Food-Allergic Kids Need Current Epi Script

From the recent ACAAI Meeting

Food-Allergic Kids Need Current Epi Script

BALTIMORE — Just 30% of food-allergic children presenting to a pediatric outpatient clinic have a current prescription for an epinephrine autoinjector, with far fewer having chart documentation of how to administer it, according to a new study.
"It was a surprise," lead investigator Christopher Couch, MD, told Medscape Medical News before presenting the findings here at the American College of Allergy, Asthma & Immunology (ACAAI) 2013 Annual Scientific Meeting.
"This study started as a quality-improvement project. There's room for much improvement ― and some of those quality-improvement measures include physician education," said Dr. Couch, a pediatric resident at the University of Nevada School of Medicine in Las Vegas.
The retrospective chart review of outpatient visits at 2 pediatric resident clinics included 57 patients (mean age, 6 years).
Most of the patients, 53%, were allergic to peanut, with 30% allergic to egg, 26% to shellfish, 18% to tree nut, 5% to milk, and 4% to wheat.
Although 67% of the charts documented the prescription of an epinephrine autoinjector at some time, only 30% of patients had a current prescription, with just 18% having documentation of administration instructions, and 14% having documentation of a food allergy action plan.
The study also found that 58% had received a referral to an allergist and that 58% had undergone laboratory testing for allergy-specific serum IgE levels.
Three quarters of the patients had Medicaid insurance, and 21% were Spanish speaking.

 

There's room for much improvement ― and some of those quality-improvement measures include physician education. Dr. Christopher Couch

 

Current guidelines from the National Institute of Allergy and Infectious Diseases on the management of food allergies recommend that patients be prescribed epinephrine autoinjectors on a yearly basis, that instructions be given regarding use and administration of the medication, and that an emergency action plan be discussed with the patient and written down, said Dr. Couch. A plan for monitoring expiration dates should also be outlined with the family, he said.
"Many residents aren't aware that the prescription does expire," he added. "We have paper charts, but with electronic records, it's a great opportunity to have pop-up reminders 1 year after the prescription is written."
Dr. Couch pointed out that the results may reflect physician oversight "or could simply be a lack of documentation in the chart. We cannot conclude that the prescriptions were not filled by the patient."
Asked by Medscape Medical News to comment on the findings, Ronna Campbell, MD, from the Mayo Clinic Department of Emergency Medicine, in Rochester, Minnesota, said, "Food allergy in children is frequently a lifelong condition that requires ongoing reassessment and management. I agree with the authors' conclusions that development of quality-improvement strategies would be helpful in ensuring consistent and appropriate long-term management so that patients are adequately prepared to manage anaphylaxis should it occur."
Dr. Campbell's recent review on this topic pointed to evidence that many clinicians do not know how to properly demonstrate autoinjector use (Pediatr Emerg Care 2012;28:938-942).
"In a study of junior and senior medical staff demonstrating the use of the EpiPen, Mehr et al revealed that, in 37% of cases, the physician's demonstration would have failed to deliver epinephrine to a patient," Dr. Campbell wrote in the review. "Furthermore, 16% of the physicians would have self-injected their thumb had they been using an actual EpiPen."
Asked whether failure to prescribe autoinjectors might be related to physician lack of confidence or knowledge in this area, she said, "One could speculate that that is a possible cause, but it is more likely that it just gets overlooked because there are no systematic ways of ensuring that the prescription is renewed."
Dr. Couch and Dr. Campbell report no relevant financial relationships.
American College of Allergy, Asthma & Immunology (ACAAI) 2013 Annual Scientific Meeting: Abstract 5. Presented November 10, 2013.

Allergy Myths

Defining Allergy Fact from Fiction

The greatest allergy myths and misconceptions, debunked

BALTIMORE, MD. (November 7, 2013) – From gluten allergy and hypoallergenic pets, to avoiding the flu shot because of an egg allergy, there are a lot of common myths and misconceptions about allergies. Many might be shocking due to a great deal of false information in the media and on the Internet. And some of the misconceptions can be damaging to your health if vaccinations are skipped and extreme dietary avoidances are taken.
But where did all of these misconceptions come from? According to a presentation being given at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), previously held beliefs from medical experts and public perception are partially to blame.

“Many early medical beliefs have been proven to be incorrect as research has advanced,” said allergist David Stukus, MD, ACAAI member and presenter. “Unfortunately, some of these beliefs are still on the Internet, where an astonishing 72 percent of users turn to for health information.”

In his presentation, Dr. Stukus outlined some of the greatest allergy myths, and explained why they are false.

