Itchy and Scratchy all Over- Paraphenylenediamine What???

Over the past 2 weeks I've had 2 interesting patients with prolonged episodes of a severe rash all over her body and/or itchy eyes.   Even after a good history we were both left scratching our heads. The cause of the rash was a mystery. 

We applied a patch test looking for chemical that might be causing the reaction.  And what did we find?  They were both highly allergic to a molecule called para-phenylenediamine (try to say that fast 3 times in a row), also called PPD.   Both episodes of the occurred after dying their hair!

PPD is a chemical commonly used in permanent and semi-permanent hair dye because it gives the hair a natural color.

You can find PPD in:
* Permanent hair dye          * Semi-permanent hair dye
* Henna Tattoos                 * Textiles
* Fur dyes                          * Dark Colored Cosmetics
* Black Rubber                  * Photocopying and printing inks

This is a common allergy and affects almost 9% of the people we look for with contact allergy.  This is increasing in prevalence over the years.  We aren't sure why, but some possible culprits are:
- earlier use of hair dye at an earlier age
- common placement of henna tattoos
- more individuals (including men) are dying their hair (and beards) at home

How can you tell your hair dye has PPD?

* The easiest way is to look to see if there are 2 bottles in the kit.  PPD has to be "activated" by a 2nd compound, typically hydrogen peroxide. 
* You can also read the ingredient list. 
And if you can't learn to love those gray hairs?

- Always test your self with the hair dye before applying it and
-Tell your hair dresser of your PPD allergy.
What are some safe hair dyes that are PPD free?
* Lady Grecian® Formula
* Temporary Color Spray
* Clairol® Loving Care Hair color
* Vegetable-based hair dyes such as juglone from walnut shells
* Jerome Russell’s Color Mousse
* Grecian® Formula
*Sun-In®, Spray-In Hair Lightener

That time of the year....off to camp!

Canoeing, care packages, horseback riding, sleeping out doors, that's right, it's almost time to leave for camp. It is such an exciting time for so many families.

 

For kids with food allergies or insect allergies, it can be just as scary as it is exciting.

 

Allergic reactions to food and insects don't have to be paralyzing though. Developing an action plan for what to do in case there is an accidental ingestion or insect sting before your child leaves for camp can empower your child to have control over their allergy.

•  Review signs and symptoms of an allergic reaction
•  Make sure your child and the nurse know what causes the problem.
• Consider getting a bracelet or necklace that will alert others to the
• problem
• Send adequate emergency medicine with your child and/or to the nurse.
• Teach your child how to use their emergency medication

 Here is a great template for an action plan that you can print out, complete, review, and send with your child.

 

Anaphylaxis Plan- English
Plan de emergencia para anafilaxis- Espanol

 

Knowing is power!  Have a great time at camp!

Practical Pointer

Check out this practical pointer I wrote in The Consultant.

Hope it helps you to remember to take your medication!
http://www.consultantlive.com/display/article/10162/1494277

Haste makes Waste

This old adage is true for allergies as well...




Don't delay in starting your allergy medications before the pollen counts rise.



Waiting too long to take allergy meds is one of them most common mistakes allergy suffers make. Then you are behind the ball!



Instead, prepare by taking medication that has worked for you in the past just before the season starts.



Pay attention to the weather: When winter weather turns warm, pollens and molds are released into the air.



Start treatment prior to exercising. Most medications take about 30 minutes to work.





Good luck in surviving the season and let me know if I can help!



Jennifer Collins, MD

380 2nd Avenue, NY NY 10010



646-438-7893

Did you know?

Have you found out what you're allergic too?


Did you know that more than 75% of people with seasonal allergies actually have mild symptoms all year round that they tolerate.

Just because symptoms are mild, you should know what is causing your allergy. All the more reason to see an allergist and get tested!

Can you guess what might be causing your problem? Here's what's blooming/present when throughout the year.

• Tree, grass and ragweed pollens thrive on cool nights and warm days.
• Molds like heat and humidity.
• Pollen levels tend to peak in the morning hours.
• Rain washes pollen away, but their counts can soar after a rain.

