Asthma: life-style choices?

I gave a lecture to the local hospital family practice residents this morning about asthma.  Some thoughts come to mind. It's a shame that most asthma medications are not in the $4 or $10 prescription plans.  If we were still recommending theophylline, they probably still would be. So with the cost so high it's really important to ensure that our patients are really using their medications. There are always choices, so I want to be able to help patients by advising which triggers to manage - whether allergic or physical e.g cold air or exercise.  Then provide medication choice and schedule that is realistic. We have some new diagnostic and management tools that help keep asthma under control, and can minimize the amount of drugs that are needed when possible. Also, smoking and asthma definitely do not mix.

Shortness of Breath in Exercise Not Always Asthma

Please feel free to discuss this with me. MIAMI BEACH -- Researchers suggested here that many people who are diagnosed with exercise-induced shortness of breath and asthma frequently may be misdiagnosed. In this study, patients exercised and the combination of symptom assessment, physical examination, and pulmonary function testing was used to make a diagnosis. "We found that of the 785 patients who were being treated for shortness of breath in our clinic, 362 of them -- about 46.2% -- were simply overexerting themselves," said Tim Stewart, a physician assistant at the Colorado Allergy and Asthma Centers in Denver. Another 168 people (21.4%) were suffering shortness of breath because they were not fit for the level of exercise they attempted, Stewart reported in a poster presentation at the annual meeting of the American College of Allergy, Asthma & Immunology here. Of the total, 20.9% or 164 of the patients were experiencing exercise-induced bronchospasm -- defined as a 15% drop in forced expiratory volume at one second (FEV1) in relation to exercise or drop of 10 to 15% with pulmonary symptoms. "Many people come to us with shortness of breath during exercise," Stewart said. "We try to replicate as much as possible what happened during exercise that caused their breathing problems, and what we found was that quite often these people were being treated for asthma yet they had some other problem." The researchers found, for example, that in 59 cases, patients had vocal cord dysfunction -- a syndrome that causes asthma-like symptoms as a result of abnormal closure of the vocal cords. "Exercise-induced bronchospasm by self-reported symptoms and/or clinical history without confirmation by an exercise challenge are often incorrect," Stewart said. "This may lead to the inappropriate use of asthma therapy." Stewart and colleagues reviewed findings in 328 males and 457 females, ranging in age from 3 to 68. Often symptoms appeared when patients were engaged in more than one activity, but most occurred during free runs. He said 588 individuals (75%) described symptoms while exercising outdoors; 197 people complained of symptoms that occurred while exercising indoors. In the vast majority of patients, symptoms occurred while they were running, but 22 people said they had symptoms while using a treadmill; 12 experienced shortness of breath on a stationary bicycle; three had symptoms while swimming; and two while using an elliptical device. When they presented to the clinic, Stewart said, 549 (70%) had been diagnosed with dyspnea; 261 (33%) with seasonal or perennial rhinitis; 112 (14%) with asthma, and 104 (13%) with cough. Many of the subjects had multiple diagnoses. Stewart said that among adolescents, many developed shortness of breath when they attempted to move from recreational leagues to varsity athletics, and overexerted themselves while trying to perform at a higher level than they were ready to achieve. "A lot of these individuals came to us because they were not responding to their medication for asthma," said Jerald Koepke, MD, clinical professor of medicine at the University of Colorado Health Science Center in Denver and a founder of the clinic. "Of course, they weren't responding because they didn't have asthma. In 85% of the cases we were able to decrease medication in these patients." Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered preliminary until published in a peer-reviewed journal.

Mr. Whiskers Lives for Another Day

I hope it's not a case of misery loves company, but I do tend to see conditions in groups.  Take this last week, for example.  At the beginning of the week, it was "post-nasal drip" time, and at the end of the week, positive reactions to cat.  Most people who have allergic reactions to cats know well enough that they are sensitive around Mr. Whiskers - sneezing, itchy watery eyes, or itchy skin. But for those who suffer from recurrent sinus infections, or post-nasal drip, they are often aware of any triggers.  It's in those patients that we can find positive reactions to dust, mold or pet dander. Even though you may test positive, I know it's going to be heartbreaking not to allow your kitty to sleep on the pillow anymore, but you may feel a lot better if you do.

More Food Allergy News

Remember to read food labels carefully if you have reactions to foods.

Today (Oct.27th 2009) the Colorado Department of Public Health and Environment (CDPHE) issued an allergy alert on undeclared peanuts in Dove Caramel Pecan Perfection ice cream, as it may contain undeclared peanuts and therefore people who suffer from an allergy to peanuts may be adversely affected by consuming it.

