What are 7 Things You Don't Know About Colds?

Myths about colds and flu abound this time of the year.  It's hard to know what's fact or fiction. Bottom line we all want to stay healthy for the holiday season. 

Corrie Pikul of Oprah recently interviewed me on 7 things you didn't know about the common cold.  Her article is a myth buster on topics like milk and mucous, why honey is good for a cold, and how you are most likely to get sick.  Want to read the article?  Click here to  Oprah read her tips.
 

Cost Savings Coupons

This is a repost of coupons for allergy and asthma medications with updated links.  I hope this helps you and your family save on medications.

Please let me know if you have any questions.

Asthma Medications


Asmanex- $15 off
Asmanex Coupon


Advair - $10 off
Advair Coupon

Dulera- up to $75 off
Various Offers

Symbicort- 1 month free
symbicort Coupon

Zyflo CR
Zyflo CR Coupon

Epinephrine Offers

Auvi-Q- $0 copay
Auvi-Q Coupon

Epi-Pen
Epi-Pen Resources

Adrenaclick
Resources

Allergy Medication

Alavert
$1 off Alavert
Allergra
Allegra $2-4 off


Claritin

$2 off Claritin

Zyrtec

https://www.zyrtec.com/offers

Nasal Allergies

Astepro
Astepro Savings Card

Nasonex-
$20 off

Omnaris- Assistance with Copay

Pay only $17 for Omnaris


Patanase NS- up to $10 off

$10 off Patanase

Qnasl NS- Up to $25 off

Qnasal Coupon

Help I'm Allergic to Pumpkin....

This time of the year we see pumpkin in everything from beer to ice cream.  I thought it'd be the perfect time to talk about pumpkin allergy.

Pumpkin is a delicious gourd and commonly added to salads, pies, and beverages.  The seeds can be cooked and ground into flour.   Some people use the flour as bait for fish.

Luckily, allergy to pumpkin  is rare and only a few case reports exist in the literature.


Interesting Facts About Pumpkin Allergy

• Pumpkin belongs to the Curbitacea family. Other members of this family are watermelon, zucchini, squash, muskmelon, and cucumber
• We don't know the incidence of pumpkin allergy; there are a few case reports in the literature
• Most allergy to pumpkin is caused by the seed rather than the pulp. 
• You can be allergic to the seed, pulp or both.
• If you have pumpkin allergy, you make also react to squash, zucchini, watermelon, muskmelon and cucumber and other seeds. 
• Some people may develop pumpkin allergy from a cross reaction from a tree pollen, called birch.
• You can be tested for pumpkin allergy by an allergist by pricking the skin

Symptoms of pumpkin allergy are:

• Itching or blisters in the mouth
• Swelling
• Hives
• Shortness of breath or
• Asthma 

If you're worried you have pumpkin allergy, see an allergist and they can test you.

Want to talk to me about your symptoms? Please call the office at 212-679-3574 or email me at jcollins@grammercy.com. As always you are welcome to visit our website to learn more.

Holiday Cooking with Food Allergies

Cooking with Food Allergies
November traditionally marks the start of warm baked goods cooking in the kitchen.  Baking together is a fun, wonderful activity to do with children that produces a delicious sharable treat in the end. 
However, for children and families with food allergy, baking together is often challenging. 

Parent's are left to figure out substitutions to recipes and modify them on the fly to make them allergy free for their loved ones.  This is often time consuming and offers it's on set of challenges.

Below is a list of resources for allergy free recipes and places to order allergy free mixes for your convenience.

I hope below helps fill your holiday table with delicious food.  If you have other resources, please feel free to share them.

Happy Holidays- Dr. Collins!


Bumbalooza- I love this company!  Created by two moms who loved to bake who had kids with food allergies, they've created easy-to-make treats and instructions to help you identify where the kids can help! Whether it is counting, pouring, stirring or tasting, the opportunities to bond are limitless!

Cookbooks
 Allergen's Free Baker's Handbook- written by a mom with children who have food allergies, this book is filled with wonderful recipes for everyday.
Allergy-free Desserts: Gluten-free, Dairy-free, Egg-free, Soy-free, and Nut-free Delights- Want to create something sweet and tasty for your holiday table?  This cookbook with wow you with wonderful allergy free deserts. 
What's to Eat? The Milk-Free, Egg-Free, Nut-Free Food Allergy Cookbook- easy directions and easy recipes fill this cook book.  You'll be surprised by what you can do without milk, egg and nuts.


 

Doc, but I'm allergic to Penicillin

About 1 in 10 Americans avoid antibiotics because they think they are allergic.  The most common antibiotic blamed for allergy is penicillin.  The actual incidence of true penicillin allergy is very low.  This is a troubling problem as more and more bacteria are becoming resistant to common antibiotics. Penicillin is first line to treat many diseases including sinusitis and diseases during pregnancy making it important to know if you are actually allergic.

Here are some interesting facts on penicillin allergy

• About 85-90% of people will out grow true penicillin allergy after ~10 years
• There are 2 components in penicillin that can cause an allergic reaction
• There is a skin test available for penicillin allergy that is up to 98% accurate for detecting penicillin allergy
• An allergist can challenge you with penicillin in the office to detect if the allergy is true or not.

What should you do if you have penicillin allergy?

• Get tested by an allergist to see if the allergy is true.
• Your doctor will place various allergens on the skin and may challenge you will penicillin if the initial testing is negative.

Want to talk to me about your symptoms? Please call the office at 212-679-3574 or email me at jcollins@grammercy.com. As always you are welcome to visit our website to learn more.

So what is sinusitis anyways...

This time of year, I have many patients telling me that they have "sinusitis" and it runs in their family. I'm always a little shocked that people think it's normal to have a chronic runny nose, mucous runny down the back of their throat or sneezing every morning.  Trust me, you don't have to live that way!

In our face we have 4 sinus cavities that are lined with tissue that can become inflamed over time.

What are signs you may have sinusitis?

