Dear Dr. K: My father, who is 70, has had two near-fatal anaphylactic reactions to yellow jacket stings. His cardiologist says he shouldn’t see an allergist for venom immune therapy (VIT) because he‘s on a beta-blocker since he had a heart attack. What should I tell him? Tell him it’s a matter of relative risk and he should see an allergist. This is a complex problem, but not a rare one, so a little explanation will help. First of all,…
By Sasha Klemawesch – A recent article in the Annals of Emergency Medicine gave me both pause for thought and a good chuckle. The researchers studied human behavior on escalators and moving airport sidewalks. They observed that more than 90% of passengers in these conveyances failed to move by stepping or walking, despite having no one in their immediate path. Moreover, they observed fairly frequent startle responses when fellow “travelers” asked to be able to step or walk past….
A peanut patch vaccine is the newest option being studied for children with severe allergy to peanuts. The two types of “vaccine” that have received the greatest study are oral immunotherapy (OIT), and sublingual immune therapy (SLIT). Both approaches are flawed and thus have not been approved by the FDA. Oral therapy provides the best results in terms of vaccine protection against peanut exposure, but it has an intolerably high frequency of side effects. Sublingual therapy is less prone to…
The Medical Letter recently published guidelines for treating COPD (chronic obstructive pulmonary disease): For all COPD patients – Stop smoking. Patients with mild disease should use a short-acting bronchodilator inhaler as needed: either albuterol (beta agent), or ipatropium (muscarinic agent), or a combination of both (combivent). Patients with moderate disease should use regular inhaler treatments of a long-acting broncho-dilator – either a beta, muscarinic or combination agent. Patients with severe disease should add a daily inhaled steroid to step 3…
The FDA has mandated that over-the-counter products containing chlorhexidine gluconate be labeled citing the risks of allergic reactions, including the rare anaphylaxis. Chlorhexidine is used as a topical antiseptic wash but is also found in prescription oral rinses. In medical settings, chlorhexidine is often used as a pre-op scrub or as a cleanser prior to IV or central line placement.
The Mayo Clinic estimates that 1% of the American population has undiagnosed celiac disease (gluten sensitivity).
If you must open windows for “fresh air,” a useful trick to avoid allowing pollen into the house is to insert and air-conditioning filter(s) into the opening. Fresh air comes in, but free of mischievous pollen.
Uppercase terms for longer names of ailments are very common. The ones mentioned here are the two most common mimics of true food allergy in infants. Symptoms of FPIES (food protein-induced enterocolitis syndrome) are vomiting/reflux with diarrhea, and of FPIAP (food protein-induced allergic proctocolitis), colic and diarrhea. Blood (either visible or microscopic) in the stool is common with both. FPIAP tends to occur at younger ages, often in the first two weeks of life, and occurs in infants who are…
Many people among us contend with unknown-to-us dreadful conditions. Periodically in this newsletter, we highlight new research that could lead to a truly better life for some of our neighbors. One such challenge is hereditary angioedema (HAE) – a genetically inherited disorder that leads to severe, and sometimes life-threatening, swelling throughout the body. Often-affected areas are the extremities, gut, face and airway. A deficiency of the protein C-1-esterase inhibitor is the culprit. Lack of this protein allows a build-up of…
Alpha-1 Antitrypsin Deficiency (AATD) is an uncommon – but not rare – genetic disease that seriously affects the lungs, occurring in about one of every 3,000 people. Alpha-1 Antitrypsin (AAT) is an enzyme that protects our lungs from protein damage and neutrophil elastase. Neutrophils are one of the white blood cells in our blood stream that migrate into our lungs to help kill microbial viruses and bacteria. In the normal state of affairs the neutrophils release elastase and other chemicals…