“Cedar Fever” is a term given to allergies associated with cypress and juniper tree pollen. The scientific family name for these trees is “cypressaceae”. Although these allergies are typically thought of affecting people in Austin Texas and Santa Fe New Mexico, many people are affected each winter in Arizona as well. The common symptoms of Cedar Fever include: sneezing, nasal congestion, runny nose, throat drainage, and itchy, red, watering eyes. Other symptoms, which are easily overlooked, are achiness, fatigue and low grade fevers, hence the name “cedar fever”. Oftentimes these symptoms are attributed to the common flu. Allergies to this type of tree pollen can also trigger asthma.
In Arizona there are many trees which are “anemophilous” or wind born pollinators. The dry warm climate and wind allow these trees to reproduce. Juniper and cypress trees are evergreen trees and come in a variety of shapes and sizes. They can be short or tall and resemble a bush more than a tree. The easiest way to distinguish between cypress and juniper trees is to look at their cones. The cypress trees have large round cones, while the juniper tree has “juniper berries”. These trees are not as prevalent down here in the valley; however, as you travel further north, higher altitudes support the growth of pine trees and juniper trees, also referred to as Pinyon-Juniper Woodland. These plants produce pollen that can be carried 40,000 feet up into the atmosphere and can be transferred fifty miles from the source. Typically the valley’s highest pollination season is in winter, or early December through February.
In summary, if each winter you feel like you have recurrent sinus infections, a cold, lasting flu, or asthma, your symptoms may just be from the native plants of Arizona. The next time you hear residents of Texas and New Mexico complaining of “cedar fever”, let them know that they are not the only ones who can lay claim to the allergies associated with Cedar Fever.
TIME OF YEAR: A cold is a viral infection, which is caused by one of many rhinoviruses that affect the nose. Although it is possible to “catch” a cold at any time, cold viruses are more common during the winter months. By contrast, an allergic reaction is an immune response to a harmless substance and is most prominent during the spring and fall months when pollen counts from trees, grasses, and weeds are at their highest.
One symptom is difficulty swallowing. When the esophagus becomes chronically inflamed it can even spasm and cause food to become lodged or impacted. This is a quite painful reaction, which may result in the individual regurgitating water and saliva. Often these symptoms are quite alarming and patients will seek immediate medical treatment in the emergency room. Fortunately, the symptoms resolve once the food has passed or after it is removed via endoscopy. Foods that typically become impacted are items that are thick in consistency, such as meat, or items that swell with the introduction of fluid, such as bread or rice.
If eosinophilic esophagitis becomes a chronic problem, structural changes of the esophagus may occur. The most common structural changes are the formation of esophageal rings or strictures. These rings in the esophagus cause food to “catch”, and swallowing can be obstructed. If the strictures become severe, a gastroenterologist will perform a procedure called “dilation”. The purpose of this procedure is to break or stretch the rings or adhesions and prevent food from becoming obstructed in the esophagus.
Valley Fever is the common name for Coccidioidomycosis, an infection caused by fungi known as Coccidioides. This fungus is found in the soil in certain lower deserts of the desert southwest including southern Arizona, south and central California, southwestern New Mexico and west Texas. It can also be found in parts of Mexico and Central and South America. The name Valley Fever is actually the shortened older name for Coccidioidomycosis, which was San Joaquin Valley Fever. The association between the disease and the causative agent was made in the San Joaquin Valley in California.
With all this ominous news, how does one know if they have Valley Fever? Well, the incubation period is typically between 7 and 21 days, meaning clinical disease is apparent 7 to 21 days after exposure. Thinking back to our recent Haboob, individuals would start experiencing symptoms around July 12th to July 26th. But symptoms may remain subclinical for weeks or even months. Many times individuals never even realize they had Valley Fever due to the mild nature of their illness. 
Nitric oxide is a gas that is produced naturally in the airways and is detectable in the exhaled breath. Research has discovered that eNO levels significantly increase when airway inflammation is present. It is now possible to measure this gas in order to aid in the diagnosis and management of asthma as well as other lung diseases. Levels will be high in untreated or poorly managed asthma and will lower when asthma therapy is initiated and asthma is controlled. Therefore, the results of the test can help to determine how well inhaled anti-inflammatory medications (such as steroid inhalers) are working and can provide further guidance regarding when to increase or decrease medication dosages. This will be helpful in determining patients minimal effective dose of medicine.
Research has revealed vitamin D’s role with calcium, and how it affects our bones and parathyroid glands. Vitamin D is important for the absorption of calcium by the intestinal tract. It prevents problems with our bones, such as osteomalacia in adults and Ricket’s disease in young children. This supplement also prevents abnormal function of the parathyroid glands. Finally, we know that vitamin D plays a role in our immune system; however, the specific role is still unclear.
There is a special group of individuals that have a unique reaction to aspirin and the NSAlDS. These are a subset of asthmatics. Twenty percent of asthmatics are sensitive to aspirin and NSAIDS. This group of asthmatics have what is called Aspirin Exacerbated Respiratory Disease (AERD). It was originally known as Samter’s Syndrome or Triad Asthma. AERD is a combination of asthma, chronic sinusitis. nasal polyps and then a reaction to aspirin or an NSAlD, This reaction is not a true allergic reaction but an exaggerated response of the body to the biological effect of aspirin or all NSAIDS. This reaction is characterized by watery itchy eyes. runny nose. nasal congestion, sinus-like headache and a severe exacerbation of asthma. An aspirin reaction occurs between twenty minutes and three hours after ingesting the aspirin or NSAlD. 
