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

Itchy after Sex?

Earlier this week a young woman in my practice complained of discomfort, vaginal itch/burning with intercourse.  Symptoms started immediately with intercourse and lasted for a few hours.  Using latex condoms didn't help alleviate symptoms. And she was worried- the discomfort she experienced was putting strain on her relationship with her partner and she suspected something was wrong.  She'd tried talking to her gynecologist, but was frequently diagnosed with "yeast" infections despite not having symptoms.

What could be going on?  We suspected seminal fluid allergy.  What should you know about seminal fluid allergy?

What is seminal fluid allergy?

• Allergy to a protein in the seminal fluid
• Symptoms include vaginal itching, blistering, redness, and even swelling within 30 minutes of contact with seminal fluid
• Can be limited to one partner or all partners
• Is not associated with infertility
• Commonly presents in your 20's
• Often is misdiagnosed as yeast infection or other infections.
  

How is seminal fluid allergy diagnosed?

• Using latex or animal skin condoms to avoid contact with the fluid often prevents symptoms
• An allergist may skin prick test with fresh seminal fluid or ask you to use condoms to prevent symptoms

What are your options for treatment?

• Using condoms regularly to prevent symptoms
• Your allergist may discuss desensitizing you to the seminal fluid through a graded introduction.  This is a good option if you are trying to get pregnant.

If you are worried you have seminal plasma fluid allergy, seek out an allergist for diagnosis and treatment.

My patient started using condoms regularly with good results   Her relationship with her partner has improved and she's not worried that something is "wrong" with her any longer.

Want to read more?  Here's a great website-  http://www.seminalplasmaallergy.org/

Probiotics in the News

This is a great article on the effects of probiotics recently in the Wall Street Journal  I thought you'd enjoy.

http://online.wsj.com/article/SB10001424127887324784404578143402702878118.html?mod=WSJ_article_RecentColumns_YourHealth

Recent publication

Check out my lastest publication on Allergic bronchopulmonary aspergillosis in the Journal of Allergy and Asthma.  It looks at patients with a severe from of asthma caused by mold sensitivity who were treated with Xolair (omalizumab).  We showed that there was a decrease in oral corticosteroid use in these patients.  Using xolair might be an additional treatment modality for this difficult to treat group.

http://www.dovepress.com/articles.php?article_id=11467

http://www.dovepress.com/articles.php?article_id=11467

I hope you find it interesting and helpful.  

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.