Approximately 4% to 8% of children and 2% of adults in the United States suffer from food allergies, and their numbers are rising. Risk factors associated with developing a food allergy include: A family history of allergies, elevated Immunoglobulin E concentrations, and being younger than 3 years old.

The foods that are most commonly associated with food allergies are cow’s milk, eggs, peanuts, tree nuts, fish, shellfish, soybeans, and wheat.

A severe allergy that may be life-threatening is usually classified as an anaphylactic-type allergic reaction. Many of those who suffer from nut allergies have this type of exaggerated reaction to them.

Anaphylaxis is a severe and sometimes fatal allergic reaction that presents as itching, redness, hives, wheezing, dizziness and, as it progresses (usually very rapidly) swelling of the tongue, lips and face, shock and respiratory difficulty (sometimes not all these symptoms are present, though). It requires immediate medical attention which may involve administration of epinephrine and giving of Oxygen to the patient.

A Medical Mystery: Was it a Sudden Seafood Allergy?

I love mysteries.  This is a medical one from today's Washington Post.  I see patients with food allergies frequently.  I also see many patients who think they have food allergies, and it turns out to be another condition.


Was it a sudden seafood allergy? No.
Research sheds light on dangerous reactions

By Sandra G. Boodman Special to The Washington Post
Tuesday, October 20, 2009


This cannot be happening again, Hayden Newell thought as the angry, red, ferociously itchy welts encircled his waist and spread up his arms. The 57-year-old metallurgist from tiny Boones Mill, Va., who was attending a business lunch in Florida, knew what would probably happen next: His lips would grow numb, making it hard to speak, he would become short of breath and his blood pressure would plummet: all unmistakable signs of anaphylaxis, a potentially fatal allergic reaction. Newell knew from experience that he had to get to an emergency room -- fast.
The same thing had happened a month earlier, in August 2008, an event that culminated in an early-morning ambulance ride to a hospital in Roanoke. At the time, his general practitioner suspected that Newell had developed an allergy to the oysters he had eaten the previous night. But tests revealed no shellfish allergy, so Newell had grazed at a buffet, sampling shrimp, scallops and meatballs.
What, he wondered, as a colleague drove him to a Florida ER, could be causing these frightening episodes that came out of nowhere?
The probable answer did not emerge until nearly six months later, and it seemed downright bizarre. The diagnosis, shared by a growing number of patients on two continents and described in two recent studies, has upended long-held views about an allergy previously considered rare.
"It has changed our thinking," said Newell's allergist, Saju Eapen of Roanoke."This was not something we looked for in the past."
* * *
In July 2008, Newell spent several days visiting his nephew in rural North Carolina. Three days after returning home he noticed a red spot between two toes on his left foot, evidence of a tick he had picked up while walking barefoot in the country. He extracted it and, assuming the bite had become infected, called his doctor, who prescribed an antibiotic.
Problem solved, Newell thought.
But a month later, hours after a dinner that included oysters Rockefeller and filet mignon, both of which he had eaten many times before, Newell awoke at 3 a.m. to discover that his chest and waist were blanketed by itchy hives.
"I wasn't sure what was going on," Newell said, so he got up and took a shower, increasingly alarmed by the huge, spreading welts. "I got into bed and tried to relax until morning."
At 7 a.m., while driving to his general practitioner's office, Newell realized his lips felt numb. He sat in the empty waiting room, hoping the doctor would arrive soon, while he could still talk. Instead, the nurse took one look at him, he recalled, and said, "You're having anaphylactic shock. We need to get you to a hospital right away." She called 911, and Newell was whisked by ambulance to a nearby ER, where he was given Ben-adryl and other drugs to counteract the severe allergic reaction. His doctor, thinking he might be allergic to oysters, sent him to Eapen.
The allergist performed skin tests and took blood samples, warning Newell to stay away from shellfish. A few weeks later, after tests found nothing, he was told it was safe to eat seafood. The next month was the fateful Florida buffet. This time, the hives appeared more quickly, in less than an hour.
"I figured, it's got to be some kind of seafood," said Newell, who this time had eaten crab and scallops, but not oysters.
Eapen said that at this point he wasn't sure whether Newell was suffering from a true anaphylactic reaction or chronic hives, which can cause anxiety and shortness of breath. He prescribed an EpiPen, a device that administers an emergency epinephrine injection, which he told Newell to carry at all times. Then he handed him an order for a blood test. In the event of another attack, he told Newell, doctors should test his blood for levels of serum tryptase within three hours. An elevated reading would indicate true anaphylaxis, not just anxiety.