• On a day with no wind, airborne allergens are grounded.

• When the day is windy and warm, pollen counts surge.

Moving to another climate to avoid allergies is usually not successful – allergens are virtually everywhere.

Let me know if I can help!

Jennifer Collins,MD

380 2nd Avenue, NY NY 10010

646- 438-7893

Kaboom! The pollens are back....

The trees in NYC exploded this week with pollen- everywhere I look I see people with red tearing eyes, sneezing on the street, and runny noses.

While it is more socially acceptable to have allergies than a springtime cold, no one wants to be around any one who's pouring out mucous!

How can you conquer your allergies?
Know what you're allergic to and try at best to avoid it. 
See your allergist to get tested so you don't throw money away on less effective over the counter medications.

It's difficult this time of year if tree pollen is your nemis.  After such a long winter, everyone wants to soak up as much of the sun and fresh air as possible.  Makes it tough though if you can't breathe through your nose.

Using medication at least 30 minutes before you encounter the pollens will help keep you breathing normally.



Let me know if I can help!

Jennifer Collins, MD- 380 2nd Avenue, 9th Floor NY, NY 10010
(646)-438-7893

Spring time Allergy Tips

Over the next 2 months I'll be providing daily- weekly tips on how to conquer your allergies.

Stay tuned for ways to keep you less itchy & scratchy!

Jennifer Collins, MD
Allergy/Immunology

Asthma Medications To Be Withdrawn from the Market

Pay attention to the below alert for asthma medication that will be withdrawn from the market over the upcoming months.  If you are on one of these medications, please see your doctor to have your medications changed.

The affected products, manufacturers and their phase out schedule include:
· Tilade Inhaler (nedocromil; King Pharmaceuticals) -- June 14, 2010

· Alupent Inhalation Aerosol (metaproterenol; Boehringer Ingelheim Pharmaceuticals) -- June 14, 2010

· Azmacort Inhalation Aerosol (triamcinolone; Abbott Laboratories) -- Dec. 31, 2010

· Intal Inhaler (cromolyn; King Pharmaceuticals) -- Dec. 31, 2010

· Aerobid Inhaler System (flunisolide; Forest Laboratories) – June 30, 2011

· Combivent Inhalation Aerosol (albuterol and ipratropium in combination; Boehringer Ingelheim Pharmaceuticals) – Dec. 31, 2013

· Maxair Autohaler (pirbuterol; Graceway Pharmaceuticals) – Dec. 31, 2013

After those dates, these medications will not be sold or distributed in the United States. Dr. Chowdhury acknowledges, especially in the case of Combivent, that patients with COPD may experience additional costs from co-pays on individual inhalers as opposed to the combination, but a greater good is in consideration. Additional time is also granted for Maxair to allow patients to become reaccustomed to a non-breath activated inhaler. He noted "the phase out of these chlorofluorocarbons is an example of how international cooperation will help mankind."

Patients using the inhalers scheduled to be phased out are advised to talk to their health care professional about switching to one of several alternative treatments currently available. Until then, patients should continue using their current inhaler medication.

Kick Butts Day March 24, 2010

Kick Butts Day is a day of activisim to encourage youth to take action against tobacco.


Check out the website for details for more information and local events. www.kickbuttsday.org

Weekly Pollen Counts

Looks like the pollen counts are starting to rise!

Customized for BROOKLYN, NY 11211, March 15, 2010

Courtesy of the Makers of ZYRTEC®.

Predominant Pollen: Maple, Cedar/Juniper and Elm.

Predominant Pollen: Maple, Cedar/Juniper and Elm.

Monday High Low 55 41 Monday, March 15, 2010	Tuesday High Low 46 39 Tuesday, March 16, 2010	Wednesday High Low 53 42 Wednesday, March 17, 2010	Thursday High Low 56 43 Thursday, March 18, 2010

The information contained in these reports is provided by third parties for informational purposes only, and does not represent a guarantee of accuracy or an endorsement, direct or implied, by McNeil Consumer Healthcare, a Division of McNEIL-PPC, Inc.

