FLU, ASTHMA AND ALLERGIES

We are in Flu season, and people with allergies and asthma should take prevention measures to avoid getting sick.

ASTHMA’S AFFECT
Adults and children with asthma, especially when poorly controlled, are more likely to have significant breathing issues if they get the Flu compared to individuals without asthma or other chronic diseases.

IS IT AN ALLERGY OR IS IT THE FLU?
Some allergy symptoms may be confused for flu symptoms. For parents of children with asthma or allergies, telling the difference between allergic disease symptoms and the flu may be a bit difficult.
Itchy eyes, a scratchy nose or sneezing are symptoms of allergies, but if your child suffers from asthma and develops a fever or nausea and vomiting, consult your physician.”
Here’s how to tell if you are suffering from allergies or something more severe

Allergy Symptoms
Runny Nose
Sneezing
Stuffiness
Itchy, watery eyes
Itchiness in the nose, mouth or throat

Flu Symptoms
Runny Nose
Coughing
Sore throat
Tiredness
Fever
Nausea or vomiting
Diarrhea
Lack of appetite

FOOD ALLERGIES AND VACCINES
Vaccination for the flu is among the best prevention tools available to prevent complications from the flu. But what if you are allergic to a substance in the vaccines?
“Individuals with egg allergy may be at risk for an allergic reaction to ... influenza vaccines due to the egg content in the vaccine preparations,” reports Dr. Casale. “Before getting vaccinated, review the information posted on www.aaaai.org and consult with your health care provider. In most cases, vaccination can be tolerated if done according to ... recommendations.”

IF YOU DO GET SICK
The Centers for Disease Control and Prevention recommends that people with flu-like symptoms stay home for at least 24 hours after they are free of fever.
If you experience severe symptoms, including difficulty breathing, chest pain/pressure, dizziness or persistent vomiting, seek emergency medical care.


AVOID CONTRACTING OR SPREADING THE FLU
• Wash your hands frequently with soap and warm water
• Hand sanitizers may also be effective
• Use a tissue to cover your coughs and sneezes
• Avoid touching your eyes, nose and mouth
• Stay home if you feel ill
• When possible, avoid close contact with sick people
• Obey school/business closures and other public health advisories

Avoid Allergy and Asthma Triggers and Keep the “Bah Humbug” Out of Your Holidays

Thanksgiving, Hanukah, Christmas, Kwanzaa and New Year’s — the fall and winter holidays bring festive times and seasonal activities that can trigger allergies and asthma. Allergists suggest the following tips to steer clear of potential culprits and enjoy healthy holiday cheer this season.

• Identify the Source of Your Suffering: Finding out what triggers your allergy and asthma symptoms is an essential first step. If you’re not sure, make an appointment to see an allergist, who can identify the source of your suffering and help stop it.
• Wash the Tree Before Trimming: Terpene is a potential allergen found in the oil or sap of live Christmas trees, evergreen wreaths and garlands. Mold also can reside on trees, and pollen is commonly found on junipers and cedar evergreens. Use a leaf blower in a well-ventilated area to remove some of the pollen from live trees and decorations. Wash the tree, especially the trunk, outdoors with a garden hose and leave in a bucket of water in the garage or on a covered porch to dry. Wear gloves when handling the tree to avoid contact with sap.Artificial trees also may harbor dust and mold. Wash them outside as well to help remove allergy triggers. When storing an artificial tree and decorations for next year, place them in airtight bags or containers.
• Let it Snow… Outside: While the artificial snow contained in aerosol cans helps bring the outdoor ambience in, these sprays can trigger asthma and allergy symptoms. Also be wary of scented candles, scented items including potpourri and wood-burning fireplaces. Your best bet is to avoid using these items if they trigger symptoms.
• Deck the Halls… After a Good Dusting: Menorahs, ornaments and other holiday decorations stored in attics and basements during the off-season often gather dust and mold that can cause an allergic reaction when they are removed from storage and readied for use. Clean each item thoroughly before decking the halls, dining room or tree. When packing these items away, store them in airtight containers to minimize dust and reduce your prep time next year.
• Plan Ahead for Healthy Travel: Traveling for the holidays has its challenges, but there are several things you can do to keep asthma and allergies in control whether you’re on the road, on board or at your destination. Talk to an allergist before you depart to identify preventive and emergency relief strategies. Pack your medications in your carry-on bag so they’ll always be there for you at a moment’s notice. If you’re allergic to dust, consider bringing your own pillow and mattress covers. Early morning and late evening travel, when air quality is generally better and traffic is lighter, also may be helpful. When renting a car, be sure to request one in which no one has smoked.
• Chill Out: Stress makes it harder for your immune system to do its job. Take time to decompress and stay on schedule with any allergy and asthma medications to prevent symptoms from interfering with holiday fun.
• Guard Against Flu: When people gather, viral illnesses such as the flu are more likely to be passed around.

