Loving Your Pets



Yes, pets can cause allergies but they are adorable and make their way into your hearts and families. We get it! It is true that the gold-standard treatment for pet allergy (or allergy in general) is avoidance or to remove the trigger – i.e. remove the pet from the home. In some settings, this is the best option for the patient and/or family. However, most families are attached to their pets and would rather get rid of their allergist than get rid of their pet. Often it is not (or even a consideration for that matter).

If the pet remains in the home, the most effective intervention is to remove the pet from the bedroom. Washing the pet frequently, twice a week, may be helpful but understandably, this can be burdensome and not always practical. The use of HEPA filters may provide some benefit. The most effective option for treating pet allergy, aside from avoidance, is allergen immunotherapy or allergy shots. All dogs and cats have the potential to cause allergy.  Contrary to popular belief, there is actually no such thing as a “hypoallergenic dog” or hypoallergenic dog breeds. The particles responsible for allergy in cats are much smaller than those in dog and remain airborne for significant lengths of time. Pet allergy has the potential to cause severe allergy and asthma symptoms and should be taken seriously. We are here to help as best we can!

Battling Recurrent Sinus Infections?



Sinus disease is a major health problem.  Americans spend more than $1 billion each year on over-the-counter medications to treat it.  People who have allergies, asthma, or structural blockage in their nose or sinuses and people with a weak immune system are at greater risk.  People who smoke or who are exposed to tobacco smoke get sinus infections more frequently than non-smokers, and smokers respond less well to treatment than non-smokers.

A bad cold is often mistaken for a sinus infection.  Many symptoms are the same, including headache, facial pain, runny nose and nasal congestion.  Sinus infection is often caused by bacterial infection, but sometimes it can be caused by viruses and molds.  Acute sinus disease by definition can last up to eight weeks.  Anything that lasts longer than eight weeks is considered chronic.

A healthy child or adult can get up to four colds a year.  If you are a smoker, a day care worker, or a teacher, you might get more than this.  Most colds resolve just with symptomatic treatment, but some can progress to sinus infection.  One clue is that a cold will resolve in 7-10 days.  A sinus infection typically lasts longer than ten days.

Sinus disease is often confused with rhinitis, which is simply inflammation of the nasal passages.  Rhinitis could be caused by a cold or by allergies, and it should not be treated with antibiotics.  The diagnosis of sinusitis depends on symptoms and requires an examination of the nose and throat.  Your doctor will look for redness, swelling of the nasal tissues, colored secretions and bad breath.  An exam might involve the use of a rhinoscope, a long flexible fiberoptic tube that allows for a more thorough exam of the nose and the opening of the sinus cavities.  If the diagnosis is uncertain, or if you do not seem to get better with an antibiotic, then a CT scan of the sinuses will be done.  This is the best way to see all of the anatomy of the sinus cavities, and to be certain whether or not a blockage is present.

Antibiotics are the standard treatment for bacterial sinusitis.  Antibiotics can be taken from between five days and six weeks, depending on the duration and the severity of the sinus infection.  Overuse of antibiotics is a concern, so treatment is not given unless there is clear evidence of infection either on exam or by CT imaging of the sinuses.

If underlying allergies are a contributing factor, then using allergy medications, such as nasal sprays, oral antihistamines, and even allergy shots can help to treat or prevent recurrent infections.

Nasal saline washes such as the Neti Pot or Sinus Rinse can also be helpful in flushing away thick secretions.   Used at the onset of a cold, nasal saline washes can often prevent a cold from progressing to a sinus infection.

Remember that the diagnosis of a sinus infection is not easily made over the phone.  If you have treated your symptoms for at least seven days and have not improved, then you should see your doctor to see if further evaluation or treatment is needed.  If you get more than four sinus infections a year, or if your sinus infection does not improve with standard antibiotic treatment,  then testing for underlying allergy, immune deficiency or other risk factors should be done.

Keeping Asthma In Check


The best way to keep your asthma in check is to avoid what triggers your asthma. Common asthma triggers include:
• Allergens such as pollen, mold, dust mites, and pet danders
• Irritants in the air such as tobacco smoke and air pollution
• Extreme weather conditions of heat, humidity and cold air.
• Exercise
• Emotions–not only sadness and stress, but also sometimes laughter.
• Respiratory infections

Some other health problems can make asthma symptoms worse, such as obesity, acid reflux, sleep apnea, stress and depression.  If you have one of these other problems, let your allergist know so that they can be addressed as a part of your overall treatment.

Treating your asthma includes identifying and avoiding asthma triggers when possible.  Nearly everyone needs some medication in addition to avoidance measures.  In addition, some people benefit from monitoring their lung function with a portable device like Wing or a peak flow meter.  This type of device allows you to measure your airflow, and then to follow the Asthma Action Plan that you and your allergist create.

There are many effective medicines to treat asthma.  In simple terms there are two kinds:  quick relief medicines (short acting bronchodilators like albuterol) and long-term control medications (like inhaled corticosteroids, long-acting bronchodilators, and other oral and inhaled medications) that control airway inflammation.  The right medications depend on your triggers, asthma severity and your your control.  The goal is to make you feel your best with the least amount of medication.