Remember to visit ZyrtecProfessional.com for free product samples, patient education materials and more!

You are receiving this email because you are subscribed to the Weekly Allergy Outlook Program from McNEIL-PPC, Inc. Please click on the link below and follow the instructions to be excluded from future email communications about the Weekly Allergy Outlook Program. Unsubscribe.

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Asthma Management 101

Spring is about to be sprung in NYC. The daffodils are just poking there sprouts through the ground this weekend and there really isn't a more beautiful time in the city.

Along with the beautiful weather comes, lots and lots of tree pollen, and we should see the counts start to rise in the next few weeks.

As the pollen counts rise, in many people so do asthma symptoms. I wanted to review with you how to tell if you asthma is controlled or not.

1) Cough
-Do you cough more than 2 x per week?
-Do you have more than 2 night time awakenings because of cough?

2) Chest tightness and shortness of breath
- Do you have these symptoms more than 2 x per week?

3) Rescue Inhaler Use
- Are you using your rescue inhaler more than 3 x per week?

4) Quality of Life
- Do you feel your symptoms are interferring with your everyday activities, work or school?

If you've answered yes to any of these questions, it's a good idea to touch base with your doctor to tune up your regimine before the pollen counts become elevated.

Let me know if I can help!

Doctor, I looked like Dr. Dolittle!

I hear this complaint at least weekly in my practice. Patients come in with horror stories & pictures of their lips, eyes or ears kept swelling to the point that they looked like Eddie Murphy's character in Dr. Dolittle. So what's going on?

Most commonly, they are having an allergic reaction called angioedema. Angioedema is a transient, non-pitting, localized swelling of the subcutaneous (just beneath the skin) or mucosal tissues.

This is most commonly from:
- food (kids- eggs, milk, peanut, and adults- tree nuts, peanut, shellfish, and fish)
- drugs (most commonly ACE inhibitors (blood pressure medication), aspirin, or ibuprofren), or
-environmental allergens (air born allergens like pollens).

What does that mean? basically, hives form on areas of the thin skin allowing an watery (exudative) like fluid to fill the space. Because the skin is thin, it easily swells and grows in size leading to the Dr. Dolittle look. You might also experience nausea, abdominal paint, hypotention, and itchy eyes.

Up to 15% of the population will experience an episode of angioedema. There are other genetic and aquired conditions that cause angioedema, but these are much rarer than an allergic reaction.

If you have an episode of angioedema, take an antihistamine (like benadryl) and seek medical help. You should be evaluated by an allergist/immunologist to determine the specific cause.

Wait, I'm allergic to honey dew?

Interesting case the other day....

Patient tells me everytime she eats honeydew, her mouth and throat start itching and she thinks she's allergic.

We do skin testing and ragweed pollen is very positive.

So what's going on?

This something called Oral Allergy Syndrome. It's most common with people who are allergic to birch pollen who eat tree fruits, like apples, pears, and cherries. Basically, a protein in the birch pollen cross reacts with proteins in these tree fruits. Similarily, honey dew cross reacts with ragweed pollen.

There are lots of other examples including:
- zucchini and ragweed
- asparagus and ragweed
- fig and grass

These proteins are denatured with heat & cooking the fruit or vegetable prevents to allergic reaction. In some people, just peeling the fruit or vegetable will solve the problem, as most of the allergenic proteins are located in the skin.

In most cases, people with oral allergy syndrome won't progress to anaphylaxis, however, we still recommend avoiding the offending food, unless it's cooked.

There is some evidence that immunotherapy with the cross reacting pollen can help treat oral allergy syndrome, but we still need more data.

Need more help?  Please visit Gramercy Allergy and Asthma at 205 East 22nd Street, New York, NY 10010

Food Allergies 101- The Juries Still Out

I get asked all the time, "Why are food allergies more common these days?"

But is that really true, or are we just more aware of food allergies? It's an interesting question that was tackeled by Branum and Lukacs in this months issue of Pediatrics.

They looked at the databases from the national Center for Health Statistics for the incidence of food allergies and eczema. They found increases in food allergy and eczema in children from 1997-2007.