1. I’m Allergic to Artificial Dyes – There is no scientific evidence to support a link between exposure to artificial coloring and allergies. Controversy exists regarding evidence for artificial coloring and behavioral changes in children, as well as dyes causing chronic urticaria and asthma.
2. I Cannot Have Vaccines Due to an Egg Allergy – Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever and rabies shots. However, it’s now safe to get the flu shot, which can help prevent serious illness.
3. At-Home Blood Tests Reveal All You’re Allergic To – These tests might be able to reveal sensitization, but being sensitized to a certain allergen, like milk, doesn’t mean you’re allergic. These sort of at-home screening tests are not reliable and can often lead to misinterpretation, diagnostic confusion and unnecessary dietary elimination.
4. Highly Allergenic Foods Shouldn’t be Given to Children until 12 Months of Age – For most children, there is no evidence to support avoidance of highly allergenic foods past four to six months of age. New evidence emerging shows that early introduction of highly allergenic foods may promote tolerance.
5. I’m Allergic to Cats and Dogs, but Can Have a Hypoallergenic Breed – Unfortunately, there is no such thing as a truly hypoallergenic dog or cat. Allergens are released in saliva, sebaceous glands and perianal glands. It’s not the fur people are allergic to. It is true that some breeds are more bothersome for allergy sufferers than others.
6. I’m Allergic to Shellfish and Cannot Have Iodine Imaging – Radiologists and cardiologists often use iodinated contrast during CT scans and other procedures for better imaging. Since shellfish contain iodine, many physicians have linked a contrast reaction to a shellfish allergy. However, this is false, and a shellfish allergy has nothing to do with the reaction. In fact, iodine is not and cannot be an allergen as it found in the human body.
7. I Can’t have Bread, I’m Allergic to Gluten – You can have a gluten intolerance, but it’s extremely rare to have a true allergy. Most allergic reactions to these foods stem from wheat. Many people self-label as having gluten allergy and avoid gluten without any medical indication.

With information being widespread online via social media portals, how do you know what to believe and what not to believe?

“If you think you may have an allergy, you should see a board-certified allergist for proper evaluation, testing, diagnosis and treatment,” said Dr. Stukus. “Misdiagnosis and inappropriate treatment can be dangerous.”

The ACAAI Annual Meeting is being held Nov. 7-11 at the Baltimore Convention Center in Baltimore. For more news and research being presented at the meeting, follow the conversation on Twitter #ACAAI.

It's been too long since I posted, so this is to let you know that I am starting up again!
There's a lot of news in the allergy world, with the upcoming launch of the first steroid nose spray available over the counter in the U.S. and interesting research findings that I will share with you.
The leaves are falling, but there's still mold and ragweed in the air. This should go after the first heavy frost- but I hope this won't happen too soon!

The pollen estimate for this week

Customized for SOMERVILLE, NJ 08876, September 19, 2011. Courtesy of the Makers of ZYRTEC®.

Local Allergy Levels* Predominant Pollen: Ragweed, Chenopods and Grass.

Weather Forecast* Today September 19 Cloudy 70° 42° Tuesday September 20 Cloudy 69° 55° Wednesday September 21 Cloudy 73° 55° Thursday September 22 Cloudy 70° 70°

Advice for Treating Common Colds

From the National Center for Complementary and Alternative Medicine

Director's Page
Josephine P. Briggs, M.D.

Echinacea—What Have We Learned and Where Are We Going?

December 20, 2010

Everyone gets colds. Doctors' offices are packed with patients seeking relief from symptoms or looking to treat occasional more serious complications. There are also countless home remedies, and store shelves are filled with over the counter medicines and herbal supplements. Among the latter is echinacea—a popular herbal supplement made from the stems, leaves, or roots of the purple coneflower.

As we head into the cold and flu season, it's not surprising that the press has given a lot of attention to the NCCAM-funded study by Barrett et al. in the Annals of Internal Medicine. Although the authors noted that there were small trends in the direction of a benefit from echinacea—an average half-day reduction in duration, or an approximate 10 percent decrease in severity—they concluded that this dose and formulation of echinacea does not significantly change the course of the common cold.

These results and conclusions are consistent with a large body of previous clinical research. That studies of herbals are often not definitively positive or negative is a challenge that we are attempting to address as a major theme of our upcoming strategic plan (to be released in early 2011): the need for basic and translational research on natural products. In particular, the plan calls for better understanding of biological effects and the development of biomarkers or other translational tools prior to the initiation of lengthy, complex, and expensive clinical trials. With such knowledge and tools it will be possible to design clinical studies that test mechanistic hypotheses at the same time that we study clinical outcomes. For example, inclusion of biomarkers derived from basic and translational research would greatly increase insight, particularly into "negative" or equivocal studies.