Newell didn't have to wait long. In December, after eating chicken and beef -- but not seafood -- he was driving home from a business lunch in Norfolk when he felt the unnerving itching.
"I was thinking, 'I won't be able to eat anything,' " as he pulled off the highway and headed for the nearest hospital, he recalled. The episode did lead to one definitive answer: His serum tryptase level was elevated, which meant the anaphylaxis was genuine. But what was he so violently allergic to?
At an appointment the following day, Eapen asked a crucial question: "Do you remember if you had beef when you had shellfish?" The answer, Newell said, was yes, every time.
Eapen said he thought knew what was wrong. When the allergist asked about tick bites, Newell told him about the July incident.
Eapen took a blood sample and told Newell he was sending it to a lab at the University of Virginia School of Medicine for testing that might point to the suspected culprit: an allergy to red meat. Eapen was familiar with groundbreaking work underway at U-Va.'s allergy clinic that had found a link between a reaction to tick bites and the development of a sudden allergy to red meat, as well as pork and lamb, in people who had eaten it all their lives without incident.
A team headed by U-Va.'s Thomas Platts-Mills, an internationally prominent allergist, published a study in February detailing the cases of 24 adults who developed a sudden allergy to red meat. Eighty percent had reported being bitten by ticks weeks or months before the allergy appeared, and many had experienced anaphylaxis as much as six hours after eating red meat, a highly unusual occurrence because food allergies typically cause violent reactions within minutes.
Similar findings were reported in the Medical Journal of Australia in May by a team of Sydney allergists.
So how does a tick bite trigger a sudden allergy to meat?
Scott Commins, an assistant professor of medicine and lead author of the U-Va. study published in the Journal of Allergy and Clinical Immunology, said that in susceptible people such as Newell, a tick bite that causes a significant skin reaction seems to trigger the production of an antibody that binds to a sugar present on meat called alpha-galactosidase, also known as alpha-gal. When a person who has the antibody eats meat, it triggers the release of histamine, which causes the allergic symptoms: hives, itching and, in the worst case, anaphylaxis.
But many questions remain unanswered, said Platts-Mills, whose research is continuing. His lab has collected data on more than 300 patients from across the country and abroad.
"We're sure ticks can do this," he said. "We're not sure they're the only cause." Nor do researchers know why anaphylaxis is so delayed or why only some people develop a problem after tick bites. They do know that the allergic reaction is dose-related: Eating a tiny amount of meat probably won't cause a serious reaction. A large steak will.
Commins said researchers have also observed that people with certain blood types appear to be more at risk. Those with the rarest types -- B and AB -- do not appear vulnerable, because their blood is chemically similar to alpha-gal.
Climate appears to play a role: Blood samples from Boston and Scandinavia almost never reveal alpha-gal antibodies, which are common in samples from patients in Virginia, North Carolina and other parts of the South, as well as parts of Australia.
Testing of Newell's O-positive blood in Platts-Mills's lab revealed very high levels of alpha-gal, and other tests confirmed that after more than a half-century of eating meat, he now had an untreatable allergy. Newell is now enrolled in a large allergy study at U-Va.
Eapen can't advise Newell -- or the 30 or so other patients in his practice found to have a meat allergy -- to do much except avoid red meat, lamb and pork.
An enthusiastic cook, Newell said he misses making and eating his favorite dishes: beef bourguignon and beef Bolognese. The biggest problem, he said, is avoiding meat at business lunches, which often take place in steakhouses.
"It's probably better for me in the long run," Newell said wistfully, "but I'd still like a nice steak occasionally."
If you have a medical mystery that has been solved, e-mail medicalmysteries@washpost.com. To read previous mysteries, visit http://www.washingtonpost.com/health.

Teaching

On Thursday I am giving Medical Grand Rounds at Somerset Medical Center. My talk is called "I've got Sinus" because it's often hard to tell whether your symptoms are from your nose or your sinuses. The sinuses drain into the nose as well as the Eustachian tubes which drain from the middle ear. Patients with middle ear disease or allergic rhinitis may have ear popping as a symptom. If you have ear popping and it is bothering you, you should see your doctor.