In which population were food allergies most prevalent? Non-Hisapnic White and Black and Hispanic Children had the highest prevalences.

While the number of outpatient visits for food allergy evaluation almost tripled during this period, we still don't know if we are diagnosing more food allergies or if the incidence is actually increasing.

Stay tuned!

Practice Makes Perfect

Great you're well on your way to dare I say, a person who exercises regularly!

You're at the 2 week mark and things must be getting easier. I'm sure you've noticed an increase in your endurance, improvement in breathing, energy level and mood. Better yet, are you noticing muscles and a new shape to your body.

Practicing exercise just like everything else makes it perfect.

Don't forget, keep site on those goals you set out 2 weeks ago. Is it time to set new ones? I say go for it! Reward yourself for sticking to your plan.

Keep up the great work!

What's your Goal?

Congrats on comitting to yourself to exercise! That is the first step on a life long journey to living a healthier lifestyle. Now that you've said you will do it, how do you figure out what's a safe amount?

Are you a total couch potato that thinks exercise is walking to a from the bathroom during commericials? Or a regular gym goer that wants to add a little umph to their routine to lose those last few pounds?

Really be honest with yourself about where you are and where you want to be in 2 weeks time (yes, you will notice improvement in as little as 2 weeks!). If you are really out of shape, talk to your doctor to determine a specific safe plan for you.

Set a realisitic goal. Write it down.

*If you're totally out of shape, start with 2 minutes of walking in place in the privacy of your own home. Every other day, add 2 minutes onto this.

* Totally buff and tough, committ to taking a new class at the gym or working out with a friend you know will push you. Try a new activity to startle your muscles.

Stick with this for the next 2 weeks and you'll notice your new activity feels pretty comfortable & possibly you're pants are a little looser.

Exercise and the Immune System- An Added Benefit

Immune what? This is a typical question that people ask me after I tell them what I do for a living. Your immune system is how your body fights off infections (bacterial, viral or fungal) on a regular basis.



As New Yorkers, we are bombarded daily with germs from the subway, door handles, the gym. An interesting question is how is the immune system affected by exercise? Does the intensity of exercise matter on the effect on your immune system?



On average, most of us experience about 2-3 colds per year. How does exercise affect this?



There is very good evidence that regularly exercising boosts your immune system and keeps you less susceptible to infections. Researchers at Appalachian State showed that those who walked regularly at a quick pace had 50% less colds than those who didn't exercise regularly.



Interesting, very intense exercise (like in those training for a marathon) for prolonged periods of time actually causes pertubations in the immune system making it weak. The body to produce naturally steroids and adrenalin & these hormones act to weaken the immune system for up to 72 hours after the event, making you more susceptible to infection. Not willing to give up your training program, there is some evidence that eating probiotics and food before and during the workout helps maintain the strength of your immune system



What about if you have a cold? Should you continue your exercise program or wait till you're 100% better?
Light to moderate exercise when you have a cold actually stimulates your immune system while intense bouts of exercise weakens it and may prolounge your infection.



Bottom line- regular exercise helps keep you healthy!

Have you set your date yet?

Did you know?

20 minutes after quitting smoking your heart rate drops.

12 hours after quitting smoking the carbon monoxide level (a toxin) in your blood drops to normal.

After quitting smoking for 2 days, you can smell and taste better!

It's pretty rewarding to know that you'll reap the benefits of a positive decision in your life so quickly.

Please write in and let me know how it's going and what you are doing to stay on track.

Want help quitting smoking in NYC?

Here is a direct link to all areas of Manhattan where you can receive direct help with quitting smoking.

http://www.nyc.gov/html/doh/downloads/pdf/csi/cessation-guide.pdf

It's a Nasty Bug

So many New Yorkers are plagued right now with an awful cold- it starts in your sinuses, and then travels to your voice making you hoarse, and consume more tissues than should be humanly possible. Everyone seems to be coughing, blowing there nose and hoarse.

It's a good time to talk about how to know when you have a viral versus bacterial infection and whether antibiotics will work our not.