• pain or pressure in your face
• chronic mucous in your throat
• bad breath
• frequent sinus infections
• nasal congestion
• loss of smell or taste

Common causes of inflammation are:

• allergies- pollens (ragweed and weed pollen this time of the year), dust mite, animals, and roaches are common causes
• chronic infections
• nasal polyps

Don't despair!  There is treatment for sinusitis and you don't have to live with all that mucous.  Allergies run in families and are incredibly common.  About 30% of the population in the US is allergic.

What are some treatments?

• Depending on the cause, your doctor may recommend medications like a nasal spray or pill
• It may be necessary to look in your nose with a small camera (nasal endoscopy) to see if there is an infection or polyp.
• If symptoms don't improve they may recommend that you get imaging of your sinuses (CT Scan)
• If allergies are the cause, they may recommend allergy immunotherapy (allergy shots).

If you have these symptoms, you should see your primary doctor, or an allergist to get checked to see what is driving your the inflammation in your sinuses.

Need help figuring out the cause of your sinusitis?  Please call the office for an appointment 212-679-3574. We are located at 205 East 22nd Street @ 3rd Ave, NY NY 10010.

Food additives and Allergies

More and more foods we eat have additives.  These are chemicals that the food industry adds to food to color, flavor, preserve, and keep them emulsified. 

Just like anything else, you can be allergic to these additives.  In the allergy world we refer to them as hidden food ingredients.

What are some symptoms you might be reacting to food additives?

• Hives,
• Nasuea,
• Diarrhea
• Abdominal pain/cramping
• Rashes

What are common food additives that cause allergic reaction?

• Food dyes
• Cinnaminic aldehyde (a common flavor enhancer)
• Propolyene glycol
• Benzoic acid
• alpha tocopherol

What should you do if you suspect a hidden food ingredient is causing your symptoms?

• Speak with an allergist about being tested to see if this is triggering your symptoms.
• Be prepared to provide a detailed diet history along with when your syptoms are happening.

Want to talk to me about your symptoms?  Please call the office at 212-679-3574 or email me at jcollins@grammercy.com.  As always you are welcome to visit our website to learn more.
 

Back to School with Food Allergies

I love the end of summer- the mixed weather of warm and cool.  It reminds me that soon the beauty of fall will arrive.  The end of summer also brings the excitement of going back to school- seeing old friends, meeting your new teacher, and the anticipation of a new year.

For parents and children with food allergies, going back to school may bring on feelings worry about an accidental food allergy exposure.  Did you know about 3 million children suffer from food allergies!  The most common ones are peanut, eggs, milk, wheat, tree nuts and soy. 

Here are some simple tips that hopefully help alleviate any anxiety or fear you might have about an accidental food exposure.

Communicate

• Meet with your child's teacher, principle, and/or school nurse prior to starting school to make them aware of the allergy
• Fill out any school forms that the school requires to have epinephrine & any other medications on site.
• If your child has a severe allergy, you might consider a bracelet  Allermates has some fun ones for children.   Putting allergy stickers on their cups/lunch bags/clothes is a great option for young children You can customize them at Allergy Stickers.

Train

• Make sure that they know how to administer the medication.  Did you know that NYS training on delivery of epinephrine is not mandatory for school nurses/teachers.
• Talk about common signs of an allergic reaction:  hives, swelling, cough, shortness of breath, vomiting, and even anaphylaxis.
• Good news! A generic epinephrine auto-injector recently came to market.  This will help reduce your costs.  The training for the device is a little different from Epi-Pen so make sure that everyone at school/home knows how to use the device that's available in your school.
• Teach your child how to ask about the ingredients in snacks and to talk about their food allergies with their friends.

Plan

• Pack allergy free snacks.  You might include enough to share with other kids.
• Think about areas outside of the cafeteria where there might be an exposure- field trips, art class and school parties.

Hopefully, these simple tips will help you prevent any accidental exposures this upcoming school year!

Need more specific advice or training on how to use an epinephrine pen?  Please email jcollins@gramercyallergy.com or call the office for an appointment 212-679-3574.  We are located at 205 East 22nd Street @ 3rd Ave, NY NY 10010.

Allergy and Nutrition- Expanding our Practice

Over the past year I've written several posts on the role of nutrition and allergy.  It's an important topic to me and I often spend time with my patients learning about what they are eating to see if it might be affecting their health.

I'm so excited to announce that starting in September, we'll have a nutritionist in the office!  Her name is Stefanie Casillas, RD and she'll be starting with us every Thursday.  When I asked Stefanie about what she hoped to add to the practice she said, "My passion lies in helping clients learn to nourish their bodies and optimize their health. Whether your goal is to lose weight, manage blood sugar, live healthfully with food intolerance, or improve your overall nutrition, I would love to help your patients on their journey!"  I knew then she'd be the perfect addition.

A bit about Stefanie- her original background is in education in NYC where she worked as a teacher.  She decided to change career paths and became a dietitian at Beth Israel Medical Center.  Afterwards, she joined the staff at Beth Israel Medical Center as an inpatient nutritionist.  She's had extensive experience in teaching cooking classes and even working on a roof-top farm!

Whether you have questions for her like, how do I deal with food intolerance, food allergy or lose weight?  I know you'll love working with her and know a consultation with her will change your life in a positive way.

Want to schedule an appointment with Stefanie?  Call the office at 212-679-3574, www.gramercyallergy.com, or email me at jcollins@gramercyallergy.com

Hypoallergenic Dog- Truth or Fiction?

I love dogs and so do many New Yorkers.  About 72.2 million households have dogs in the USA.  And in NYC,  there are about 600,00 dogs according to a survey by the American Veterinary Association & American Community Association. The medical benefit of animals in the home is strong. Dogs provide companionship, stress reduction and bring a lot of love into the home. 

Sadly, about 20% of the population are allergic to dogs.  These symptoms can lead to allergies, asthma and disputes within the family.  Most animals have the same "rights" as others in the home and being allergic to a pet can be the source of family stress. Uncontrolled allergies and asthma can lead to poor school/work performance, overall reduction in quality of life and even emergency department visits.

