Tuesday, November 10, 2015

How Can You Get Control Over Uncontrolled Asthma?


Gramercy Allergy and Asthma is a referral site for patients with uncontrolled asthma.  We see some of the toughest cases of allergic asthma in New York City.  Patients with uncontrolled asthma often visit the emergency room several times a month or year. They have little control over there symptoms of cough, chest tightness, shortness of breath and wheezing and feel trapped by asthma symptoms.  They are woken up in the middle of the night with coughing and a feeling that they can't catch their breath.  Asthma symptoms prevent many from doing the things they love like dancing, going for walks with their loved ones or just going outside.  

But what many who have uncontrolled asthma don't realize is that you don't have to live with uncontrolled asthma.  Here's a few things you can do to gain control over your asthma.

Get a Control of Your Asthma!
1) Knowing What You're Asthma Triggers is Vital To Gaining Control.  

Approximately 85% of asthma is associated with allergic triggers.  Animals, dust, change of season, thunderstorms, and pollens will often trigger an asthma attack.  Avoidance measures like using dust mite covers for your pillows, removing feathers from your bed, repairing leaks and knowing when you use your inhalers can often make the difference between being symptom free and an asthma attack.  Uncontrolled nasal and sinus allergies are often the spark that leads to uncontrolled asthma.  Speak with your allergist about a comprehensive plan for tackling your asthma and allergies.

2) Know Your Level of Total IgE.
Immunoglobulin E (IgE), one of 5 types of immunoglobulins (Ig) in our body.  Immunoglobulins are proteins important in fighting bacterial, virus and in causing allergy.  IgE is one of the proteins responsible for triggering an allergic attack and is a marker of total body allergic inflammation.  Have an elevated IgE?  See an allergist.  They can help you.  There are medications that help block IgE from triggering an asthma attack.  Your allergist can help identify which medications will be best for you to prevent an asthma attack. Having elevated IgE can be a marker of more difficult to control asthma
3) Verify you are using your medications correctly.  
Asthma medications are complicated, confusing and often look alike.  Verify with your doctor that you are using yours correctly- it's easy to make a mistake.  Something simply as correcting your delivery of medication may keep you out of the emergency room.

4) Get your Vitamin D Level Checked.
Low vitamin D levels are associated with more frequent attacks according to a study published in The Journal of Allergy.  Persons in this study with low vitamin D levels were 25% more likely to have an asthma attack according to researchers.  Have low vitamin D?  Vitamin D known as the sunshine vitamin is naturally made by our skin when exposed to sunshine.  If you're not able to get outside regularly then take a supplement.  Aim for at least 600 IU/day.
5) Look for Eosinophilia
Eosinophils are a type of blood cell associated with allergic inflammation.  They are often elevated in persons with severe allergic asthma.  Having elevated eosinophils can be a marker of more difficult to control disease.  Elevations in eosionphils are detected via a simple blood test.

6) Look for Other Problems
Not all asthma is created equally.  Persons not responding to typical medications may have something else going on that's causing them to have poorly controlled asthma.  Uncontrolled sinus disease (sinusitis), allergy to aspirin (aspirin exacerbated respiratory disease), loss of smell, recurrent nasal polyps,  frequent infections (ear, sinusitis and pneumonia), and long term use of oral steroids are signs that something might be missing from your asthma care.  

6) Still Have Difficult to Control Symptoms- See an Allergy, Asthma and Immunlogy Specialist
Allergist/Immunologists are specially trained to deal with difficult to control asthma.  Expect a detailed history of your environmental and job exposures, environmental testing,and medication teaching.  They will help identify the cause of your uncontrolled symptoms and help you avoid it whenever possible.  Allergists may prescribe medications like omalizumab (xolair) or mepoluzimab (nucala) that required monthly injection to fight the proteins that are causing your asthma. They are highly trained to deal with immune problems and will help you get to the root cause of your problem.  