Viral Infections
*Viral infections are often feel worse than bacterial infections because they antibiotics DON'T have any effect on them.
* Simply put, we really have no good treatment for them other than rest & symptom relief.
* They can last anywhere for 10 -14 days with lingering effects for almost 3 weeks.
*May or may not be associated with a low grade fever. (99<100 F)

Bacterial Infections
* Respond very quickly (within 24-48 hours) to antibiotics.
* Typically are associated with a high grade fever (>101 F)
* Symptom relief medications help.


If you have any cold that lasts longer than 5 days you should see your doctor.

Best of luck staying warm and well in this cold weather!

Keep Those Knees Up!

Congratulations! You've decided to start an exercise program. Scared? Any time you decide to change your behaviour it's a brave move. It takes confidence to look at yourself and say, "I'm willing to change!" It's also incredibly empowering to know you can change.

What can you do to insure you'll succeed?

1) Set a goal, set a time.
Create mini weekly, monthly, and a yearly goals for yourself. Have a birthday or dinner party coming up? If not, schedule one to work towards that you'll look great for and work towards it.

2) Be kind to yourself.
* Totally out shape? Start with 2 minutes of walking in place. Each other day increase this by 2 minutes. Repeat several times a day. When you're up to 16 minutes, take your routine outside. Don't be embarassed by how little or much you can do. This is only for you!

3) Have fun!
* Change your attitude towards exercise- it should be play time for your mind and body. Find something, anything active you enjoy and puts a smile on your face. Take a new aerobics class, work out with a friend, try rock climbing, dance classes anything you think will be fun.

4) Vary your routine.
* Whether you are a triaathelete or total couch potato, give your body some variety. However great of shape you think you're in, you'll be surprised to discover how quickly a new routine will give you sore muscles. For example, my family contains many avid runners and swimmers, and no one of my family could walk after last year's families football game!

5) Calculate your Body Mass Index (BMI).
* BMI?? What's this? This can tell you what a healthy weight is for yourself. http://www.nhlbisupport.com/bmi/

If you're out of the range for a healthy weight, work slowly towards fitting into that range (> 25).
If you're in your range (BMI 18-25), work towards staying in the range.

Commit to weighing yourself weekly, naked first thing in the morning. It's much easier to lose 1-2 lbs than it is to 10 lbs!

6) Build Exercise into Your Daily Routine.
* I'm so proud of my Mom, a self described loather of exercise, she committed to building walking into her daily routine. When she goes to the grocery store, she parks as far as she can from the entrance. You can do this to in the city. Get off the subway or bus one stop earlier. Take the stairs. Walk to work. Take a walk around the block at lunch. Get a coffee at the deli 2 blocks away, rather than across the street.

A weight loss of as little as 5 lbs has benefits for asthma symtpoms, blood pressure, arthritis, and mood!

Good luck and I'll be writing again soon with more tips and encouragement!

Here we go...Quit Smoking 101

Okay, you've committed to quit smoking, or at least trying to quit smoking, and that is the first step.

Below are some tips to help you succeed.

1) Set a quit date.
* It doesn't have to be today, just set a date. Tell people when you are going to quit so they can help support you.

2) Ask for help.
* Talk to your doctor, friends, family, co workers. Tell them you are quitting smoking and ask them to help you. Call 311- there are lots of free resources for individuals trying to quit smoking.

3) Clean up before you quit.
* Wash all your clothes and throw away all your lighters & ash trays so you won't have triggers to remind you to smoke. Not having a light easily accessible may give you a few minutes to get through the urge.

4) Start a breathing program.
* Pay attention to how you breathe. Breathe deeply for 1-3 minutes daily. Pay attention to how your lungs are working. It may sound silly, but this will make you more intune with how your lung function is improving as you go forward.

5) Replace one habit with another.
* Many people tell me they don't won't to quit smoking because they are scared they'll gain weight. Don't replace smoking with eating! Don't replace smoking with eating! Chose another habit that you can easily incorporate into your day- like exercise, drinking a glass of water, calling a friend etc... Most importantly, make it a healthy habit and something you want to do.

Good luck!