Tuesday, March 29, 2016

What Are Hives?

What Are Hives?

Hives, or urticaria, are itchy red bumps that often feel like your body is under attack. Approximately 20% of people will have an episode of hives at some point in their life.   There are many causes but all result from the release of a chemical in your skin called histamine.  The presence of free histamine in the skin causes welt like marks (hives) that are intensely itchy.  Sometimes there are specific triggers and other times, hives appear randomly leaving you covered with itchy red marks.  These attacks leave patients feeling helpless, itchy and desperate to find a cause and solution. 

What can you do if you have hives?  The first step is to try to identify the cause and learn what your triggers are.  Gramercy Allergy and Asthma  is here to help! Gramercy Allergy and Asthma  is a referral center for difficult to treat hives in NYC.  We’ve see all types of causes of hives and can help you get them under control.

What Are The Types of Hives?
1) Acute Hives
  • Last for less than 6 weeks in duration
  • Can be caused by allergic reactions like foods, food additives, medications, sunlight, bug bites, medications, infections or other medical problems like thyroid disease
  • Look like welts, redness and flushing in the skin.  Are often associated with burning, itching and heat.

2) Chronic Hives

  •  Are similar to acute hives, but last for more than 6 weeks in duration
  •  Occur daily to several times per week
  •  There's often no identifiable trigger of the hive and they occur randomly over the entire body.
  •  For some, hives are triggered by infection, thyroid disease, inflammation in the body,                exercise, sunlight, auto-immune disease, cold temperatures, vibration and other non-specific triggers like food preservatives and dye.

What should you do if you have hives
  • See your allergist.  They will help you to identify the cause, and establish treatment for you.
  • You should expect them to take a detailed history of potential causes, possibly test you for triggers, and check your blood for other potential causes.
  • There are medications that can help stop hives including antihistamines, leukotriene blockers and for some medications like omalizumab, anti-bodies to the IgE trigger of hives.  
Want Gramercy Allergy's help in treating your hives?  Gramercy Allergy is a referral center for difficult to treat hives and we are here to help.

Want more information on hives?  http://acaai.org/allergies/types/skin-allergies/hives-urticaria

Click here to schedule an appointment or visit our website gramercyallergy.com.

Tuesday, March 15, 2016

What's New In Skin Allergy in NYC?

I just returned from the American Contact Dermatitis Society 27th Annual Meeting  in Washington DC. This entire day was focused on new and emerging trends in skin allergy including hot topics in contact dermatitis. I was surrounded by experts from around the world in contact dermatitis- we shared patient stories and brainstormed about difficult cases.  I learned so much and am excited to bring back this information to you my patients in NYC.

One exciting new development for my patients with contact dermatitis is the introduction of the American Contact Dermatitis Society's new app for CAMP.   It's a free and easy way of using your product list in stores.

If I've created a safe product list for you, put your search codes (found in the upper left hand corner) and you're set to go.  A word of caution, as products formularies are updated, the list won't automatically update.  This app is easy to use and you can create favorite lists of your "safe" products.  I  know you'll find this helpful and a welcome addition to your safe list.

Some of the topics discussed were: 
Emerging sensitizers in contact dermatitis
The role of the skins microbiome in the development of contact dermatitis
Phenylenediamine allergy
Patch testing in pediatric patients
Food patch testing

Announcing the Contact Allergen of 2016!Announcing the Contact Allergen of the Year

There they announced the 2016 contact allergen of the year- Gold Sulfate.   More on this from the blog coming soon.  These contact allergens are important sensitizers in our personal care products. One in four people are sensitized to commonly used products like shampoos, soaps, make ups and lotions.

Past winners have included:

I also learned that VMW hypoallergenics is introducing a Superskin-starts-here Set for people recently diagnosed with contact dermatitis.  This is designed to get you started with sample size products to reduce the possibility of irritation.@VMVinNYC

I'm brought back all of this information back to the practice and am excited to help those with skin allergy.

Schedule an appointment if you need help with your difficult to treat skin with our office.  Schedule an appointment here


Sunday, March 13, 2016

What's the Best Way to Tackle Springtime Allergies in NYC?


Warmer temperatures in New York this weekend has everyone day dreaming about NYC spring! Longer days, more sunlight and being outside with friends and family bring about smiles and spring fever.  We shed winter coats and sweaters in place of smiles, light scarfs and lots of outside activities.  But for one out of seven people, spring pollen hovering in the air trigger asthma  and allergy. 

What can you do this year to put yourself on the attack mode against pollen so you can enjoy NYC spring?

Don't let the pollen get you down! Here are 5 tips to springtime allergies in NYC.

