Thursday, June 28, 2012

The Poison Sofa Incident

A true mystery...solved!

From 2006 to 2007, approximately 60 Fins presented to their dermatologists with a strange rash on the backs of their legs, buttocks, and backs. Symptoms were difficult to treat and pervasive. Testing revealed little information as to what was causing such a reaction and all involved were puzzled. The rash spread internationally throughout the UK and Sweden affecting 100's. It was a true mystery.

It was only through careful history by Dr. Rantanen, a Finish dermatologist, learned that each person had recently bought the same sofa from China. He methodically deconstructed the sofa testing approximately 40 component. Inside the sofa he discovered a small sachet containing dimethyl fumarate in crystal form. Sachets were included to inhibit mold growth during transport. It was a true eureka moment when he patch tested the individuals with the crystals & it caused a severe rash. And the so Dr. Rantanen cracked the case of the poison sofa incident!

What is dimethyl fumarate? Dimethyl fumarate (DF) is a profound sensitizing agent and able to cause reactions at levels <1 ppm. DF crystals are highly volatile and can vaporize after 6 weeks. Rashes are severe and very difficult to treat. This product is commonly placed in shoes, furniture and other items shipped from overseas. Dimethyl fumarate has achieved notoriety two times after the discovery was made that it was responsible for the rash landing on the cover of British Journal of Dermatology and as contact allergy of the year in 2011.

In 2009, levels <0.1 ppm were banned in products by the European Union, but occasionally they slip through.

There is one reported case from Canada, but luckily, we’ve not seen any cases of dimethyl fumarate allergy in the US yet (although what out because currently it's not regulated here).

Worms for an Allergic Nose?

Allergic disease is on the rise in developed countries when compared to undeveloped countries and we have no idea why. There are many hypotheses....

Are we too clean?  

Do we use too many antibiotics?  
Is early use of tylenol affecting our allergies?  

Is it because we don't have parasitic worm infections? 
That's right parasitic worms, you read correctly. Worms are known to alter the immune system and in the past many have hypothesized that infections with worms leads to a decreased allergic response.  Could this be a potential treatment for your nasal symptoms this summer? Believe it or not, over 130 people agreed to be infected with parasitic worms and observe their nasal symptoms and medication uses.
There's been two well designed studies looking at the question of does worm therapy actually decrease symptoms and medications for hay fever or allergic rhinitis?  Dr. Croft from the UK recently published her studies in the Cochrane database in April.  130 people where treated with whipworms, hookworms or placebo.  They reported on their symptom reduction, quality of life, and medication usage.
The results were disappointing.  Treatment with both whipworms and hookworms showed no benefit.  Treatment did not significantly improve the percentage of days with minimal symptoms, decrease medication use, or improve quality-of-life scores.  Not surprisingly, patients treated with worms, reported increased stomach and gastrointestinal issues including increased gas, stomach pain, and nausea.

As much as I want to help my patients with their allergic disease, I must admit, I'm glad that don't have to make this recommendation!

Stay tuned for more interesting research in Allergy/Immunology.

Tuesday, June 26, 2012

DiVersity, dIverSity, dIVERsity, dIverSITY- you have to love it!

Ever wonder if your health is effected by the type and variety of bacteria living in your intestines?
Well researcher Abrahamson et al. did and my patients ask me this question at least once a week.  

Abrahamsson et al. (JACI 2012;129:434-440) recently published research that that looked at the type bacteria and microdiversity (variety among the same type of bacteria) of bacteria in infants with and without eczema over the first year of life.

The results are fascinating!  

Infants followed who had eczema had lower total diversity and decreased microdiversity of bacteria (Bacteroidetes and Proteobacteria) when compared to infants free of eczema at 1 month.  After 12 months, the trend for decreased types of of Proteobacteria continued and stool in bacteria became less diverse.  Infants without eczema had greater numbers of Bacteroidetes and Proteobacteria at 1 year.  

This study was far from conclusive, but adds to a growing body of literature that the type and variety of bacteria living in our gut does influence the development of allergic disease.  Controversy exists over which is more important- the diversity of the specific type or the actual bacteria the development of allergy in infants.  Researchers continue to work on this question, so stay tuned!  

Monday, June 4, 2012

Cost Savings Coupons

I hear more and more from my patients their co-pays are increasing and they are finding it difficult to pay for medications.  I thought it would be helpful to consolidate all the links for asthma and allergy medication into one convenient spot.  Hopefully this helps put a little money back into your pockets!  Medications are grouped by condition and then alphabetical.

Asthma Medications

Asmanex- $15 off
Asmanex Coupon

Advair - $10 off
Advair Coupon

Dulera- up to $75 off
various coupons for dulera

Symbicort- 1 month free
symbicort Coupon

Zyflo CR
Zyflo CR Coupon

Epinephrine Offers

Auvi-Q- $0 copay
Auvi-Q Coupon

Epi-Pen Resources


Allergy Medication

Allegra-$2-4 off


Clarinex http://www.clarinex.com/application/savingsCoupon.action?link=savingsCoupon_couponConfirmation&web_program_id=00000300





Nasal Allergies

Astepro- up to $25 off copay


Nasonex- $15 off


Omnaris- Assistance with Copay


Patanase NS- up to $10 off


Qnasl NS- Up to $25 off




Eye Allergies