Friday, March 29, 2013

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. 

Thursday, March 28, 2013

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

Wednesday, March 27, 2013

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

Tuesday, March 26, 2013

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.  

Monday, March 25, 2013

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!

Saturday, March 23, 2013

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