Expanded Office Hours

To better serve you, I am expanding my office hours for allergy shots.

We'll be open Monday from 9-6 and Wednesday 10-7 in the 380 2nd Avenue Office and Tuesday from 10-6 in the Williamsburg (101 Broadway office).

I'll be spending every other Thursday in Tribeca at 77 Worth from 9-5.

Please let me know if you have any questions.

Fall Allergies or Falling Prey to a Cold

I recently had the opportunity to speak with Jane Wilkens Michael of Spry Magazine about fall allergies and colds.  Check out her article on her blog below.  I hope you'll find some useful tips.


http://blogs.spryliving.com/fall-allergies-or-falling-prey-to-a-cold/

380 2nd Avenue Office Will Be Open Monday

I've just learned wonderful news that power was restored to our 380 2nd Avenue office.  We will be open on Monday.  Again if you need to reach me in the meantime, I'm available via email jcollins@nyee.edu.

Hurricane Sandy- Update

Dear Friends and Patients,

I write this hoping to find you and your families warm and safe after this terrible storm.  My thoughts and prayers are with those who are without power or water.  I've been overwhelmed by the generosity of neighbors and friends. 

These upcoming days and weeks will be difficult for those of you with asthma and mold allergy and as we reopen our offices we commit to taking care of you during this difficult time.

For those of you with reception, I wanted to update you on the status of our offices and appointments.

Our phone lines for the 380 2nd Avenue and Tribeca 77 Worth offices are down.  

If you need to reach me, you can call Williamsburg office for a secretary at 718-384-6933 or if it's an emergency and you need to speak with me directly, you can reach me via email- jcollins@nyee.edu.  

With luck and the efforts of the men and women of Con Ed, the 380 2nd Avenue office will be open on Monday morning. 

Please keep safe.

Jennifer Collins, MD

What's the biggest immune organ in our bodies?

Welcome to the the first part of the role of allergy and the intestines.

The intestines of course!  Amazingly, our intestines when stretched out are almost a 1/4 of a mile long.  Just beneath the surface the are collections of lymph nodes (areas where immune reactions are initiated) called peyer's patches and mucosal associated lymph nodes (MALT) and immune cells.  These areas are where our immune system encounters some of the first exposures to bacteria, food, and learns to differentiate safe items from non-safe.  This differentiation is key to maintaining a healthy well functioning immune system.

Bacteria populates our intestines as soon as we are born and plays many critical roles.  Our relationship with gut bacteria is mutually beneficial.  Important functions of the bacteria are helping our bodies develop oral tolerance to food, altering the way the immune system recognizes dangerous pathogens via various pattern recognition, and helping our bodies digest food. The types of bacteria living  in our guts vary depending on our diet (meat versus vegetarian) and where we live in the world. Through these roles, the bacteria receives its own nutrition and a safe place to live.      

So why is this relationship important to our immune system?

• Our first exposures to food (breast milk or formula, vegetarian versus meat based diet) may influence the types of bacteria living in us
  
• Gut bacteria help teach immune cells which patterns in nature are safe or not safe

• It's possible that early use of antibiotics changes the numbers and types of bacteria we have in our guts and ultimately may affect the way the immune system develops

Our understanding of these concepts is still in its infancy.  Stay tuned from more information as it's available.

"Tell me what you eat, and I will tell you what you are."

In my practice, questions about the relationship between the immune system and food are commonly asked.   I see in the news, grocery stores, and advertisements words like pre-biotic, pro-biotic, and vitamins and claims for improved immune function.  Patients complain about digestive issues, abdominal pain, bloating and possible allergies. Many are concerned about gluten sensitivity, wheat allergy, and foods to increase their immune system.  This month's Nature Reviews in Immunology is dedicated to research talking about "how dietary choices affect immune cells".  More and more research is being done in this area and thought with the eating season of the holidays rapidly approaching it was worth spending a few posts on this fascinating area of research. 

I couldn’t start this topic without a bit of a tribute to Jean Antheleme Brillat-Savarin – a French lawyer, author, and one of the first foodies.  More than any individual, Brillat-Savarin was a proponent in the role of food, digestion, and health.  He had so many wonderful quotes about food, life, and eating, but his adage “Tell me what you eat, and I will tell you who your are.”  illustrates the important relationship between food and our immune system.  I might modify it to say, tell me what you eat, and I’ll tell you what kind of bacteria live within your intestines and how they impact your immune system.