Get Tested

Knowing what you’re allergic to and what triggers your symptoms is the first step to avoiding the offending pollen.  Skin testing is an office procedure where small amounts of various allergens are put on your skin (typically arm/back). Reactions take place typically within 30-45 minutes, but some can have a delayed reaction up to 8-10 hours later.  A local reaction will tell you what is causing your reaction.  There are many non-medical ways of avoiding allergens and your allergist will create a specific plan for you based on your testing results.


Follow the Pollen Counts

Check the weather report daily?  Then take a peak at what's happening with the pollen in your are.  Pollen.com and weather.com are some of my favorites for keeping tabs on local levels.  Be advised, tree pollen in NYC is already on the rise!

Start Medications Early
Overwhelmed by the number and variety of over the counter allergy medication in the drug store?  Your not alone!  Your allergist will help you create a plan of when to start medications, and which medications work quickly. They'll help to insure you aren't taking more than you need to control your symptoms and that you are aware of the side effects.  Taking allergy medications early and as directed can prevent you from developing severe symptoms that can interfere with your work, school and life.  

Rock Your Shades
Always pack and use sunglasses this spring in NYC.  Glasses help protect your eyes from airborne pollens and dust.  This will help stop itchy watery eyes without the use of medications.

Amp up Your Moisturization Regimen
Your skin is your first line defense against pollen.  Keeping  skin well moisturized can help prevent pollen from triggering an eczema flare. If you have pollen induced eczema, make sure you turn down the water temperatures in your shower and wash your face after spending time outdoors.


Change Your Routine
Showering at night will help wash away airborne tree pollens off your hair so you aren’t carrying them into your bed at night.  Tree pollens are highest in the morning.  Change your exercise routine from morning to evening to help naturally decrease your exposure to tree pollen.

Visit Gramercy Allergy for more specific advice on how to tackle spring pollen!

Want more specific advice on surviving New York’s Allergy Season?  Visit our website http://www.gramercyallergy.com or click here to schedule an appointment online.


Sunday, February 21, 2016

What is Paraben Allergy?

The FDA doesn’t regulate the chemicals in cosmetics and it’s up to consumers to be aware of the chemicals we put on and in our bodies on daily basis.  More and more, people are experience allergy to their cosmetics and personal care products.  These reactions cause itchy red swollen skin. As a cosmetic allergist, I have many patients who are a loss for what’s triggering the reaction. They know that certain lipsticks make their lips dry and irritated or sometimes a shampoo will trigger itchy dry irritated skin, but are confused about the exact cause.  This type of allergic reaction is called contact dermatitis.  

One common allergen in personal care products that triggers an itchy eczematous rash is parabens. 

What are Parabens?
  • Parabens first introduced in the 1920’s are preservatives to help prevent bacterial and fungal growth.  Since their introduction, they’ve become some of the most common preservatives uses. 
  •  Parabens come from an aromatic organic acid naturally found in fruits and vegetables called 4-hydroxybenzoic acid.  This forms the basis for parabens.
  •  There are many types of parabens, but the most commonly used ones are methylparaben, propylparabens and butyl parabens.  These types of parabens are often mixed into one product type to provide broad spectrum protection against microorganisms.  Manufacturers do these to reduce the concentration of each one individually but provide the same type of preservative effect.

  • Parabens can also cross react with chemical commonly used in sunscreens – para-aminobenzoic acid (PABA) esters, and in hair dye (paraphenylenediamine).
·      Parabens may also go by these names:
o   Methylparaben
o   Ethylparaben
o   Propylparaben
o   Butylparaben
o   Benzyl-parahydroxybenzoate (p-hydroxybenzoate)
o   Methyl-parahydroxybenzoate (p-hydroxybenzate)
o   Ethyl-parahydroxybenzoate (p-hydroxybenzoate)
o   Propyl-parahydroxybenzoate (p-hydroxybenzoate)
o   Butyl-parahydroxybenzoate (p-hydroxybenzoate)
o   Parahydroxybenzoate (p-hydroxybenzoate)

Where do you find Parabens?
  • Parabens in personal care products:
    • According to the American Chemical Society, they are used in almost 85% of all personal care products.  Common products like toothpaste, shampoo, lotions, sunscreens, moisturizers and lipsticks contain parabens.  They are also found in some topical medications like corticosteroid creams and anti-itch sprays. 
  • Parabens in food products:
    • You might be surprised to learn that parabens are added to food products like: pancake syrup, mayonnaise, salad dressing, baked goods, candy, food dye, soft drinks and fruit juices, spiced sauces, processed vegetables, and jams/jellies
    • Parabens are also found naturally in food products like mango, blueberry, mango, strawberries, cocoa beans, carrots, vanilla, and onions.
    • You can also find parabens naturally in some wine and beer products.

