Cedar Fever Is Coming To Town

Comments Off on Cedar Fever Is Coming To Town Written on October 10th, 2014 by
Categories: Allergies, Allergist, Allergy Advice, Allergy Shots, Pollen in Arizona

“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.


Allergy Shots or Drops: Besides the Obvious, is there a Difference?

Comments Off on Allergy Shots or Drops: Besides the Obvious, is there a Difference? Written on October 1st, 2014 by
Categories: Allergies, Allergist, Allergy Advice, Allergy Articles, Allergy Shots

What are the treatment options for documented allergic disease?  If you do not know what the facts are, the answers can be very confusing.  When treating hay fever or allergic rhinitis, asthma and sometimes eczema, there are three main categories of treatment options.  First, one should always try and avoid any offending allergy triggers.  Second, there are a variety of medications that may be effective.  Lastly, allergen immunotherapy, also known as allergy shots, can be instituted if the first two options are ineffective.  So where does allergy drops fit in, if at all?


Allergy drops, or more properly known as sublingual immunotherapy (SLIT), are a form of allergen immunotherapy developed in Europe.  The purpose of sublingual immunotherapy is the same as traditional subcutaneous immunotherapy (SCIT) or allergy shots.  Subcutaneous immunotherapy works by readjusting or rebalancing the immune system so that it stops reacting to allergy triggers.


When someone is allergic his or her immune system has made an allergic antibody to a pollen, dander or mold.  This antibody, when exposed to the allergen, starts a reaction that ends with the symptoms of hay fever or asthma, such as runny nose, nasal congestion, and watery itchy eyes, coughing or wheezing.  This is actually an over-active immune system.  Therefore the goal of subcutaneous immunotherapy is to calm down this over-active immune response.  For allergy shots to work, the patient needs to be allergic to substances that are appropriate for allergen immunotherapy.  The allergy shot serum should include the allergens the patient is allergic to and not include the ones that they are not reactive to.  This means the serum should be customized to each patient.  Also, the serum must be mixed correctly in that certain allergens cannot be put together in the same serum as they degrade each other.  This process takes time but is the best long-term solution to control allergies.


Sublingual immunotherapy has the same biological effects as subcutaneous immunotherapy.  This was refined in Europe and has shown excellent benefit when used in the appropriate patient.  Sublingual immunotherapy works best in those individuals that are not allergic to a lot of different allergens.  Currently there are no FDA approved sublingual extracts or serum in the United States. This also means that insurance companies will not cover sublingual immunotherapy. Studies to obtain FDA approval are ongoing.  When FDA approval is obtained, sublingual immunotherapy will be an appropriate treatment option for the control of allergic rhinitis or hay fever and asthma.


So what is the problem?  Unfortunately, there is a lot of misinformation about sublingual immunotherapy.  Many practitioners advertise drops as being safe with no potential for systemic or severe reactions like can be seen with subcutaneous immunotherapy.  This is not true.  Systemic reactions can occur with sublingual treatment therefore care must be taken when sublingual immunotherapy is started and advanced. Local reactions in the mouth, throat and stomach also occur. Sublingual immunotherapy, when it obtains FDA approval, needs to be performed under proper supervision by a physician specifically trained in allergy and immunology.  Also, like subcutaneous immunotherapy, sublingual extracts should be customized for the patient.  There is no one drop fits all.


When sublingual immunotherapy receives FDA approval, it will be an added treatment option for patients with allergic rhinitis or asthma.  If avoidance measures and medications do not adequately control symptoms and the patient is only allergic to a few allergens, then sublingual immunotherapy may be the next step in treatment.  In patients who fail to respond to sublingual immunotherapy or who react to a multitude of allergens, then traditional subcutaneous immunotherapy would be the best option.  Until that point, make sure your treatment program is appropriate and backed by scientific study.



Do I have a Cold or might it be Allergies?

Comments Off on Do I have a Cold or might it be Allergies? Written on September 27th, 2014 by
Categories: Allergies, Allergist, Allergy Advice, Allergy Articles, Allergy Shots
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The fall season is here and along with that comes a common comment heard in our office….. “I don’t know if I have a cold or allergies but I feel miserable.” The symptoms of colds and allergies often overlap and have a similar presentation. This article is going to look at some of the differences between these two very common conditions.