The movement of local farming and farm to table dining illustrates the interest that our society has in the relationship with food and their bodies.  There's an abundance of information out on the Internet and in grocery stores about ways to increase your immune system through food products and improve the health of your intestines.  It's difficult to tell how to navigate the system and what's true. Over the next few weeks we'll start with the basics and move gradually through the topic in the hopes of helping you navigate the system, keep a healthy immune system, and survive the holiday eating push.  

I hope you enjoy!  

Cough, cough, cough

So many people are coming into the office these past few weeks complaining of coughing.  The change in season brings about asthma, and cold season.  It's difficult to tell the difference and knowing when you're sick with a cold versus having an asthma attack is important.

Signs of Asthma:

• dry cough often worse at night
• chest tightness
• feeling short of breath
• wheezing
• not contagious
• often triggered by nasal allergies, a cold, change in temperature or weather

Signs of a Cold

• sore throat 
• nasal congestion
• fatigue
• low grade fever
• cough often times productive
• can often trigger an asthma attack

Remember- see your doctor is you aren't sure and you're aren't feeling well.

Enjoy Fall!

Kosher Food Allergy Blog Site

Many of my patients keep kosher and thought you'd be interested in a new blog dedicated to kosher food allergies. kosherfoodallergies.blogspot.com 

For persons with milk allergy, kosher products are an excellent resource, they are clearly labeled dairy free.

The blog is dedicated to specific issues kosher patients might face and tools to deal with them.  I hope you'll find it helpful and useful.

Good luck surviving the heat!

Methyldibromo glutaronitrile/phenoxyethanol Allergy

Could one product cause a rash on the eyes, hands and vagina?

Absolutely! Methyldibromo glutaronitrile/phenoxyethanol is a common preservative found in make-up, personal wipes, shower gels, shampoos, massage oils, and sunscreen, body, face and hand lotions. It’s composed of 80% phenoxyethanol and 20% methyldibromo glutaronitrile. The methyldibromo glutaronitrile is the principle agent causing sensitization.

Each of my patients admitted to using personal care wipes on a regular basis.

The incidence of sensitization is on the rise and repeated exposure to this product at low levels over time can cause an allergic contact dermatitis. This substance is monitored closely in Europe.

Methyldibromo glutaronitrile/phenoxyethanol is difficult to avoid and goes by many names on ingredient lists:

• 1,2-Dibromo-2,4-dicyanobutan

• 2-Bromo-2-(bromomethyl) glutaronitrile

• 2-Bromo-2-(bromomethyl) pentanedinitrile

• Glutaronitrile, 2-bromo-2-(bromomethyl)-

• Methyldibromo glutaronitrile

• Pentanedinitrile, 2-bromo-2-(bromomethyl)-

What should you do if you have this allergy?

Avoid the chemical! Simple avoidance of products containing this preservative will alleviate your rash.

What are some safe personal wipes without methyldibromo glutaronitrile?

Always-Wipes to go

Charmin-Freshmates Wipes

Seventh Generation-Free & Clear Baby Wipes

Visine-Soothing Wipes
Suspect you might be sensitive to methyldibromo glutaronitrile?

• See your local allergist for patch testing.
Want more information?
 http://householdproducts.nlm.nih.gov/index.htm is a great website that is easily searchable.

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.

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!  

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
Epi-Pen Resources

Adrenaclick
Resources

Allergy Medication

Allegra-$2-4 off

http://www.allegra.com/sign_up_to_save.aspx

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

Claritin

http://www.claritin.com/claritin/en/offers/index.jspa

Zyrtec

https://www.zyrtec.com/offers

Nasal Allergies

Astepro- up to $25 off copay

http://www.astepro.com/patients/savings.html

Nasonex- $15 off

http://www.nasonex.com/nasx/special-offers.action?link=personalizedProgram&web_program_id=00400000

Omnaris- Assistance with Copay

http://www.omnaris.com/getOmnaris/get-Omnaris.html

Patanase NS- up to $10 off

http://www.astepro.com/patients/savings.html

Qnasl NS- Up to $25 off

http://qnasl.com/Register

Veramyst

http://www.veramyst.com/index.html



Eye Allergies

Pataday

http://www.pataday.com/

Spring Fever!

Hopefully, you were able to get out and enjoy this beautiful weather this weekend.  Sunday really felt like the first day of spring in NYC and the streets were filled with bikers and runners all enjoying the end of winter.The streets and subways were also filled with the sound of frequent sneezes and bless you!

As much as I love spring, it does have a dark side- allergies. 

The temperate winter and early warm weather mean this going to be a brutal allergy season for those of you who suffer.  Allergist are expecting it to be a long, long season.  Don't fear, there are things you can do to prevent your allergies from interfering with enjoying this gorgeous season!