For now, the best advice for treating the common cold is to stay home, get plenty of rest, and drink lots of fluids.

Allergists Offer Ragweed Survival Guide

Allergists Offer Ragweed Survival Guide   The start of back-to-school season also marks the start of ragweed misery for one in five Americans. Find relief from the sneezing, stuffy nose and watery eyes caused by this pesky weed. Follow these tips from the American College of Allergy, Asthma and Immunology (ACAAI):   Start taking allergy medications in early August.  Get treated for pet allergies year-round to make ragweed allergies more         tolerable. New research suggests allergies to dogs, cats or dust mites         "prime" the system, making hay fever suffering even worse.  Stay inside between 5 a.m. and 10 a.m. If you must be outside, wear a        National Institute for Occupational Safety and Health (NIOSH)-approved      N95 respirator mask.  Protect your eyes with glasses or sunglasses that fit close to your face.      Steer clear of air pollutants.

Back to Basics

It looks like Summer is here!  It's hot and humid and everything is green.  There are 4 basics of successful allergy management which I share with every patient. One is often overlooked.  Can you guess which one?
1. Avoidance - if you know what you are allergic to, and can reasonably avoid it, then cut your exposure.
2. If you get an allergeen in your nose, eyes or skin - wash it out (or off!).
3. Take your allergy medicine as directed.
4. Allergy shots (immunotherapy) can build up your immunity so your allergy symptoms last for a shorter period of time and you may need less allergy medicine.

If you guessed (2), you are right!

Often overlooked, but can make a big difference.  If your eyes are itchy and burning, use a long-lasting lubricant eye drop which does not contain any drugs.  I have several good recommendations for my patients.
If your nose is itchy, and you are sneezing a lot, use saline nasal spray or a NetiPot to wash all the bad stuff out!

Whare are you? Whare am I?

It's been a while since I've posted.  That's mainly because I don't want to post for the sake of posting! Forgive the rant! It's Monday morning at 9am and my 9am patient has not shown up!  During the past weeks I've had so many prospective patients take the first and last slot of the day, and then not show up.  If you can't make your appointment or change your plans just simply call.  You will be doing a great favor not only to me but to the other patients who can only come in before or after work.

Pet Allergies and Travel Again

Question of the Week from AAAAI

Posted 3/15/2010

How do I prepare for plane travel if I have allergies to pets?

Cats and dogs are allowed in plane cabins which for some people may cause allergy symptoms, such as itchy and watery eyes, sneezing, coughing, wheezing and hives. If you are extremely sensitive to pets, you must have a plan in place, which often may include pre-treatment of your allergy and asthma condition by your allergist. Even when you have tolerated an allergen such as from a cat and/or dog, a subsequent exposure may provoke an asthma attack or a more severe allergic reaction, at that time.

Flying with pets has caused enough of a concern that in an editorial by the Canadian Medical Association Journal, a complete ban of pets on planes was recommended. The Canadian lung association also reported that more than three-quarters of those polled in a survey wished that airlines offered pet-free flights.

It is essential to have the proper prescribed medications on hand in your carry-on if you suffer from pet allergies, especially if you find yourself soaring at 30,000 feet with pets on your flight!

Please talk to me about this if it is a concern for you.

Eczema in Early Childhood May Influence Mental Health Later

ScienceDaily (Feb. 10, 2010) — Eczema in early childhood may influence behavior and mental health later in life. This is a key finding of a prospective birth cohort study to which scientists of Helmholtz Zentrum München contributed. In cooperation with colleagues of Ludwig-Maximilians-Universität (LMU), Technische Universität München (TUM) and Marien-Hospital in Wesel, North Rhine-Westphalia this study followed 5,991 children who were born between 1995 and 1998.