Need specific advice regarding your asthma?  Visit us at gramercyallergy.com or click here for an online appointment.


Thursday, November 5, 2015

How to Go Hiking When You Have Allergies?

People mistake New Yorkers for not loving the great outdoors. They forget that the Catskills are just a quick train/drive away and for us it’s the perfect getaway weekend.  The Hudson Valley/Catskills offer hiking, camping and apple picking.  The warm weather makes leaf peaking this time of the year a true treat.  Golden yellows, brilliant orange and vibrant reds fill the valleys and mountainscape.  But if you have allergies, this type of interaction with nature can be a bit of a perilous adventure. What's the best way to deal with allergies and hiking?

Here are a five tips to handle your allergies before you head out for your next big hike.

Use and Bring your Asthma Medication

  • Any experience hiker will tell you to always be prepared when you go hiking.  Elevations can bring about dramatic temperature changes and winds.  If you have asthma, the change in temperature and/or exercise required to climb the mountain might trigger an attack.
  • Pack your inhaler with you in your bag.  Make sure you use it before you start your climb to prevent your lungs from getting tight.  When you’re on the mountain, you might have limited resources to emergency care so prevention of symptoms is key.

Know What You Are Allergic To Before You Head Out

  • Get tested!  Find allergy relief by knowing what you are allergic to so you can prepare and avoid it.  About 5% of Americans are allergic to molds. Common molds that cause problems are Alternaria. Aspergillus, Cladosporium, and Penicillium. The dirt and decomposing leaves are full of molds, fungi, smuts, and rusts that might trigger you to have an allergy attack. As you hit the trail you’ll potentially disturb these molds causing them to release spores into the air that may cause you to have an allergy attack.
  • If you are among those who are allergic to molds, speak with your allergist about developing a plan for treating acute symptoms. Toss in a few anti-histamines into your bag to stop acute symptoms.


  • We forget that there are stinging insects in the woods.  Bees over live underground, wasps and hornets build nests on fallen trees, and fire ants are on the ground. If you have or suspect you are allergic to any of these insects, make sure you pack your epi for your next hike.
  • Love the outdoors, and allergic to stinging insects?  Did you know that there's treatment for stinging insect allergy that's almost 99% effective? Talk to your allergist about getting treatment for insect allergy it can potentially save your life. 

Don’t touch The Pines

  • Many forget about delayed allergic reactions when they go hiking.  There are many substances in the woods that can cause a rash up to 10 days after your home.  This is called contact dermatitis.
  • A sticky resin leaking from pine tree bark causes rashes in about 5% of the population.  This is called colophony allergy.  You can potentially exposure your
  • About 5% of the population is sensitive to the sticky resin from pine trees known as colophony.  This can cause a severe rash on your skin that might require your allergist’s attention.

Be Cautious of 3 Leafed Plants.

  • In New York we have 3 main types of plants that can causes severe contact dermatitis- poison ivy, poison oak and poison sumac.  All three have similar characteristics and classically will have 3 leaves clustered together.
  • Did you know that poison ivy loves to grow in apple orchards?  The vines climb wrap around the trunk of the tree.  Bringing back fall foliage as a souvenir? Be careful there's not poison ivy or poison oak in your beautiful fall foliage mix.  You'll typically find poison sumac, the least prevalent poisonous plant, in wet marshy areas.   The reaction will typically take place several days later and be characteristic of an itchy linear rash.
  • Collecting fire wood for the bonfire?  Don't burn the poison ivy.  You will aerosolize, uroshiol, the chemical that causes the reaction, into the air allowing it to cover your body and enter your lungs.

Want to know what’s triggering your symptoms or need help with your next hike?

 Gramercy Allergy , New York City's Top allergy offices, would love to help!  Dr Collins brings over a decade of experience treating allergy and immunology.  She's happy to solve the most difficult problems.  Visit us anytime for more specific advice and to determine what is causing your symptoms. Book an appointment online here.

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