What are some signs you might have allergies?

• itchy watery eyes, swollen eyes
• fever
• sinus pressure
• frequent sneeze
• runny nose
• constant phlegm
• rashes

How can you prepare?

• You can track local pollen counts by zip code at http://www.pollen.com/
• Visit your doctor or allergist to get the appropriate medications early on.
• Carry extra medications, tissues, and your asthma medications with you. 
• Try exercising early in the morning when pollen counts tend to be lower.
• If you are especially sensitive, consider getting allergy shots to prevent symptoms.

Hopefully, with these tools, you'll avoid springs dark shadow & stay in it's beautiful light.

As always, please let me know if I can help.

------
It's spring fever.  That is what the name of it is.  And when you've got it, you want - oh, you don't quite know what it is you do want, but it just fairly makes your heart ache, you want it so!  ~Mark Twain

Breaking News- New Office in Tribeca!

Good news!
I've opened a 3rd location to better you serve your allergy/immunology needs in NYC.

In November, I started working at a beautiful office with friendly staff in Tribeca on the 1st Thursday of every month.  We hope to expand soon to 2 Thursdays a month.

The office is located at 77 Worth Street between Broadway and Church.  It's close to the 4,5,6 & the J/M/Z  Brooklyn Bridge/Chamber Street stop. 

You can call for an appointment at 212-966-3901 or book an appointment on line via Zoc Docs at http://www.jennifercollinsmd.com/
 
Stop by and say hello if you're in the neighborhood.  We'd love to see you!

Hey Doc- why does my toilet make me cough?

Hey Doc, every time I clean my toliet I start coughing and have to open the window and gets some air?

The holidays are wonderful time of year filled with lots of fun, food, and house guests. The not so fun part means lots & lots of cleaning to get ready for those visitors- and lots and lots of toilet cleaning.

Recently, I’ve had several patients who’ve triggered an asthma attack from the strong cleaning products they were using. They felt they had to use bleach and ammonium based products to get there bathrooms & kitchens really clean.

Many of the products in the stores, while getting rid of the dirt and making your home smell clean, are actually filling your home with indoor irritants that can trigger and exacerbate asthma. This is no fun!

Here are some “home made” cleaning products that you can use to avoid the potent products available in the drugstores. These recipes can be made with simple products like white vinegar, borax, dishwashing soap, and water.  You'll need several labeled spray bottles. 

These easy to make products will keep your home & smelling fresh while eliminating fumes and irritants that might trigger your asthma.

If you do have to use strong products, make sure the area is well ventilated, you use the recommended amount, and you take frequent breaks.

Enjoy & happy cleaning!

Glass and mirrors:

• 3 tablespoons of white vinegar + ¾ cup of water. Mix in a spray bottle

Countertops:

• 2-3 drops of dishwasher soap, 3 tablespoons of white vinegar. Mix with water in spray bottle.

 Disinfectant for Toilets:

• 1/4 baking soda + ½ cup white vinegar + 1 gallon of warm water

Or

• 1 can of coca cola

Mold and Mildew:

• 1 tablespoon baking soda + 2 tablespoons White vinegar + 1 quart of water.  Mix in a spray bottle.

Floors:

• 1 cup white vinegar + 1 gallon hot water mixed in a bucket

Hey Doc- Potatoes Give Me A Rash

Today had an interesting patient....

Every time she peels potatoes she gets a rash.  Her skin blisters and gets very itchy, but she has no problem eating cooked potato. Huh?? How can this be? Interestingly since she was young, she "didn't like" tomatoes and never eats them. But wait there's more...she also gets blisters with latex condoms and gloves.  She never thought to tell anyone that latex products gave her a rash.

How is this related you ask?

Potatoes, tomatoes,and latex share a common allergic protein to PATATIN. 

While anyone can develop latex allergy, it's more common in health care workers and children who've been hospitalized multiple times.

She was able to eat avocado, banana, chestnut, kiwi fruit, & carrot other foods that commonly cross react with latex via a different protein called chitanase. 
 

Now that your curiosity is peaked, I know you'll want to know, why can't she touch raw potato but is able to eat it without a problem?

• The allergic protein in potato (patatin) is changed by the cooking process and renders itself not allergenic.  Pretty cool!

What's the treatment for such a reaction?

• Avoidance, avoidance, avoidance of raw potato and she can eat all the spuds she wants, within reason of course! 
• She'll still continue to have problems with latex products and will have to avoid these in the future.

Stay tuned for more!

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.