---

The study has been published in the current issue of the Journal of Allergy and Clinical Immunology.
Researchers, led by Assistant Professor Jochen Schmitt of Dresden University Hospital, Dr. Christian Apfelbacher (Heidelberg University Hospital) and Dr. Joachim Heinrich of the Institute of Epidemiology of Helmholtz Zentrum München, discovered that children who suffered from eczema during the first two years of life were more likely to demonstrate psychological abnormalities, in particular emotional problems, at age ten years than children of the same age who had not suffered from the disease. "This indicates that eczema can precede and lead to behavioral and psychological problems in children," Dr. Heinrich explained.
Children whose eczema persisted beyond the first two years of life were more likely to have mental health problems than children who had eczema only in infancy.
Within the framework of the GINIplus study, scientists tracked the family history of the children, collected data on their physical health and emotional condition at age 10 years and gathered information on their daily lives. Questions were asked about the course of disease -- also in early childhood -- with special focus on diseases such as eczema, asthma, allergic rhinitis, stress tolerance and behavioral abnormalities.
Eczema is a non-infectious skin disease characterized by scaling itchy skin rashes. It is the most common skin disease in children and adolescents. Children who suffer from eczema are known to have an increased predisposition for hay fever and allergic asthma. Eczema symptoms are accompanied by a broad spectrum of secondary symptoms, such as sleep disorders.
"We suspect that it is mainly the secondary symptoms that have a long-term effect on the emotions of the affected children," Joachim Heinrich said. The authors of the study therefore recommend documenting the occurrence of eczema as potential risk factor for later psychological problems in the children's medical records, even if the actual primary disease abates and disappears during the course of childhood.

Connections

Have you ever thought what it must be like to pump gas all day long? Apart from inhaling fumes constantly, the only conversation is "Fill with regular" or "$20 of premium"...and so on.  Compare this to a visit to the barber (or hairdresser) where we try to fill the void with small talk. So now that I use the same gas station every time, I try to greet the attendant with a smile and hello and try to make some conversation beyond the needs of my gas tank. To date reward is a big smile and "my" attendant who hurries over to serve me each time I fill up.

Back Again!

It's been a while since I have posted. first, the Winter is generally quiet on the allergy scene, and there has not not been much news. Second, I follow the readership statistics and I am only seeing a few readers, so I am thinking about changing the focus of this blog to add more short comments on new drug developments, the passing scene and life in general. If you can give me feedback, I would love to know what you would like to see in this blog that you don't find somewhere else.

Scratching the Surface

From the American Academy of Allergy, Asthma and Allergy:

Scratching the surface on skin allergies

Do you often suffer from red, bumpy, scaly, itchy, inflamed/blistered or swollen skin? Dry skin, sunburn or an insect bite may be the cause. Or, you may have a skin allergy. The most common skin allergies include eczema, hives/angioedema and contact dermatitis.
Eczema
Eczema usually affects the face, elbows and knees. The red, scaly, itchy rash is more common in infants and those who have a history of allergies or asthma. Older children and adults with eczema often experience rashes on the knees or elbows (often in the folds of the joints), on the backs of hands or on the scalp.
Triggers include allergens, overheating or sweating, emotional stress, food and contact with irritants such as wool, pets or soaps.
Preventing the itch is the main treatment goal. Applying cold compresses and topical steroid and calcineurin inhibitor creams are the most effective. Antihistamines are often recommended to help relieve the itchiness. In severe cases, oral steroids are prescribed.
Hives and Angioedema
Hives are red, itchy, raised areas which may be triggered by food, latex or drug allergies. Hives can also result from non-allergic sources like rubbing of the skin, cold, heat, physical exertion or exercise, pressure and sunlight. Hives usually go away within a few days. Chronic hives can linger for months to years.
Angioedema is a swelling of the deeper skin layers that sometimes occurs with hives. Angioedema appears on the eyelids, lips, tongue, hands and feet and is typically not red or itchy-just swollen.
The allergens that trigger hives may take days to leave the body, so an allergist/immunologist may prescribe antihistamines or in severe cases, steroids. Other tips for symptom relief are cool showers, applying a cool compress or wearing loose/light clothing.
Contact Dermatitis
Contact dermatitis is often more painful than itchy. It is characterized by an itchy, red, blistered reaction from poison ivy, nickel, perfumes, dyes, latex products or cosmetics. Some ingredients in medications can cause a reaction, most commonly neomycin, an ingredient in antibiotic creams.
Allergic contact dermatitis reactions can happen 24 to 48 hours after contact. Once a reaction starts, it takes 14 to 28 days to go away, even with treatment.
Contact dermatitis can be treated by scrubbing the skin with soap and water after exposure and using prescribed antihistamine and cortisone medications. Calamine lotion, oatmeal baths/milk soaks and cool compresses can offer relief.

DID YOU KNOW?

• About 27% of children who have food allergies also have eczema or skin allergies.
• Contact dermatitis leads to approximately 5.7 million doctor visits each year.
• More than 3,700 substances have been identified as contact allergens.

To the Point

Skin allergies are painful and unpleasant but an allergist/immunologist can relieve symptoms and possibly control them.

Are you allergic to cockroach?

Banish cockroaches

A protein in cockroach droppings triggers symptoms. Clean practices can help.

