New Medication Approved for Chronic Hives!

(Omalizumab approved by the FDA for Chronic Idiopathic Urticaria)

Chronic idiopathic urticaria (CIU) is a skin disease where patients get red and itchy hives that come and go for more than 6 weeks.  About 40% of CIU patients also experience angioedema, which is when there is swelling in the deep layers of the skin.

There are many different causes of hives including viruses, allergic reactions to specific foods, drugs, and insects, as well as other specific triggers, so it’s important to see your board certified allergist for an accurate diagnosis!  The allergist, after taking your history, doing a comprehensive physical exam and the tests that are appropriate for your situation, will determine if you have CIU.

In general, the first step in the treatment of CIU after it has been diagnosed is antihistamines.  If this works, it will help suppress the hives and the swelling. Unfortunately, for up to ½ of the patients with CIU, this does not work!  This is bad news for the up to 1% of the world’s population who suffers from CIU, including the 1.5 million people in the U.S. who have this condition.

Omalizumab (Xolair®) is a targeted therapy that binds to Immunoglobulin E (IgE), the “allergic antibody”.  It is currently used as a treatment for persistent asthma.  The recent FDA approval was mainly based on the results of two major studies (ASTERIA I and II), which studied patients who did not respond to approved doses of antihistamines.  The study showed that omalizumab significantly improved hives and itchiness, and in many patients completely cleared the symptoms.  The quality of life was also significantly improved for patients treated with omalizumab, as CIU can be associated with depression and anxiety.

If you are someone who suffers from chronic hives, please see your board certified allergist for an accurate diagnosis and treatment plan!  There are new things happening in the field that could significantly change your quality of life.

-by Faith Huang, M.D.

Allergy & Asthma Associates of Southern California provides relief from allergies, asthma, sinus problems, chronic cough and other related conditions. Dr. William E. Berger, Dr. Warner W. Carr, Dr. Mark S. SugarDr. Christina D. Schwindt, and Dr. Faith R. Huang together with their staff specialize in allergy and immunology in Southern California.

If you or your child is suffering from hives or any other type of  allergy, please call us at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

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Oral Immunotherapy for Food Allergy

Oral immunotherapy for food allergy has gotten a lot of attention recently. It has been something that has intrigued patients, parents of food allergic children as well and allergists as a potential future therapy. Currently, the standard of care for patients with food allergy is strict avoidance of the trigger food(s).

Oral immunotherapy, or OIT, requires patients to start consuming a tiny amount and subsequently consume a larger and larger amount of the food to which they are allergic until their bodies become desensitized to it.  Oral immunotherapy patients generally start consuming the biggest serving they can tolerate without a reaction (which is sometimes a dose as little as 1/10,000th of an egg) and slowly build up from there over the course of months. Once they reach their target dose (generally what would be considered a normal portion size such as a peanut butter sandwich), patients must eat the food on a daily basis to keep their bodies from regaining the allergy. This is called the state of desensitization.

While oral immunotherapy has shown promise in clinical trials, it remains experimental. Some researchers have criticized those in clinical practice for making OIT available too soon, before more rigorous studies have been completed to assess its safety and effectiveness.  This is definitely a controversial topic in our field today, but I always think it is a good thing when 2 groups of very smart physicians challenge each other and really think about how we will progress as a specialty to help our patients in the safest and most beneficial way.

I have many patients and friends ask me my personal opinion on OIT.  I think that OIT for the treatment of food allergies is promising. Many studies have showed that OIT can desensitize the majority of patients who undergo it. My main hope is that there will be more data in the future regarding if OIT can induce a state of tolerance. Tolerance is different than desensitization.   When you are in the state of desensitization, you need to eat that amount of food protein on a daily basis to keep being in the state of desensitization. Tolerance is when you can eat the food whenever you feel like it. If you go a few days, or months without eating the food, the next time you choose to eat it you will be fine. With desensitization, if you skip a few days of eating the food, it is possible you would have an allergic reaction to the food the next time you eat that food.  I definitely believe that OIT is promising, but so far it is not clear to me if it would actually “cure” food allergy versus keeping you in a desensitized state where daily consumption is necessary.