Teach an Old Dog

I just got a talking GPS. I know (or thought I knew) my way to work every day. Last week the GPS suggested a different route, so I had a few minutes to spare and gave it a try.  I had found a new route that saves me 10 minutes!  I tried the same tactic coming back, eager for a new way!  I was routed 6 miles out of the way, and ended up on the Garden State Parkway in the rush-hour.  So the moral is....  It's never too late to try new ideas, but always be careful when experimenting.

New Content on Website

I just posted a new audiology section on our practice website http://www.entcarepc.com/.  You can also send genereal questions to ur audiologists at audio@entcarepc.com

Nonallergic Rhinitis Symptoms More Severe Than Allergic Rhinitis

Don't be surprised if you think you have allergies and your skin tests are negative.  You may have non-allergic rhinitis.  That's why I take a very detailed history - there are many different types of rhinitis.

A comparison of symptoms in patients with allergic rhinitis (AR) and non-allergic rhinitis (NAR) revealed that those with the NAR experienced worse symptoms. The findings are according to new research presented at the 2009 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in San Diego, CA.

The study assessed 78 patients with AR and 31 patients with non-allergic rhinitis (NAR), measuring quality of life (QOL) in both groups using a common questionnaire. To the surprise of the authors, NAR patients experienced a significantly higher symptom severity than their peers with AR, including having their regular and recreational activities affected, disrupted sleep, tiredness, and watery eyes.

The study's authors believe that that many patients with allergy-type symptoms may have other, as-yet-undetermined causes of their symptoms, and that further research is warranted.

Title:
Quality of Life in Allergic and Non-Allergic Rhinitis

Author:
Nick Debnath, MD; Rodney J. Schlosser, MD; Richard J. Harvey; Shaun A. Nguyen, MD, MA; Charley S. Coffey, MD; Karen M. Drawdy, PA-C

I didn't know I was on medication

In the last few days, I saw 2 patients who were taking over-the-counter antihistamines bought at one of the large warehouse stores, and they forgot to mention this when I asked what medications they were taking.  Later they remebered! It's common to think that over-the-counter (OTC) medications are not as strong or effective as prescription products.  Not so!  The 24 hour antihistamines we have available e.g. loratadine or cetirizine, are the same strength as when they required a doctor's prescription for branded prescription Claritin or Zyrtec.  When you see your doctor, don't forget to mention all the non-prescription or OTC products you are taking as well as any vitamins, hormones, dietary supplements or herbal products.  If you are on several, make a list and give a copy to the doctor for your medical record.  It will be appreciated, and make your visit more productive.

Fruit and Vegetable Allergy

 Allergic reactions to fruits and vegetables are usually mild and often they just affect the mouth, causing itching or a rash where the food touches the lips and mouth. This is called oral allergy syndrome. A number of people who react in this way to fruit or vegetables will also react to tree and weed pollens. So, for example, people who are allergic to birch pollen are also likely to be allergic to apples.

Cooking can destroy a number of the allergens in fruits and vegetables, so cooked fruit often won't cause a reaction in people with an allergy to fruit. Pasteurised fruit juice might not cause an allergic reaction either, for the same reason. However, the allergens in some vegetables, such as celery, aren't affected by cooking. Some fruits and vegetables, such as tomatoes, are more likely to cause a reaction as they get riper.

Man, it's the Grass

No, not that kind of grass.  It's grass pollen, and its still hanging around in the air of Central New Jersey.  At this time we expect only mold and weeds outdoors to tickle noses, eyes and lungs, but the grass is still there.  As proof of this I saw a recent patient who only usually experiences symptoms in the summer, when grass pollinates.  He is experiencing his worst symptoms now, and tested negative for ragweed and the other weeds in our area.  I have developed my allergy testing panels especially for Central Jersey, but also to account for heredity. Allergies are inherited. Another recent patient was Scandinavian in origin, so I was not surprised to see sensitivity to birch tree.  Also, having 2 birch trees in the back yard did not help!  For some interesting graphs of the pollen count in your area over the past month, visit pollen.com and enter your zip code.

Weekend off with a lump in my throat

In the last few days, I have seen 4 patients with a feeling of something in their throat all the time.  This may not be you, but think of silent (nonacid) gastric reflux. This was the problem for these 4 individuals who had symptoms lasting up to 5 years!  My ENT colleague can look down into the throat with a flexible endoscope, and the diagnosis can be made in minutes. This may not apply to you so please don't consider this as specific medical advice.  I"ll be back on Monday.  Have a great weekend!

Mr. Whiskers Caused my Runny Nose!