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.

SYMPTOM ONSET: One of the early differences between colds and allergies is how rapidly symptoms occur. Cold symptoms generally have a gradual onset over a period of several days. A cold may begin with a general sense of fatigue, sore throat, or runny nose and over time progresses to severe nasal congestion, headache, and perhaps even fever and body aches.  The symptoms of allergies have an abrupt onset (when exposure to the allergen occurs) with one of the first and most common symptoms being sneezing…..often multiple times in a row.

DURATION OF SYMPTOMS: Cold symptoms persist for anywhere from 5-10 days and then gradually improve.  Allergy symptoms may last for months or as long as you are exposed to the allergy trigger.  If you are symptomatic greater than 10 days, you will want to consider the possibility of your symptoms being of an allergic nature.  Remember, a person can develop allergies at ANY time in their life, so just because you don’t have a history of allergies in the past, doesn’t mean you don’t have them now!

SYMPTOMS: How many times have you been asked in a health care setting, “what color are your nasal secretions” (Interesting question huh?!) This is an important clue to determine the cause of your symptoms. Both conditions may cause a runny nose or nasal congestion but nasal secretions will be consistently clear and watery when you are experiencing allergies. A cold virus may begin with clear nasal secretions but over 3-4 days the mucous becomes yellow/green and opaque as the illness develops. Another important difference is that itching of the eyes, nose, throat, or ears are uncommon with a cold but are very common allergy symptoms. If you have a fever or feel achy, chances are you have a cold and not allergies. It is important to remember that with either allergies or a cold, continued nasal discharge that becomes thick, brown, dark yellow, or green might indicate a sinus infection and may require the use of an antibiotic.

While a cold is a condition that just requires a bit of time to clear up, allergies do necessitate treatment.  If you are experiencing allergic symptoms which are persistent in nature, seek the advise of an allergist so that appropriate testing and treatment can be initiated. At Allergy, Asthma, & Immunology, our clinicians and staff are committed to improving your health and your quality of life. We look forward to hearing from you!


Eosinophilic Esophagitis, what is it?

Comments Off on Eosinophilic Esophagitis, what is it? Written on August 25th, 2014 by
Categories: Allergies, Allergist, Allergy Advice, Allergy Articles, Allergy Shots
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Lately the media has been paying more attention to food allergies, and for good reason.  Food allergies are increasing in America, and we are not sure why.  One such food allergy issue is eosinophilic esophagitis.  This is a medical condition that occurs when the esophagus becomes inflamed with eosinophils, which are white blood cells associated with allergies.  The inflammatory reaction is most often diagnosed by obtaining a biopsy of the esophagus during a procedure called an esophagogastroduodenoscopy, also known as an endoscopy.  If the inflammatory reaction occurs repeatedly, over time people may experience esophageal spasms, weakening of the LES (lower esophageal sphincter) and possibly structural changes of the esophagus itself.  There are a variety of symptoms that someone may experience with eosinophilic esophagitis, the most common symptoms are explained below.

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.

Other symptoms may occur due to the regurgitation of stomach acid, which result from the LES not working properly.  The LES is a muscle that prevents acid from leaving the stomach and entering the esophagus.  The LES is the reason we can stand on our head and food won’t rush out.  In infants the LES does not work as well as it does in adults.  This is why infants tend to “spit up” after eating.  Inflammation from eosinophilic esophagitis interferes with the LES and allows stomach acids to wash up into the esophagus.  This acid causes burning pain, chest discomfort, regurgitation of food and various other symptoms.

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.

In closing, eosinophilic esophagitis can cause a myriad of symptoms and is still under diagnosed.  Food allergies quite often play a major role in eosinophilic esophagitis, and there are ways to test for food allergies with a board certified allergist.  This can include skin testing and blood testing.  If you are experiencing some of these symptoms, talk to your physician or seek an allergist or gastroenterologist who are familiar with this condition and are willing to work as a team with you.