There are health risk concerns with corticosteroids.  They are powerful medications that can be dangerous if taken in excessive amounts.  Medical research over the past 30 years shows that when taken as directed, inhaled corticosteroids are safe and well tolerated, and one of the most effective treatments for asthma.

In recent years new medications for severe asthma have become available that fall into the category of biologic medications.  These typically block a specific antibody or other chemical that the body makes in excess that has made the asthma worse.  Currently these biologic medications for asthma are given in the form of an injection or intravenous treatment in the office.  If you have severe asthma that is not controlled with other medications, your allergist will discuss these medications with you.

When allergies play a role in asthma, then you should consider allergy shots.  These are very effective in relieving allergy symptoms and in some cases cure your allergy.  The treatment typically occurs over several years involving injecting small amounts of the allergen in gradually increasing amounts over time.  Allergy shots are generally given for three to five years, and sometimes longer.

Most of all, remember that your allergist is an asthma specialist.  You allergist can help you learn more about your asthma and develop a treatment plan that works for you.   You should see an allergist if:
• Your asthma symptoms interfere with your daily activities or your sleep.
• You’ve had a life-threatening asthma attack.
• Your doctor believes that you are not responding to your current treatment.
• Your symptoms are not usual.
• You’ve taken oral corticosteroids for asthma more than twice in one year.
• You have been hospitalized for your asthma.
• You need help to identify your asthma triggers.

Although asthma can be treated and symptoms can be controlled, there is not yet a cure for asthma.  Preventive treatment should allow you to lead a normal, active lifestyle.

If you would like to see if your asthma and allergies are not under control, take the asthma and allergy symptom test from the American College of Allergy, Asthma & Immunology.

Managing Eczema




Atopic dermatitis or eczema is a chronic inflammatory disorder of the skin that can range in severity from scattered, mild patches to very severe itchy, red, rash that can affect all of the skin. In people with eczema, even normal looking skin can be very itchy. Eczema is sometimes called the “itch that rashes” because itching leads to scratching that can worsen eczema and lead to more itching. It is important to identify environmental allergens that may be contributing to eczema. Food allergies can contribute to severe eczema, but in general, before broad food allergy testing is done, the skin care regimen should be optimized.

The skin of people with eczema has a dysfunctional barrier that makes it hard to retain moisture. Good regimens for eczema generally involve daily baths (soaking for 15-20 minutes) using a non-soap cleanser such as Cetaphil followed by patting the skin dry and then applying topical steroids to active, eczema lesions. The rest of the skin should undergo very aggressive moisturizing. Moisturizers can be applied several times per day. Plain, unscented petroleum jelly is often the best option to use on the skin for most individuals. The better the basic skin care regimen, especially using petroleum jelly or simple moisturizers (avoid scented lotions and those with too many ingredients), the easier it is to prevent flares of eczema and itching. In severe cases, bleach baths (2-3 days/week) and wet wraps may also be considered.

Living With Food Allergies



A diagnosis of a life threatening food allergy is a life-changing experience for individuals and their families. While living with food allergies requires always being vigilant, having a game plan helps make it manageable. There are many excellent national and in some cases local resources to guide families living with food allergies. FARE (Food Allergy Research & Education) is one of the most prominent national groups. They have a very useful “Food Allergy Field Guide” that is geared to families newly diagnosed with food allergy and can be downloaded in PDF format. Their website ( has a lot of resources.  Locally, the Asthma and Allergy Foundation of America- St. Louis Chapter (AAFA-STL) is a fantastic organization. While they are geared a little more toward asthma, AAFA-STL holds Food Allergy 101 meetings throughout the year and has other resources.

How families deal with food allergies varies from family to family, in part because everyone has a different risk tolerance. For example, some families avoid all foods labeled with “may contain”, “processed in the same facility”, “processed on shared equipment”, and etc., while other families may allow consumption of foods with such labels in certain circumstances. Good rules to live by are:

ALWAYS have access to epinephrine. Lack of access or delayed administration when having a serious reaction are more likely to lead to poor outcomes.

ALWAYS read labels. If a food is not labeled, and you do not know who made it, then it is best to avoid it.
Communicate effectively with friends, family, schools, and caregivers regarding the food allergy. Advocating for yourself or your family member is essential.

Traveling and eating out can present their own challenges. A recent New York Times article discussed the difficulties individuals with food allergies may have when traveling by plane. Allergy Eats is a good resource to check out when it comes to dining options.

It is important to remember that some food allergies may be outgrown, especially those to cow’s milk (dairy), eggs, wheat, and soy. Peanut, tree nut, finned fish, and shellfish allergies are less likely to be outgrown, but some individuals can still outgrow these. Therefore, regular follow up with your allergist is important. There are also new exciting treatment options currently available or on the horizon. Studies with the peanut and milk patches have been very promising. Oral immunotherapy (OIT) for foods is also an option for some individuals – but not for everyone. Our practice offers OIT with the first goal being risk reduction or significantly decreasing the risk that an accidental exposure will lead to a life threatening reaction or anaphylaxis.