Common dogs marketed as hypoallergenic are  poodle, labradoodle, Spanish waterdog, and the Airedale terrier. Recently I've had several patients develop allergies after getting a "hypoallergenic" dog.  They are a bit dumbfounded  as they were told that these dogs couldn't cause allergies.  After welcoming their dog into their family, at a loss for what to do next.  Symptoms are severe and they question even giving up their pet.

I thought it would be worth looking at the data to see if this is truth or fiction.  Luckily, there was a study in Journal of Allergy and Clinical Immunology in 10-2012 that asked the same question.

The protein that causes dog allergy is called Can f1 and it's found in the hair and coat of all dogs. 

The researchers measured the levels of Can f1 in dust samples from the hypoallergenic dogs versus allergic dogs and found the levels to be slightly higher in the hypoallergenic dog dust sample!  Unfortunately, there is no thing as a hypoallergenic dog.  Want to read the study yourself?  http://www.jacionline.org/article/S0091-6749(12)00793-2/fulltext

Don't despair though! If you are having allergies to your dog or other pet, seek out an allergist and they will help develop a plan so you will feel better.  The answer isn't always giving up your pet.  Symptoms can be controlled often with some simple environmental control measures, medications, and allergy shots if needed. 

Want to talk to me about it?  Please feel free to email jcollins@gramercyallergy.com or call the office for an appointment 212-228-2312.  We are located at 205 East 22nd Street, NY NY 10010



It's no wonder that truth is stranger than fiction.  Fiction has to make sense.
- Mark Twain.

 

August in New York...

... is one of exodus.  The city empties as residents seek to be calmed by the sea, cooled by the green shade from a mountain top, or inspired by the intoxicating glow of the moon from the other side of the world.  

As exotic and relaxing as all this sounds, traveling with allergies and asthma at times can be dangerous. Being in unfamiliar territory can pose some unexpected challenges.  

Recently my patients have told me stories about their difficulty with allergies- like a moldy apartment in Buenos Aires, Brazil that triggered an asthma attack, cedar storm in TX during a music festival causing severe sinusitis and loss of voice, and sunscreen allergy during a surfing expedition in Costa Rica causing a very bad rash.

Here are some easy tips to keep you healthy, safe and focused on your priority as Robert Louis Stevenson says, "For my part, I travel not to go anywhere, but to go. I travel for travel’s sake. The great affair is to move.” 

Have food allergies?

• Do a quick search to see what restaurants in the area are friendly for those with allergies.
• Have a travel anaphylaxis kit to carry in you carry on or purse

Have asthma?

• Bring an extra inhaler along with you in your bag.  You never know what kind of environmental triggers you'll be exposed to in your vacation home.
• Check out common triggers/environmental exposures you might face 
• Ask your doctor to put together an emergency supply of medicine that you can bring with you in case you get sick- this will help keep you out of an unfamiliar emergency room,

Have skin allergies?

• Bring travel size versions of your favorite sunscreens, moisturizers, shampoos/conditioners
• Ask your doctor for a small tube of a corticosteriod to carry with you just in case; no one wants to be be itchy and scratchy while on vacation

Going somewhere where they speak another language?

• If you have food allergies  translate your food allergy before you go.  It might help to put this on a card and carry it with you to make sure there's no confusion
• In many countries asthma and allergy medications are over the counter.  Translate your problem so you'll be able to effectively communicate with the pharmacist there.

With these simple effective tips, your vacation will be filled with laughter, love, and beautiful memories rather than a trip the doctor

Want more directed tips on allergies and travel?  Feel free to email me at jcollins@gramercyallergy.com, click here to schedule an appointment, call the office 212-679-3574 or check out our new website- www.gramercyallergy.com

-----

"Bizarre travel plans are dancing lessons from God"– Kurt Vonnegut

Exercise Induced Asthma

The weather in NYC these past few days has been beautiful! It's such a treat to go outside in August and not melt.  I'm seeing more and more New Yorkers outside running, rollerblading and biking and just enjoying the sunshine and late days.

Every now and then, I'll see someone start coughing while they are exercising or reach for their inhaler.  I wonder, do they have exercise induced asthma?

What Causes Exercise Induced Asthma?

• As we breathe air through our noses, water is added so when it enters our lungs it humidified.
• When we exercise, we use our mouth to breath and water isn't added to the breathe.
• Some people (those with exercise induced asthma) are more sensitive to this "dry " air
• The dry air causes the muscles in the lungs to contract making the air ways smaller.
• This contraction and narrowing causes exercise induced asthma

What are signs of Exercise Induced Asthma?

• Cough
• Increased fatigue
• Chest Tightness
• Shortness of breath
• Wheezing

All of these symptoms would occur with exercise

Should I Avoid Exercise if I have Exercise Induced Asthma?

• No!
• Speak with your doctor or asthma specialist if you suspect you have exercise induced asthma
• They'll put together a specific plan to help keep you moving and enjoying the summer days.

Want to Learn more about Exercise Induced Asthma?

Feel free to email me jcollins@gramercyallergy.com , book an appointment on line or give the office a ring at 212-679-3574.  We can put together a specific plan tailored your needs.

 

Summer Cold or Summer Allergies?

Summer Cold or Summer Allergies?

 

Lately many people have been coming into my office complaining of a summer cold.

They have a stuffy nose, are sneezing sore throat, and have sinus pressure.

 

Is it a cold or could it be summer alleriges? 

 

What causes summer allergies?

 

• Pollinating summer plants often bloom during or after thunderstorms.
• Grass Pollen counts typically spike in mid June through early August
•  Goosefoot plants and Nettle, and Plantain are active July through August
  
  Grass Plant Flower

Goosefoot Plant    

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Platain Plant

 

 

How can you tell if you have a cold or summer allergies?

• It can be difficult and you may need to see a doctor to differentiate
• Allergies often cause itchy watery eyes, runny nose, sneezing, and nasal congestion
• Symptoms can be intermittent and associated with pollen counts
• Summer colds last only a few days (5-7); They are often accompanied by feelings of fatigue, low grade fever and often others around you will be sick.