There are risks to OIT. There are allergic reactions that can occur when you are going through the process of oral immunotherapy.

The research studies will continue and the debate will go on regarding OIT, which in the end will benefit the food allergic patient.

If you have any questions regarding research on food allergy, whether it is OIT or other modalities, please ask one of the board certified allergists at Allergy and Asthma Associates of Southern California!

-Faith Huang, M.D.

Allergy & Asthma Associates of Southern California provides relief from allergies, asthma, sinus problems, chronic cough and other related conditions. Dr. William E. Berger, Dr. Warner W. Carr, Dr. Mark S. SugarDr. Christina D. Schwindt, and Dr. Faith R. Huang together with their staff specialize in allergy and immunology in Southern California.

If you or your child is suffering from a food allergy or any other type of  allergy, please call us at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

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What’s causing this rash?

As allergists, we see many patients with rashes of all types.   There are many different causes of rashes, and one type has been in the news lately–a preservative found in many popular wet wipes and baby wipes has been determined as the cause of allergic contact dermatitis in some children. Allergic contact dermatitis is caused by exposure to a substance or material to which the patient has become extra sensitive or allergic.  Although a reaction to a substance may not first happen when the patient is first exposed to it, regular use can eventually cause sensitivity and a skin reaction to the product.

The skin reactions from the wipes that have been recently reported have ranged from disfiguring patches to crusting, swelling, blistering and tiny cracks in the mouth, cheek, hands and/or buttocks of young patients.  Recently, researchers have reported that all of the skin reactions involved certain brands of wipes.  The children were between the ages of 3 and 8, and none were wearing diapers.

The brands of wipes that have caused the rashes contain a well-known preservative, called methylisothiazolinone (MI), a chemical that is found in roughly half of all the wipes sold in the United States.

In the latest cases of skin reactions that have been reported, standard antibiotic and steroid cream treatments were initially given for what doctors had incorrectly diagnosed as one of a number of common skin conditions. These treatments didn’t work, but when the children stopped using the wipes, their skin recovered.

The rashes were proven to be caused by the preservative by patch testing, a method of putting various substances on the skin using a sticker-like sample, and seeing how the skin reacts.

The board certified allergist can help determine if someone has allergic contact dermatitis to a number of different substances.  We would start by taking a detailed history, doing a thorough physical exam, then determine if patch testing would be appropriate in helping determine the cause of the rash!

 

-Faith Huang

Allergy & Asthma Associates of Southern California provides relief from allergies, asthma, sinus problems, chronic cough and other related conditions. Dr. William E. Berger, Dr. Warner W. Carr, Dr. Mark S. SugarDr. Christina D. Schwindt, and Dr. Faith R. Huang together with their staff specialize in allergy and immunology in Southern California.

If you or your child is suffering from allergic contact dermatitis or any other type of  allergy, please call us at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

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Pregnancy: to eat nuts or not to eat nuts?

One of the most common questions I get from expectant mothers is if she should eat nuts or avoid them during pregnancy, to avoid her future baby having food allergies.   I asked the same question during my own pregnancy 3 years ago, and my training in pediatrics and allergy did not necessarily help me decide, as there were different scientific papers pointing in both directions and the evidence was mixed.

When I did my pediatric training, we were taught to have mothers with a family history of allergies to avoid peanuts.  However, in 2008, the American Academy of Pediatrics (AAP) reversed its advice regarding pregnancy diets in mothers with a family history of allergies.  The AAP now longer suggests avoiding peanut. The results of studies on this question have been mixed, but most suggest a “healthy” diet is helpful to reduce allergy risks, but that the avoidance of specific allergenic foods is not necessary.

A recent study published in JAMA Pediatrics last week supports the idea that among mothers without peanut or tree nut allergies, eating peanuts or tree nuts during pregnancy was not a risk factor for these allergies.  The study suggests that it may actually be protective. In contrast, mothers with peanut or tree nut allergies consuming nuts they could ingest had a slightly, but in scientific statistical terms, “non-significant”, increase infant allergy risks.