Skin Allergies

Skin allergies

Winter is often a time that people suffer with dry, red, itchy skin. Allergies may be responsible for the itching. The most common skin allergies include eczema, hives, and allergic contact dermatitis.
Eczema
Eczema (also commonly called atopic dermatitis) is more common in infants and small children, but can also affect older children and adults. In infants it often affects the face, the forearms and the thighs. In older children and adults the rash usually affects the crease behind the elbows and knees, but it can affect other areas as well.
Triggers can include allergens (like pets and dust mites), irritants (like wool), excessive dryness (like using deodorant soaps), overheating and sweating, and emotional stress.
Preventing the itch is one of the main goals in treatment. Lubrication of the skin is the most important treatment. Antihistamines are often used to suppress the itch, and topical medications such as topical steroids and other anti-inflammatory medications can be used. In severe cases, oral steroids like prednisone are needed.
Hives and angioedema
Hives are red, raised, and terribly itchy. They come and go in a matter of minutes to hours. They do not affect a single area of the skin—they move around! Although they can be caused by allergy to foods, medications, insect bites and stings, and even rarely airborne allergens, they most often occur for no particular reason at all. Even though a cause cannot always be found, we can always provide some degree of relief with treatment. And the best news is that they always eventually just go away.
Angioedema is a swelling that occurs in deeper layers of the skin. For that reason, it often feels different than the itch from hives. It often occurs with hives, but sometimes occurs alone. It often affects the eyelids, lips, face, tongue, hands or feet. It can also be triggered by allergies, but like hives, sometimes occurs randomly. Testing and treatment to provide relief is readily available.
Contact dermatitis
Contact dermatitis is often not only itchy, but sometimes painful. It is red, blistery, and fixed in one location where the responsible allergen came in contact with the skin. Because there is often a lag of one or two days between contact and the appearance of the rash, the cause is not always obvious. We can provide testing to try to find the culprit, and we can offer relief with treatment.
If you or someone you know has been suffering with skin allergies, please contact us. We would love to help. 

Advair and Symbicort – “Black Box Warnings”

In 2003, the FDA required the manufacturer of Advair to include a “Black Box Warning” on the package insert of this medication. The reason for this was due to the finding in a large trial that some patients with asthma who were treated with the long-acting bronchodilator, salmeterol, had a higher incidence of asthma related death and other complications from asthma than the group who was not treated with salmeterol. Since 2003 there have been further analyses and studies regarding the use of salmeterol and another long-acting bronchodilator, formoterol. Formoterol is used in the medications Foradil and Symbicort.

Opinions among experts have been polarized. Some well-respected physicians have stopped using these drugs altogether in favor of using higher doses of steroids as well as older medications such as theophylline for treatment of moderate and severe asthma. Others who are equally well respected cite data referring to the overall safety of long-acting bronchodilators salmeterol and formoterol, and continue to use them.
The FDA has recently updated its labeling regarding the use of long-acting bronchodilators. They have concluded that the benefits of these drugs for asthma treatment outweigh the risks, when used appropriately, but that they should be used only in patients whose asthma cannot be controlled with controller medications such as inhaled corticosteroids alone. The new label stipulates that long-acting bronchodilators should only be used along with a concurrent controller medication. In other words, Serevent and Foradil should not be used alone to treat asthma. Once asthma control is achieved, it is recommended to try to reduce medication. If asthma can be controlled with a low or medium dose of inhaled corticosteroids, then long-acting bronchodilators should be avoided.
The safety of long-acting bronchodilators in adolescents has been questioned in the past. The FDA has recommended that products that contain long-acting bronchodilators such as Advair and Symbicort should be used in this age group because the ease of use has helped compliance. This results in improved symptom control and less risk of complications of uncontrolled asthma such as oral steroid use, ER visits and hospitalization.
A recent study published in February of this year in the Journal of Allergy and Clinical Immunology performed an analysis of the use of formoterol (an ingredient in Foradil and Symbicort), in over 23,000 subjects. There was no evidence of an increased risk for serious events, including hospitalization and death in the formoterol group.
We at the Allergy, Asthma & Sinus Care Center review the current safety data of all of the medications that we prescribe. We are often asked if it is necessary to use medications to treat asthma, and if the medications are safe. The “cure” for asthma has yet to be found, and every medication does carry at least some potential for side effects or risk. Overall, we feel that there is a place for medications such as Advair and Symbicort. These medications are a necessary tool in order to achieve control of asthma, but we do always look for opportunities to use less medication when possible.

The Remission Rate of Asthma—When will I outgrow it?

We are commonly asked when a child will “outgrow” their asthma. The Childhood Asthma Management Program (CAMP) is a long-term and large-scale study that assessed asthma and the factors that might predict whether asthma would persist. In the study some children were given an inhaled steroid (budesonide), some were given a non-steroid anti-inflammatory inhaler (nedocromil), and some were given a placebo inhaler. Based on their asthma symptoms during the study, they were divided into three groups: remitting (no asthma symptoms in the past year), persistent (asthma symptoms at least once in each 3 month period), or periodic (not meeting the criteria for either of the other two categories).

Only 6% of children met the criteria for remitting asthma.
All three treatment groups have improvements in measures of their asthma. Surprisingly, the likelihood of remitting (or “outgrowing”) asthma was not influenced by the specific treatment. Observations were made with regard to factors that were associated with a greater likelihood of remitting. These included:
• Absence of allergic sensitization (negative allergy tests)
• Milder asthma
• Older age
• Better lung function
Some of these observations are not a surprise. For example, it seems logical to think one is more likely to outgrow mild asthma than to outgrow severe asthma.
The child who is allergic to furry pets and has furry pets is very unlikely to outgrow asthma.
The child who is not allergic and wheezes only with colds and viruses is more likely to outgrow asthma.
Like so many other aspects of asthma, these observations are just that—observations—and not a crystal ball that will predict with absolute certainty what will happen to a single child with asthma.
It was a bit of a surprise in this study to see that the use of anti-inflammatory medications did not improve the likelihood of curing asthma. Is that a reason to not use preventive medication or any medication at all? Absolutely not! The medications are proven to improve asthma control. That means less interrupted sleep, less missed school and work, less ER visits and hospitalizations, and less use of higher dose oral steroids which carry greater risk with long-term or frequent use.
It is certainly our hope that we will be able to either cure or prevent asthma altogether. But until that day, it is advisable to maintain good asthma control with the tools of trigger avoidance and medications.