Need more information? Or want to speak with me directly?  Call the office at 212-679-3574 for an appointment or visit the www.gramercyallergy.com for more information about the office.

 

 

Allergy to the Sun or Sunscreen Allergy

Everyone is talking about the importance of regular use of sunscreen (SPF 30-50) to protect your skin from the suns UVA and UVB rays.   Using regular sunscreen is a must to help prevent skin cancer and prevent early signs of aging. Lately, I've had several patient coming in complaining they've developed a serious rash in the spots they've applied sunscreen.  What do you do if you suspect or have sunscreen allergy?

Who's at Risk For Sunscreen Allergy?

• In the general population 1% of people have contact dermatitis
• About 1% of the population who  has contact dermatitis has sunscreen allergy
• Persons with dry cracked skin (eczema)
• Regular use of sunscreen
• Female and,
• being younger than 40

What are Signs/Symptoms of Sunscreen Allergy?

• A itchy red rash at the sites sunscreen was applied
• Typical spots are the face and neck, but it can be anywhere on your body.

What are Most Common Causes of Sunscreen Allergy?

•  Benzophenone-3  ( a chemical that helps absorb UV rays from the sun)
• DL-alpha-tocopherol, and
• Fragrance mix
• Other chemical absorbers ( they act like a mop for UV rays) can also be the source of an allergic reaction
• PABA's,
• Cinnamates :Octocrylene, Octyl methoxycinnamate (octinoxate), and Ethoxyethyl p-methoxycinnamate (cinoxate)
• Salicylates: homomenthyl salicylate, ethylhexyl salicylate, and trolamine salicylate
• Avobenzone, Ecamsule, Ensulizole, bemotrizinol, biscotrizole

What Should You Do if You Suspect You Have Sunscreen Allergy?

• See your local allergist to get patch tested.
• This will help determine which chemical is causing your rash
• Or if a chemical on your skin is being activated by the sun (photodermatitis)

What are Some Safe Alternatives if You Have Sunscreen Allergy?

• You can use physical blockers like titanium oxide and zinc oxide
• These will protect your skin from  UVA and UVB rays.

Want more information or need an appointment for patch testing with Dr. Jennifer Collins?  Call the office and we'll be glad to help or check out our website www.gramercyallergy.com  or 212-679-3574

Tips on Surviving the Allergy Season

I recently sat down with Susan McQuillan, MS, RDN to discuss tips for surviving the allergy season for an article she wrote for QualityHealth.com (http://www.qualityhealth.com/).

Want to read more?

Here's the link to the article.  Tips to Survive the Allergy Season

New Office and WebSite- Coming Soon!

Great News!

My new office is open and we are excited to welcome you into it.

The new address is 205 East 22nd Street @ 3rd Avenue, NY NY 10010
Phone Number: 212-679-3574
  Hours
Mon- 9-5
Wed 10-7
Thurs 10-5

Check out the new website we are putting together to serve you better www.gramercyallergy.com

Global Warming and Allergies

Global Warming and Allergies

While there's still debate over whether or not global warming is real, everyone agrees that it will have an impact on allergies.

How will global warming affect allergies?

• The increase in Earth's temperature is caused by increases and accumulation of various gases, especially carbon dioxide (CO2).  
• Increases in temperature change the way plant and trees pollinate
• Increases in temperature prolong the pollination seasons.
• Increases in CO2 directly impacts the way plants and trees grow
• This translates to early symptoms of allergies and a longer duration.

How will longer pollen seasons affect allergies?  

• Early exposure to pollen causes priming of the immune system
• Priming means that less pollen (allergen) will cause a bigger symptoms
• Increases in symptoms means more severe allergies, more missed school/work, and a bigger impact on your day to day.  

Want to see me?  Call the office for an appointment 212-679-3574 or click here to Schedule an Appointment 

Beat Your Allergies

I recently sat down with Linda Clarke from Metro Magazine to talk about how to beat your alleriges.

Check out the publication online at Beat Your Allergies

How Do You Know You Have Allergies?- Here's an Easy Screening Tool

As an Allergist, I get asked this question everyday.  Often my patients think they just have frequent colds, "sinsusitis", or a lingering cough.   Even as a doctor, it can be difficult to distinguish a cold from allergic inflammation in your nose, eyes, and throat. 

Are you worried you might have allergies and want to do an easy screen at home?

Check out this easy screening tool Screening tool for asthma and allergies

It'll take about 5-10 minutes to complete. 

If your results suggest you may have allergies and or asthma go and speak with your doctor or an allergist to get help.

Want to see me?  Call the office for an appointment 212-679-3574 or click here to Schedule an Appointment

Have Asthma? Be Careful with Aerosolized Cleaning Supplies

Have Asthma? Be Careful with Aerosolized Cleaning Supplies

Aerosolized cleaning supplies are a common trigger of an asthma attack in some people.
The strong detergents and scents can trigger the airway to spasm and an asthma attack.

What's the Safest Way to Clean if You Have Asthma?

• Use liquid products rather than aerosolized ones
• Make sure the area you are cleaning is well ventilated- open the windows if you can
• If using a squirt bottle device, spray the cleaner directly onto your towel
• Avoid strong scented products
• Make your own cleaning products  Want recipes- See my entry, Cough, cough, cough for recipes- Recipes for cleaning products

Need more tips on how to battle your allergies?  Call the office for an appointment 212-679-3574 or click here Schedule an Appointment to schedule an appointment.

Thunderstorm Induced Asthma

Did you see the lightening storm in NYC this past week?  Wow- it was amazing! The sky was filled with an amazing display of electricity and air with loud claps of thunder.   I really enjoyed watching it, but also waited for the second wave you may not know about...

The day after a thunder/lightening storm there is a  10 fold increase in asthma admissions to the emergency department!

So what's going on? 

Many would think that the rain would "clean the air" of pollen and pollutants knocking the irritants from the air to the ground, but this doesn't seem to be the case.  Why do thunderstorms trigger asthma? 


We don't know...

Some possible hypotheses on why thunderstorms trigger asthma are:

• Perhaps it's a device used by nature to pollinate when there's water available for things to grow.
   