• Vacuum or sweep the floor after meals.
• Take garbage and recyclables out frequently.
• Keep food in containers with tight lids.
• Wash dishes right after use with hot, soapy water.
• Clean under stoves, refrigerators or toasters where loose crumbs can hide.
• Clean stove tops, surfaces and cupboards regularly.
• Block areas where roaches can enter, such as
• • Crevices
  • Wall cracks
  • Floor gaps
  • Cellar and outside doors
  • Drains

Air Canada ordered to create nut-free zones

OTTAWA — The country's largest airline has been ordered to create a nut-free zone on flights to accommodate passengers with serious nut allergies.

The government agency overseeing airline consumer complaints on Thursday gave Air Canada 30 days to come up with a plan to create a "buffer zone" for each aircraft type when passengers with nut allergies warn them ahead of time.

In addition to proposing the size of the zone, Air Canada must also tell the Canadian Transportation Agency what it deems adequate advance notice to institute the specified nut-free area in the cabin.

The agency issued the directive in response to applications by two passengers, who argued that Air Canada lacked a formal policy to deal with travellers with peanut or nut allergies.

The agency ruled that the passengers in question, Sophia Huyer and Melanie Nugent, are considered persons with a disability, so the airline must lift any obstacles to their mobility through a formal policy.

The decision, however, provides Air Canada with an out.

The airline can suggest another option to accommodate passengers with nut allergies if buffer zones constitute an "undue hardship, such as significantly affecting the commercial viability of its service."

But any proposed policy will have to be reviewed and approved by the agency, it said in a statement Thursday.

Air Canada spokesman Peter Fitzpatrick said the airline is reviewing the newly released decision, and will have more to say later.

"We are now studying the ruling and its conclusions and we will respond with a submission within the time frame set out by the agency," he said in a statement Thursday.

Gwen Smith, editor-in-chief of Canadian magazine Allergic Living, spearheaded a campaign to get Air Canada to develop clear policies on allergies to minimize the risk of inflight allergic reactions.

Smith said Thursday she's pleased the agency has laid out a formal policy to reduce that risk after the letter-writing campaign didn't move Air Canada to act on its own.

"We need some formal policies. It really is risky. We found studies showing that up to one in 10 people with nut and peanut allergies were having reactions on flights, so this is significant," said Smith.

She just hopes the public "doesn't confuse" this decision with the debate swirling around newly instituted security-related measures and inconveniences placed on airline travellers.

"What people need to know is that this is not over the top. There are real reasons when you're 35,000 feet in the air and you have the kind of medical condition that can come on incredibly rapidly, this is sort of akin to somebody having a heart attack, and in fact that can be a symptom of anaphylaxis," said Smith.

Air Canada does not serve peanuts on any flights, but it does serve other nut snacks. Almonds and cashews can also be purchased from its On Board Cafe.

During the proceedings, the airline argued that it would be impossible to guarantee that meals served on flights are free of peanuts or other foods to which a person may be allergic; some meals are prepared by sub-suppliers, Air Canada pointed out.

Besides, the airline can't be responsible for passengers who may bring peanuts or other nut products on board, Air Canada argued.

In its decision, the agency says it recognizes that "for operational reasons," it may not always be possible to provide a buffer zone when a passenger does not provide advance notice.

In such instances when advance notice is not provided, and where Air Canada is unable to institute a nut-free zone at the last minute, the airline could place the passenger on the next practicable flight to give it time to institute a buffer zone, the decision states.

I wonder when airlines will create dust-free zones ... and noise-free zones... and mold-free zones.........

More on Cat Allergy

Why are cats so allergic? One reason is that we get closer to cats than to other furry pets. That's why I ask how many cats you have. The record so far is 14. Can you beat that? I then ask if the cat comes into your bedroom. Does the cat jump on the bed? Does the cat sleep on your pillow? If you cannot bear to dismiss Mr. Whiskers from your bedroom, then change the bedlinen frequently, and wash your bed linen at a high temperature often so remove the cat protein.

Winter Reflections and To Do List

Happy New Year! It's cold out and the pollen counts are down to virtually zero. In fact many pollen counting sites shut down until the spring. So it's actually a good time to think about planning for the upcoming Spring and Summer. If you were thinking of starting on allergy shots, please remember that it will take a while for you to build up the dosage to the final maintenance dose, so starting now would give you a head start and the prospect of significant relief by the Summer.  Also, all the environmental control measures that I talk about for dust and mold take a while to deliver their maximal benefit, so there's no day like to today to start!   When you spend time indoors with the heating on, your environment is often drier than at other times of year. Low humidity is a common reason for nasal symptoms, so you might want to check the humidity in your house by buying an inexpensive hygrometer.

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!