Cat Allergies (from WebMD)


Life with cat allergies -- whether they're yours or a family member's -- can raise a lot of questions. Could a cat allergy explain your son's never-ending cold symptoms? Will you regret giving in to your daughter's demands for a kitten, despite your allergies? Will a so-called hypoallergenic cat allow you to have the pet you've always wanted without making you a sneezing, sniffling mess?

Here are some answers -- what you need to know about cat allergies, from causes to treatments.

What causes cat allergies?

About 10% of the U.S. population has pet allergies, and cats are among the most common culprits. Cat allergies are twice as common as dog allergies. But contrary to what you might think, it's not the fur or hair that's the real problem. People with cat allergies are really allergic to proteins in the cat's saliva, urine, and dander (dried flakes of skin).

How do these tiny proteins cause such a big allergic reaction in your body? People with allergies have oversensitive immune systems. Their bodies mistake harmless things -- like cat dander -- for dangerous invaders, and attack them as they would bacteria or viruses. The symptoms of the allergy are the side effects of your body's assault on the allergen, or trigger.

Keep in mind that even if you don't have an actual cat allergy, your cat can still indirectly cause your allergies to flare up. Outside cats can bring in pollen, mold, and other allergens on their fur.

And what about so-called "hypoallergenic" cats? While some breeds -- like the "hairless" sphinx -- are said to be less likely to trigger symptoms of cat allergies than others, any cat has the potential to cause problems. This is true regardless of its breed, hair length, or how much it sheds. So if you know that you or another family member is allergic to cats, getting one -- no matter what the breed -- is not a good idea.

What are the symptoms of cat allergies?

Symptoms of cat allergies can include:

* coughing and wheezing
* hives or a rash on the chest and face
* red, itchy eyes
* redness of the skin where a cat has scratched, bitten, or licked you
* runny, itchy, stuffy nose
* sneezing

Symptoms of a cat allergy might develop in just a few minutes or take hours to appear. About 20% to 30% of people with allergic asthma have severe flare-ups after coming in contact with a cat.

How would I know if I have a cat allergy?

Although the symptoms of a cat allergy may seem fairly obvious, it's not always the cat that causes them. So it's a good idea to get confirmation from your doctor. After all, you wouldn't want to blame Mr. Whiskers unjustly.

Your doctor can do a skin or blood test to see if you're allergic. So the doctor may also want you to try living without a cat for a few months to see how it affects your allergy symptoms.

Is Swimming Pool Chlorine Fueling the Allergy Epidemic?

Only this morning, I saw a patient who had wheezing after swimming both indoors and outdoors.  This is a timely article.

Is swimming pool chlorine fueling the allergy epidemic?

By Megan Brooks Mon Sep 14, 10:15 am ET

NEW YORK (Reuters Health) – Swimming in a chlorinated pool may boost the odds that a child susceptible to asthma and allergies will develop these problems, a study released today indicates.

"These new data clearly show that by irritating the airways of swimmers chlorination products in water and air of swimming pools exert a strong additive effect on the development of asthma and respiratory allergies such as hay fever and allergic rhinitis," Dr. Alfred Bernard, a toxicologist at the Catholic University of Louvain in Brussels, Belgium, noted in an email to Reuters Health.

"The impact of these chemicals on the respiratory health of children and adolescents appears to be much more important -- at least by a factor of five -- than that associated with secondhand smoke," Bernard noted.

Taken together with his team's prior studies, he added, "There is little doubt that pool chlorine is an important factor implicated in the epidemic of allergic diseases affecting the westernized world."

In the current study, Bernard and colleagues compared the health of 733 adolescents, 13 to 18 years old, who swam in chlorinated outdoor and indoor pools for various amounts of time with that of 114 "control" adolescents who swam mostly in pools sanitized with a concentration of copper and silver.

In children with allergic sensitivities, swimming in chlorinated pools significantly increased the likelihood of asthma and respiratory allergies, the researchers report in the journal Pediatrics.

Among "sensitive" adolescents, the odds for hay fever were between 3.3- and 6.6-fold higher in those who swam in chlorinated pools for greater than 100 hours and the odds of allergic rhinitis were increased 2.2- to 3.5-fold among those who logged more than 1000 hours of chlorinated pool time.

For example, among children and teens who swam in chlorinated pools for 100-500 lifetime hours, 22 children out of 369 (6.0%) had current asthma, compared with those who had spent less than 100 hours (2 of 144, 1.8%). The proportions with asthma rose with longer exposure, to 14 out of 221 (6.4%) who had been swimming for 500-1000 hours, and 17 out of 143 (11.9%) who swam for more than 1000 hours.