• Others hypothesize that pollen grains rupture with contact from rain drops.  The grains get picked up by the winds occupanied by the storm spreading them down stream. 
• Fungal and mold spores increase the day after a storm along with pollen counts. 

Regardless of the reason, if you suffer from thunderstrom induced asthma, be prepared with your medications so you don't end up in the emergency room!

Here are some tips to prevent thunderstrom induced asthma:

• Stay indoors the day after a storm
• Have your medications on hand, make sure they aren't expired.
• Keep your windows closed the day after the storm
• Follow your asthma action plan

Most of all- if you are having signs/symptoms of asthma see your doctor early on.  Sadly, each day 9 people die from asthma. 
Need help getting your asthma under control this spring or what other tips?  See an allergist and find relief! Click here to find an allergist in your neighborhood

Want to set up an appointment with me? Call the office 212-679-3574 or  Click here 

Tips for Managing Springtime Asthma

Springtime Asthma

The past few days in NYC have been beautiful.  It's been an exceptionally long winter here, and New Yorkers are ready to enjoy spring!

The plants and trees are ready to burst with beautiful flowers and pollen.  For many, this bounty of pollen, causes havoc for their allergies.  And for some, may trigger their asthma.  Asthma triggered by allergies is called allergic asthma.  Many people think, "I live in NYC- there's so few tree's here, the pollen can't affect me!"Tree pollens are airborne, and wind can carry them from over 100 miles away.

How Common is Allergic Asthma?  Really Common!

• This is the most common type of asthma
• About 90% of children with asthma will have allergic triggers
• About 50% of adults with asthma will have allergic triggers
• This is why knowing what your triggers your asthma is so important.  It can help you prevent an asthma attack.  It can help you manage an asthma attack.  Doing both of these things can help you keep your life as "normal" as possible.

What are Symptoms of Allergic Asthma?  

• Cough
• Chest tightness, 
• Wheeze, and 
• Shortness of breath 
• Symptoms/attack happens the same time each year or with the same exposure (cat/dog).

What Can You Do to Control Your Symptoms?

• Talk to your doctor or allergist to have a plan for when to use your medication(s).
• Make sure your asthma medication isn't expired!
• You may need a daily medication to "prevent" symptoms.
• Have an emergency inhaler with albuterol on hand in case you have an asthma attack.
• Follow the pollen counts in your neighborhood.

Need more tips on how to battle your allergies? Call the office for an appointment 646-438-7893 or click here Schedule an Appointment to schedule an appointment.

Allergies and Your Pet

My practice loves your animals and we work with you to try to figure out how to keep them in your life without making you sick.

Love your dog and love to run with them?  Here's a simple tip for keeping the springtime pollen out of your home.

•  Wipe there coats off with a wet washcloth when you come in from outside
• The fur will collect pollen and bring outdoor allergens inside

The worst pollen season ever...?

Every spring you hear it... "This is going to be the worst pollen season ever."

You might be wondering what's going on. Are people just being hysterical and looking to complain? Or is there any truth to these claims?  If so, why are the seasons getting worse?  What actually makes for the worst pollen season ever?

What makes for the worst pollen season ever?

• Warm temperatures in Jan-Feb are a pleasant relief from the biting cold of winter, but trigger trees to start blooming and pollinating early.
• Low levels of pollen during these winter months "prime" our immune systems towards the pollen. 
• When the pollen gets into full force in the spring, because our systems are primed, it takes less pollen to trigger a reaction

Are the allergy seasons getting worse? 

• Warmer temperatures and shorter winter stretches are prolonging the pollinating seasons for plants.  
• Plants are producing more pollen for you to have a reaction to.
• Some believe that the increase in the warmer months is producing stronger pollen.
• Longer exposure to pollens means that your allergy symptoms will be longer.
• Increases in CO2 (carbon dioxide) causes plants to grow faster and more robust.  This may be an untold consequence of global warming on pollen.

So there may be some truth to the claim that it is going to be the worst pollen season ever.

Don't fear though, knowing what you're allergic to, early use of medications to prevent symptoms, and talking to your doctor or an allergist/immunologist can help you stay healthy and enjoy the spring.

Need more tips on how to battle your allergies?  Call the office for an appointment 212-679-3574 or click here Schedule an Appointment to schedule an appointment.

Allergies and Outdoor Exercise Tips

Now that spring is in full bloom, many patients are asking what's the best time to exercise outdoors if I have spring time allergies?

Want to hit the bike path or central park, but worried doing so will send your allergies into a tail spin?  Don't fear, pollen levels are highest in the morning between 5AM and 10AM.  Plan your route outside of these hours and you'll miss the peak levels.  Just in case you might want to take some allergy medication with you or just before you head out the door to prevent an allergic reaction.

Want to track pollen levels in your neighborhood?  There are some wonderful allergy apps that will give you pollen alerts.

• Pollen Forecast
• Pollen Allergy Tools

Need more tips on how to battle your allergies?  Call the office for an appointment 646-438-7893 or click here Schedule an Appointment to schedule an appointment.

Preparing for Spring Allergies

The time of the year were spring allergies start is rapidly approaching.  You know the symptoms- itchy watery eyes, runny nose, sneezing attacks, stuffy nose, and feeling like you're in a stupor.

Don't despair, you don't have to just accept that fact that the spring flowers and tree blooms make you sick.  There's lots you can do to keep yourself feeling better and find relief for your symptoms.

Start medications early.  

• See an allergist or your primary doctor to make sure you have medications on hand BEFORE symptoms start.  
• There are many over-the-counter medications you can buy without a prescription, but you may need a prescription to get yourself through the season.

All sinusitis is not infectious.

• I hear this all the time- hey doc, "I get sinusitis every spring and fall."
• If this is happening to you, it may be a sign that you have allergic sinusitis.
• What's allergic sinusitis- inflammation in your sinuses caused by allergies. 
• Speak with your doctor or an allergist about how to prevent (yes prevent!) this from happening. 
• That means less anti-biotics for you!