Although the new study may suggest that eating nuts is helpful to prevent allergies, the authors admit there are limitations to the study and that they are not specifically recommending this as an approach. In an interview with the Boston Globe, study coauthor Dr. Michael Young, an allergy and immunology specialist at Boston Children’s, said “We can’t make a recommendation based on our findings that women should eat nuts during pregnancy to protect against allergies in their newborns. But we can say that pregnant women should no longer be fearful of eating nuts.”

It is important to recognize that we definitely need further studies regarding this topic, and that a recommendation to eat nuts or not to eat nuts may differ depending on the specific person.  For example, it is likely important to consider if the patient has food allergies herself.  It is important to discuss your specific case with your board certified allergist/immunologist.  We may say that the evidence it still mixed, but can help guide you in a rational and evidence based way.

 

-Faith Huang, M.D.

Allergy & Asthma Associates of Southern California provides relief from allergies, asthma, sinus problems, chronic cough and other related conditions. Dr. William E. Berger, Dr. Warner W. Carr, Dr. Mark S. SugarDr. Christina D. Schwindt, and Dr. Faith R. Huang together with their staff specialize in allergy and immunology in Southern California.

If you or your child is suffering from a peanut allergy or any other kind of allergy, please call us at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

 

 

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Exercising with Allergies and Asthma

Do you avoid exercising because you have allergies or asthma, or both?  There are many healthy benefits of exercise, but for people with allergies or asthma, exercise can be hard, discouraging or sometimes even seem unbearable! Allergies and asthma can affect people of all skill levels, and symptoms can affect them at any point in time, anywhere.  Symptoms such as wheezing, coughing, runny nose, nasal congestion, and headache can greatly affect the person exercising, even professional or seasoned athletes.  However, even those who suffer greatly from allergies and asthma can still reap the benefits of exercise.

According to the American College of Allergy, Asthma and Immunology (ACAAI), people with asthma and allergies can exercise, as long as they take proper precautions and discuss with their allergist an appropriate plan before embarking on the exercise regimen.It is important to go to your allergist to identify specifically what you are allergic to.  For example, if you are allergic to triggers such as dust mite, pet dander or some molds, since these are indoor allergens, it may not help to move your routine indoors.

Allergies and asthma usually won’t completely prevent you from all exercise, but the symptoms you experience may have an impact on performance.  Nasal congestion or wheezing can make it harder to breath, while other symptoms such as fatigue and headache can weaken your endurance and decrease concentration.

According to the ACAAI, the type of exercise can affect your symptoms as well.  In general, people with allergies may do better with exercises that are stop-and- go, as these activities usually cause less bronchial constriction than exercise with continuous motion. Running continuously is more likely to result in bronchial issues where as swimming causes less respiratory irritation.Choosing where and when to exercise can also greatly impact which allergens you are exposed to.  For example, during allergy season, you may be able reduce your exposure.  You may be able to avoid routes where air pollution levels are high. Some pollens, such as ragweed, are more prevalent in the morning, with levels dropping at midday.  Also, cold, dry weather can irritate the bronchial tubes.

Seeing your allergist can help determine specifically what you are allergic to so you can reduce your exposure to these allergens, determine if you have asthma (and more specifically, exercise induced asthma), and figure out a treatment plan so that you can incorporate exercise as part of a healthy and safe lifestyle!

-by Faith Huang, M.D.

Allergy & Asthma Associates of Southern California provides relief from allergies, asthma, sinus problems, chronic cough and other related conditions. Dr. William E. Berger, Dr. Warner W. Carr, Dr. Mark S. SugarDr. Christina D. Schwindt, and Dr. Faith R. Huang together with their staff specialize in allergy and immunology in Southern California.

If you or your child is suffering from allergies and or asthma, please call us at (949) 364-2900 to schedule your appointment today. You can also use our online Request an Appointment form to schedule a future appointment.

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