What is Paraben Allergy?

  • Repeat exposure to skin, particularly damaged skin, but parabens can trigger an allergic reaction called contact dermatitis.
  •  According to a 2015 study by Warshaw et al, parabens caused anywhere from 1.4% of of all contact reactions. Exposure to parabens can cause your skin to become dry, itchy and swollen.

What Should you Do if You Suspect You Are Allergic to Parabens?
  • If you suspect you have paraben allergy, speak with your allergist about having a special chemical allergy test done called patch testing. 

How Can you Avoid Parabens?
  • If you have paraben allergy, then you should strictly avoid any product or food that contains these chemicals
  • Reading ingredient lists on your personal care products and food labels will be essential to preventing a future reaction.
  • Using products that are oil based will help limit your exposure
  • Be especially careful with sunscreens, processed foods, topical medications and other unexpected sources of parabens.  
  • If you visit gramercyallergy, we will generate a paraben free list of products you can safely use. 

Have further questions regarding paraben allergy or suspect you have paraben allergy?  Visit GramercyAllergy. We are experts in cosmetic allergy.  We will help identify which cosmetic product is triggering your allergy. 


Monday, February 1, 2016

How To Make Chemical Free Cleaning Products


Does cleaning make your nose stuffy or trigger you to have an asthma attack?

As spring approaches, many of us are planning doing spring cleaning.  This is a dread for many with difficult to control asthma and allergies. Cleaning with strong chemical scents and fragrances triggers chest tightness, sob, and nasal congestion; for some it can land them in their doctors office or even lead to an emergency room visit.  They have difficult to control asthma and are frustrated by the these easily avoidable triggers.  They worry about the impact of these chemicals long term on their nose, lungs and skin.  Or they just want to reduced their overall chemical exposure for themselves and their family.

Here are some “home made” cleaning products that you can use to avoid the potent products available in the drugstores. These recipes can be made with simple products like white vinegar, borax, dishwashing soap, and water.  You'll need several labeled spray bottles to start.  You can purchase these from the dollar store.  

These easy to make products will keep your home smelling fresh while eliminating fumes and irritants that might trigger your asthma. Some people like to add a natural scent by using a drop of lavender or jasmine oil to the mix.  You can purchase these in a health food store.

If you do have to use strong products, make sure the area is well ventilated, you use the recommended amount, and you take frequent breaks.  It's helpful to use a mask as well.

Enjoy and happy cleaning!

Glass and mirrors:
  • 3 tablespoons of white vinegar + ¾ cup of water. Mix in a spray bottle
  • 2-3 drops of dishwasher soap, 3 tablespoons of white vinegar. Mix with water in spray bottle.
 Disinfectant for Toilets:
  • 1/4 baking soda + ½ cup white vinegar + 1 gallon of warm water
  • 1 can of coca cola (yes this does say coca cola- cola has the same acidity as  bleach!)
Mold and Mildew:
  • 1 tablespoon baking soda + 2 tablespoons White vinegar + 1 quart of water.  Mix in a spray bottle.
  • 1 cup white vinegar + 1 gallon hot water mixed in a bucket

You can book your appointment here.

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Wednesday, January 27, 2016

Help the American Academy of Allergy Allergy Asthma and Immunology Save Patient access to Allergy Shots.

The American Academy of Allergy, Asthma & Immunology (AAAAI), a professional membership organization of more than 6,800 allergist/immunologists, is spreading the word that newly proposed regulations from the United States Pharmacopeia (USP) could dramatically limit patient access to allergen immunotherapy (allergy shots).
Help the AAAAI save patient access to allergy shots. Sign this petition to let USP know they should keep the existing requirements in place—and not move forward with these new proposed regulations.
What are allergy shots and who is proposing these new regulations?
Allergy shots, also known as allergen immunotherapy, are an important treatment for allergic diseases that has substantially improved patient care, reduced emergency room visits, decreased medication costs and decreased hospitalization.
As mentioned above, the new regulations are being introduced by the United States Pharmacopeia (USP). There is no data in the peer-reviewed medical literature that allergy shots have ever caused infections in patients, but this is the concern driving USP to propose these new guidelines.
Sign the Petition! #saveallergyshots
If these new regulations go into effect, how will it impact patients?
The more extensive procedures for mixing under the new regulations would make it highly unlikely that allergists would be able to continue to mix allergen extracts for their patients in the office setting.
Non-healthcare system employed physicians will have very limited options to secure allergy immunotherapy prescriptions for their patients. There are only two facilities that have been identified as resources for this service in the United States. Having to use outside facilities may limit the timelines of allergy shot treatment, among other consequences. Also Medicare currently does not cover allergen immunotherapy manufactured by a third party vendor. Thus, Medicare recipients, and potentially commercially insured patients, would no longer have allergen immunotherapy as a covered service. USP’s proposed requirements would directly transfer the cost of a previously covered benefit to the beneficiary. 
Sign the Petition! #saveallergyshots
What can I do to prevent these regulations from going into effect?
Again, sign this petition to let USP know: 1) you are concerned about how these proposed changes will impact patient access to allergen immunotherapy and 2) they should keep the existing requirements in place.
Sign the Petition! #saveallergyshots
Want more information about allergy shots and how they work?
Gramercy Allergy and Asthma hopes you gain control over your allergies in the new year.  We are here to help.   Call the office or click her to schedule an appointment.