Know your triggers.

• How can you avoid what's making you sick if you don't know what's causing it- you need to know your triggers and what you're sensitive to.
• Know your triggers:  If you suspect you have allergies speak with an allergist to get tested so you can devise a specific plan to avoid your triggers. 
• There's alot you can do without necessarily being on a daily medication by knowing your triggers.  
• An allergist will spend time with you educating you on when and where those triggers are present and how to avoid them.

Allergies can cause Asthma.  Repeat- Allergies can cause Asthma.

• If you have asthma, make sure you're rescue inhalers aren't expired and you have a good plan for treating exacerbations.  
• Tree pollen can trigger and asthma exacerbation.
• Having a plan and medications on hand can prevent you or your child from sleepless nights and or an emergency room visit.

Need help devising your plan for feeling better this spring season?
Call the office for an appointment a 212-679-3574 or click here Schedule an Appointment to schedule an appointment on line. 

Fat and Allergy

I know you're wondering why is an allergist talking about fat and allergy?  More and more data shows the role of fat as an inflammatory cell in our bodies.  This makes sense if you think about it in terms of diseases we often link with fat like heart disease or diabetes.  But what is the role of fat cells and allergic diseases like asthma?  We see more and more people who are obese and have asthma- could there be a link?

Fat cells cause inflammation in the body.

• You might not know it, but obesity is a state of low grade inflammation in the body.
• We think that this inflammation spills over into the blood leading to inflammation at sites other than were the fat is located.
• Patients who are obese have increased levels of free radicals and other markers of oxidative stress in their blood.
• Small changes in your weight help to decrease this inflammation.  By loosing even 2- 5 lbs, you have the power to decrease the amount of inflammation in your body. 

Macrophages and inflammation

• Macrophage (meaning "large eaters" in Greek) in our bodies are responsible for "eating" bacteria, viruses and other things that cause inflammation, like fat cells. 
• There presence is a sign of "inflammation". 
• Macrophages are found trying to eat "dying" fat cells.  As they "eat" these cells, they produce inflammatory chemicals associated with oxidative stress & inflammation.    

Leptin and inflammation

• Leptin is a pro-inflammatory hormone that induces satiety in our bodies
• Levels of leptin are increased in obesity.
• You also see increased levels of leptin in patients with asthma.
• It's still a chicken and egg situation and we aren't sure if the inflammation associated with asthma causes the body to produce extra leptin, or that the increased levels of leptin caused the asthmatic airway inflammation.  

Empowering you to improve your health through small changes with your life is a powerful tool.  Small changes  in your weight may translate to less medications, feeling better on a day-to-day basis, and getting you back to the activities you enjoy doing.

As always, want to talk more about this and how an allergist can help you?  Feel free to call the office  to schedule an appointment   212-679-3574 or do so on line Schedule an Appointment

The foods we eat affect our immune system- Vitamins and Allergy

The foods we eat affect our immune system!   

That's right, you are what you eat, and your immune system is no different.

Vitamins like A, C, E, D, and Calcium are important in keeping the cells in our bodies working at an optimum function.  Try to incorporate a serving of fruits and vegetables into each meal.  It's easy and takes little prep work. Small changes in your diet will lead to big increases in your energy level and weight.  Top your breakfast off with a handful of fresh berries in the morning, add avocado to your sandwich at lunch instead of cheese, gnash on an apple on your way home from work and ask for a veggies or a salad instead of fries next time you eat out.  Yogurt, a glass of milk or cottage cheese are simple ways of upping your calcium intake.

Want to talk more about this?  Call the office for an appointment 646-438-7893 or click here to schedule an appointment on line.  Schedule an Appointment

Have asthma? Get your vitamin D level checked.

Have asthma?  Get your vitamin D level checked.

According to the National Health and Nutrition Examination survey 2011, 41.6% of people are deficient in Vitamin D.  Who has the highest rates of deficiency?  In blacks it was 82.1% and in Hispanics 69.2%.  (Prevalence and correlates of vitamin D deficiency in US adults)

Why is this important for patients with asthma?  Low levels of vitamin D in kids and adults in some studies are associated with poor asthma control, reduced lung function, increased medications intake and increased exacerbations.  Severe and uncontrolled adult asthma is associated with vitamin D insufficiency and deficiency.

More studies are still needed to prove this association, supplementation and restoration to normal levels of > 30 ng/ml lead to improved control, less medication, few exacerbations, and improved lung function.  

What are some natural ways to increase your vitamin D?  Get some sunshine- 1 hour a day of direct light activates your skin to naturally produce vitamin D.  Want to eat your vitamin D?  Most dairy products contain vitamin D along with mushrooms, eggs, oysters and fortified tofu.  

Spring clean your health!

Now that spring is officially here (although those of you in NYC would find it hard to believe), many use that date to spring clean their diets and exercise routines.

You might wonder why is an allergist talking about the benefits of diet and exercise?  

Any of my patients will tell you, I often ask a detailed history about their activity level and what they eat.  We talk about easy ways to introduce exercise into their life, the benefits of even 1-2 lbs of weight loss, and the importance of healthy eating choices.

Why do I spend so much time with this?  The foods we eat, exercise and fat cells affect our immune system.

Over the next week, I'll be posting more about this, so stay tuned!

And We Asked... How Are We Doing?

Allergy shots, first developed in the early 1900's, are a proven way of semi-permanently changing your immune system so you tolerate the allergens that make you sick.  For example, persons allergic to cats, can get shots and then be around them with a reduction in symptoms.

Allergy shots are a wonderful treatment tool and patients often tell me the shots changed their life.  By using them, they can interact with animals, clean, play sports, and live their life without constantly feeling sick.

Traditional allergy shots are time intensive and require weekly visits for about 20 weeks to build up.  Because of this, many patients don't complete the prescribed treatment regimin or the cost of copays is too much.

Since I opened in 2009, I've offered an alternative to traditional allergy shots called cluster shots.  Using cluster shots, we give a series of injections in the office over about 9 weeks of time.  What are the advantages?  Patients feel better soon, less time for our patients, increased compliance, and less money in co-pays for the patients.  Great, right!?