The risk of asthma and allergy was not influenced by swimming in copper-silver sanitized pools and children without allergic tendencies were not at increased risk of developing allergies.

"The only plausible explanation" for these observations, the researchers argue, is that the chlorine-based toxic chemicals in the water or hovering in the air at the pool surface cause changes in the airway and promote the development of allergic diseases.

"It is probably not by chance," Bernard told Reuters Health, "that countries with the highest prevalence of asthma and respiratory allergies are also those where swimming pools are the most popular."

The current findings, he and colleagues conclude, "reinforce" the need for further study on the issue and to enforce regulations concerning the levels of these chemicals in water and air of swimming pools.

SOURCE: Pediatrics, October 2009.

Nasal Allergies May Dim Sex Life

Occasionally I plan to post an article that you may find interesting.  This is for a quiet Sunday afternoon....You could ask me more about this in the office!

Chronic Sneezing, Runny or Stuffy Nose May Leave Patients Feeling Tired and Less Than Sexy, Researchers Suggest

By Miranda Hitti       WebMD Health News

Sept. 11, 2009 -- Having nasal allergies may dim people's sex lives, researchers report.

Nasal allergy symptoms such as sneezing and having a runny or stuffy nose may be to blame, note father-and-son research team Michael Benninger, MD, of the Cleveland Clinic and Ryan Benninger of Miami University in Oxford, Ohio. 

"Even the simple act of kissing may be altered by these symptoms. Many people may not feel 'sexy' or may actually be embarrassed by their symptoms so that they would avoid intimate contact," the Benningers wrote in a recent edition of Allergy and Asthma Proceedings.
The Benningers analyzed quality-of-life surveys completed by 320 nasal allergy patients, 337 patients with nasal problems other than allergies, and 44 people without nasal problems.
Those surveys included a question about fatigue and another question about the extent to which the person's nasal problems affected their sexual activity.
Few people reported that nasal problems were taking a heavy toll on their sex lives. But those reports were most likely to come from nasal allergy patients.
About 17% of people with nasal allergies reported that their problem "almost always" or "always" affects their sexual activity, compared to 5% of people with other nasal problems and none of the healthy people.
Tiredness might also be a factor; 42% of the nasal allergy patients said they didn't sleep well because of their nasal problem, compared to 31% of people with other nasal problems and none of the healthy people.
The survey only had one question about sexual activity, and the answers to those questions don't identify the cause of those sexual problems.
"Although it is a single question and it does not give enough detail to identify the specific effect on sexual activity, this study does suggest that this may be a more significant problem for allergic rhinitis [nasal allergy] patients than has been identified before," the researchers write.
In the journal, Michael Benninger, MD, discloses financial ties to various drug companies; Ryan Benninger says that he has no financial relationships to disclose. The study itself was funded by the Cleveland Clinic's Head and Neck Institute.

Clinical Research Update

I just finished reviewing scientific research abstracts for possible presentation at the American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting which will be held next March in New Orleans. The research studies I saw were on the pathology of rhinitis and new treatments.  I can't discuss what was in the material that was shared with me, but I can tell you that I am quite excited about the possibility for new treatments combining existing drugs in one product, some new drugs that will be more convenient to take, and some new treatment indications. Once the abstracts are reviewed by the other reviewers, a committee will select the best ones for publication and presentation. When they are made public, I will post some useful information here.

Happy Holiday

I hope you enjoy the holiday today.  Did you see the pollen count?  Interestingly, the grass count is still high in Northern and Central Jersey.  If you are grass-sensitive and you plan a picnic today, take care!  Make sure you have your medications with you, or if you are on regular medication don't forget to take it this morning. Enjoy!

The High Pollen Count

Here is today's pollen count from UMDNJ in Newark;

Pollen Grains per cubic meter


TREES 0

GRASSES 76 HIGH

WEEDS 24 MODERATE

SPORES 12,137 HIGH

RAGWEED 57 HIGH

In fact. today's count is always yesterday's, as the count reflects exposure over the last 24hr. Not surprisingly weeds and ragweed in particular are high, as well as molds - which have been very high for most of the summer.  It's surprising that grass is still high - this is probably a carry over from all the rain we have been having. we will see if this persists tomorrow.  Follow the pollen count at your favorite website or in the newspaper.

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.

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.

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.

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 www.entcarepc.com.

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.