Tuesday, January 12, 2016

Why Should You Get Control Over Your Allergies in the New Year?

January is a time of resolutions and change.  The air is always a buzz with self reflection, inspiration, and people taking stock of their lives.  It's a time to ask yourself what's going well and where do you want to improve your life. The change in the calendar inspires us all to start fresh and change.  We tell our friends and family of our goals for the year hoping they'll support and encourage us.  These resolutions help drive the course for the new year and act as reminders of who we want to be and how we want to fill our year.

What are 5 reasons that getting control of your allergies may be one of the best decisions you make for 2016?

Uncontrolled Allergies Affect Our Day-to Day Life.
Those who suffer from allergies know how to well the social embarrassment of being on a day with a runny nose, a business meeting where you can stop sneezing our having to cancel a day to the park because of an asthma attack.  Allergies sufferers are often thought to have recurrent colds and to be sick all the time.  Allergies change our voice and the authority and confidence we present ideas with in meetings or school.  Asthma attacks and food allergies drive us to the emergency room every year.
Knowing what is triggering your symptoms and having a plan for prevention puts you back in control over the cause of these attacks. An allergist and immunologist will help you determine a specific plan to prevent your symptoms.  Treatments for allergies including action plans, environmental control measures, medications and immunotherapy (allergy shots).


Uncontrolled Allergies affect our sleep.
Daily fatigue and poor sleep is a common complaint of those who suffer from allergies.  Children and adults have difficulty concentrating during the daytime secondary to poor allergy control.  Nasal congestion during sleep and waking from sneezing can trigger snoring and sleep apnea.  Uncontrolled asthma can cause a persistent dry cough and frequent interruptions in your sleep cycle. Both of these disease leads to "allergic" inflammation that makes many feel groggy and tired.  Improved control over your asthma and allergies will improve your energy levels and focus.


Uncontrolled Allergies and Asthma are Preventing you From Exercising
So many of my patients tell me that they want to start to exercise, but feel they can't because of uncontrolled asthma or hives with exercise.    Asthma and hives are often triggered by exercise.  You don't have to have asthma at any other time other than during exercise to have exercise induced asthma.  Symptoms include chest tightness, air hunger, cough and shortness of breath.  Seeing an allergist will help you get control over your exercise induced symptoms so you can exercise and do the activities you want to do like hiking or run a race.

Your Allergies are Causing Skin Problems
Did you know that 12-17% of the population is affected with skin allergies including eczema  and chemical allergies.  Skin allergies cause social embarrassment, sleep disruption, and change the way we interact with others. Every day we put over 200 chemicals on our bodies that can cause allergic sensitization over time.  Treating skin allergies with topical steroids is only a band-aid approach- it stops the reaction, but does nothing to prevent it from happening in the future.    Knowing what is triggering the eczema or rash on your face and avoiding it can stop the cycle.  Seeing an allergist advice will help you determine the cause of your rash and how to prevent it from starting.


You Want to To Get Back to Nature
Many who suffer from allergy tell me how they dread the spring, summer and fall because despite wanting to go and enjoy nature, they get terribly sick from trips to the park, golf course, and being outside with their friends.  They say no to social engagements for fear of an allergy attack. They change the way they date because they are allergic to cats and dogs.  They suffer from "sinusitis" every spring and fall and have to take multiple courses of antibiotics before feeling well.Seeing an allergist now can help you put together a plan to prevent your symptoms.  Knowing what triggers your symptoms is the first step to taking back your life from you allergies.

Good luck with all of your resolutions in 2016! Gramercy Allergy and Asthma hopes you gain control over your allergies in the new year.  We are here to help.   Call the office or click her to schedule an appointment.