There are some risks associated with both traditional and cluster allergy shots. As you can imagine, that by giving more of the allergen that you are allergic to, you are more likely to have an allergic reaction.  The risk of an allergic reaction is higher during cluster allergy shots than traditional therapy because of the increased dosage.

We asked the question- what was the incidence of systemic allergic reaction for cluster immunotherapy (allergy shots) in our office compared to previous reports?

In August, Danielle, a fantastic medical student from University of Pennsylvania, used her summer break to go through all of my charts and gather data.  She worked with my nurse Jayeon, a mentor of mine, Dr. DeVos at Jacobi Medical center and myself to put together an abstract.  With everyones hard work, we were accepted for poster presentation at the 2013Academy of Allergy and Immunology's conference in San Antonio TX where we presented our data on systemic reactions to allergy shots in our office.

We just returned from a really fantastic conference (more on that in the upcoming blogs) were she presented to a warm reception.

What did we find out?  We are doing a great job!

The incidence of reaction in our patients over the past 3 1/2 years is about 10%.  This is much lower than the 33% -79% in other reports.  Additionally, most of the reactions we had were very mild (hives). Why do we think our incidence is less than other reports?  I think it has a lot to do with our patients being good at following directions and taking there medications as directed.

Want to look at the data for yourself?  Here's a PDF of the poster and a link to the abstract published in the Journal of Allergy and Immunology in February. The Incidence of Systemic Allergic Reaction During Subcutaneous and Cluster Immunotherapy: A Retrospective Chart Review

Roll out the Red Carpet....the winner is!

Each year the American Contact Dermatitis Society chooses an allergen of the year.  There's not as much pomp and circumstance as the Oscars but it's a big win.  This  award draws attention to allergens that are very common and/or under recognized.  Chemicals are chosen based on their prevalence in products and relevance of causing allergic reaction. 

The 2013 winner is..... 

Methylisothiazolinone

What is methylisothiazolone (MI)?

• MI was first introduced  in cosmetics, toiletry and suncreen products in 2005.
• It's used as a preservative to kill bacteria and fungus.
• In the 1980's, it was used in combination in high doses (15 ppm) with a preservative called methylcholoroisothiazolinine/methylisothiazolone in (MC/MI) "leave in" products like shampoo and conditioner
• After the MC/MI introduction about 8% of people had reactions to the recommended doses, and concentrations were reduced to 7.5 PPM in the late 80's and early 90's
• In 2000, MI was pulled out of the MC/MI combination with the hopes that it wouldn't be as strong of a cause of allergic reaction.  They thought it was a weaker sensitizer
• Even though they pulled it out, they didn't limit concentrations!  And concentrations increased by 25 X
• In 2004-5, the first case reports of MI allergy were described after wallpapering and using paint.
• Only 7 years ago, we started seeing reports of people developing allergic reactions in wet toilet paper
• Since 2007, the use of MI as a preservative has doubled along with reactions
• We currently don't know how common MI allergy is.

Where do you find  methylisothiazolone (MI)? - Almost any product that you'd put on your body.

• Cosmetics
• Baby products (lotions, oils, creams, and powder)
• Makeup
• Body Washes
• Hair care products (shampoo, conditioner, straighteners, rinses
• Hair coloring products 
• Nail care products
• Deodorants
• shaving products
• Skin care products
• Sunscreen
• Wet Wipes (babies, and moist towelettes)

When should you suspect you have a methylisothiazolone (MI) allergy?

• MI allergy is common but difficult to distinguish from other preservatives that are use in many personal care products.
• Consult an allergist/immunologist (Find an Allergist) or dermatologist if you have an itchy rash that won't go away.
• They'll perform patch testing and then you'll know!

Want more information?

• http://www.contactderm.org/i4a/pages/index.cfm?pageid=1
• http://www.allergeaze.com/PDFs/AP/AP123-124.pdf
• http://en.wikipedia.org/wiki/Methylisothiazolinone
• Info on Contact dermatitis

Foods to help support a healthy Immune System

Filling your diet with lots of fresh fruits, vegetables, whole grains, seeds and lean proteins will ensure that you are getting essential vitamins and nutrients that help your immune system work effectively. Our diet provides essential nutrients our immune cells need to fight off bacteria and viruses. Eat a colorful diet rich in fresh fruit, fiber, and plant based products. Teach your children to eat a rainbow of foods each day.  Vitamins, anti-oxidants and bacteria are natural ways to maintain this balance.  Vitamins are organic compounds our bodies need in limited amounts.  We get some vitamins only through our diet and bacteria manufacture others in our systems.  Critical vitamins involved in the immune reaction are Vitamin A, Vitamin C, Vitamin D,  Vitamin E and Zinc. 

VITAMIN C
Shoot for a goal of at least 500 mg of Vitamin every day to help prevent infections with cold and flu viruses.  Rose hip (the fruit of the rose plant) tea, orange juice and fresh fruits like mango are excellent sources of Vitamin C.

VITAMIN A

Orange colored vegetables like pumpkin, acorn and butternut squash, and carrots are rich sources of Vitamin A another key player in the immune system.  Milk and eggs are other great sources.

VITAMIN D

Don’t forget to get some sun to maintain healthy levels of Vitamin D.  Not able to make it out?  Dairy products are fortified with vitamin D.  Green leafy vegetables like spinach and kale also pack a punch of vitamin D and calcium.

ZINC

Order up a salad filled with spinach, pumpkin and squash seeds, chickpeas, and mushrooms to get your daily zinc, another key player in the immune system.  Oysters are fantastic sources of Zinc and just 5 oysters provides your daily dose.  

VITAMIN E

Vitamin E is a natural anti-oxidant, compounds that protect cells from the damaging effects of free radicals, found in nuts, seeds and vegetables oils.  Toss one ounce of sunflowers onto your spinach salad and your halfway towards your goal of 15 mg a day of Vitamin E.   

Hey Doc, my feet itch! Can I be allergic to my shoes? P-tert-butylphenol formaldehyde resin allergy

Everyone knows there's nothing worse than being itchy and itchy feet are no different. 

Recently I saw a young child who was scratching so much, their feet were left raw and irritated.  Her family had recently gone south to escape the winter blues, and her mom was convinced she was infected with something.  She'd gone diving during the trip for the first time and wore a wet suit all day long.  The rest of her body itched to, but her feet were the worst.  The poor child was having difficulty walking because her feet were so raw. At times she was using a sharp object to scratch her skin. She was irritated because she couldn't sleep and was getting trouble in school because she wanted to scratch her feet.    

And so they asked, can be allergic to your shoes????     YES.

What could be going on?

• There are many adhesives in shoes that are can cause an allergic reaction
• The most common adhesive used in shoes is p-tert-butylphenol formaldehyde resin (PTBPFR)
•  PTBPFR is commonly used in leather and rubber products because it works quickly, durability, flexibility and ability to resist heat
• We don't know the true incidence of PTBPFR allergy, but it's been increasing since it's introduction in 1950's
• Other common adhesives are in shoes are acrylates, colophony, and epoxy products

What are the other names of  p-tert-butylphenol formaldehyde resin?

• p-tert-Butylphenol formaldehyde (PTBP) or paraformaldehyde
•  formaldehyde
• p-tert-butylphenol 
• polymer; p-tert-butylphenol formaldehyde resin (PTBP FR)
• formaldehyde, p-tert-butylphenol polymer; 
• 4-(1,1-cimethylethyl)phenol
• formaldehyde polymer
• Neoprene adhesives

Where else is p-tert-butylphenol formaldehyde resin found?

• Glue and fingernail adhesives, tape, labels, dressings and electrodes
• Rubber sports equipment- writs guards, shin guards, goggles, and athletic tape
• The bonder used in hearing aids and prosthetic devices
• Rubber products like shoes, neoprene wet suits, and sauna shorts
• Leather products like shoes, watch straps, purses and belts.
• Varnishes

Who's at risk for developing p-tert-butylphenol formaldehyde resin allergy?

• Moisture and heat break down the PTBPFR in the product exposing the product; sensitization via the skin can then occur.
• There may be some association with sleeping on memory foam mattresses or using foam pillows
• Athletes who use sports equipement may be at greater risk

What should you do if you suspect you are allergic to p-tert-butylphenol formaldehyde resin?

• See your local allergist/immunologist or dermatologist for an evaluation.  http://aaaai.execinc.com/find-an-allergist/
• They will take a detailed history to determine the cause of your rash.
• They may recommend patch testing to determine what is causing the rash, prescribe medication and/or tell you how to modify your behavior to avoid contact with the offending chemical.

Want to read more?

•  http://www.truetest.com/PatientPDF/p-tert-Butylphenol-Formaldehyde-Resin-Patient-Info.pdf
• http://www.dermnetnz.org/dermatitis/paratertiarybutylphenolformaldehyde-allergy.html
• Check out this article in Dermatits: http://journals.lww.com/dermatitis/Abstract/2012/03000/p_tert_Butylphenol_Formaldehyde_Resin_and_Its.7.aspx

Potential Treatment for Peanut Allergy?... MAYBE!

Recently the first multi-center double blind placebo trial on sublingual immunotherapy for peanut allergy was released....and the results are promising!

What do we know about peanut allergy?

• Peanut allergy is on the rise in the US for unknown reasons and affects approximately 1-2% of the population.  
• This allergy causes havoc in families homes and schools.  Fear of accidental exposure leaves parents worried their child or love one will have a possible deadly reaction. 
• Sadly about 10 people a year die from fatal reaction to peanut.  
• Peanut allergy is rarely outgrown;about 20% of people will go on to tolerate peanut.  

Until recently there was little hope of treatment or prevention other than strict avoidance, changes to diet, and label reading.

For those allergic to peanut, good news may be around the corner....

The study:

• Recently researchers from 5 centers across the US introduced escalating doses of peanut powder over  44 weeks to 40 patients with history of anaphylaxis to peanut.   
• Most of the recruits had an allergic reaction with as little as <2 2="2" a="a" g="g" li="li" of="of" only="only" peanut="peanut" s="s">
• Groups were divided equally into 20:20.  The placebo group was given a placebo over 44 weeks and one was given escalating doses of peanut.
• They started with 0.000165 ug of peanut- this is REALLY REALLY tiny given by mouth. 
• The goal of the study was for the treatment group to be able to tolerate 16 peanuts (5 grams).

What happened?

• At 44 weeks, 70% (14/20) of the treatment group ended up being able to tolerate 496 mg of peanut powder (~ 1 2/3 of a peanut).
• At 68 weeks, 3/20 were able to tolerate 5 grams of peanut powder (~ 16 peanuts) and 2 tolerated 10 grams of peanut (32 peanut).
• At 44 weeks, 15% (3/20) people in the placebo group developed spontaneous tolerance and were able to tolerate 496 mg (1 2/3 of a peanut).

What does it mean?

• Sublingual immunotherapy with peanut does induce some level of desensitization in a majority of people with peanut allergy
• This may provide an important treatment method for kids who are exquisitely sensitive to peanut and worry about cross contamination

This is exciting news for families with peanut allergy and in the future may provide an important and life saving treatment. Please do not try desensitization at home.  This is not ready for prime time YET!

 Interested in reading the actual study?  You can access it here http://www.jacionline.org/article/S0091-6749(12)01824-6/abstract.   

Feeling Sick with a Cold or the Flu?

This season's flu is spreading quickly through offices and schools.  Many of my patients ask me how to get a good nights sleep when feeling sick.  People are often kept awake by cough, post nasal drip, and nasal congestion.  Some of the over the counter cold medications can leave you feeling drugged and jittery.  W

ant some tips on how to get a good nights sleep?  Check out this great article by Huffington Post's Sarah Klein on "How to Sleep Better While Sick". http://www.huffingtonpost.com/2013/01/17/sleep-better-while-sick-cold-flu_n_2487635.html