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Winter Bulletin

Asthma during the Winter Months

 As winter weather rolls in, so do colds and flu. For those with asthma, it can be an especially stressful time of year because even a simple cold virus can trigger a major asthma event.

Here are tips to help avoid an asthma flare: 

1. Take your Maintenance Medications. These medications help control the underlying inflammation of lungs that is characteristic of asthma.

2. Practice good Hand-Washing techniques.

3. Utilize your Peak Flow Meter. A decrease in Peak Flow will typically occur before any symptoms develop and will help clue you into a possible impending asthma flare.

4. See your provider about formulating an Asthma Action Plan that can help guide you in what to do if you do experience a flare.


Although people tend to think more of the spring and fall times for allergy symptoms, because people typically spend more time inside during the winter months, indoor allergens become bigger problems. 

Some common indoor allergy triggers are: 

Dust mites. These microscopic bugs flourish in mattresses and bedding. When their droppings and remains become airborne, they can cause allergy symptoms in people who are sensitive to them. 

Mold. This fungus thrives in damp, humid areas such as basements and bathrooms. When its spores get into the air, they can trigger allergy symptoms. Although many people believe they are allergic to Christmas trees, it's actually not the trees, but the mold that can collect on them that is more likely to cause allergy symptoms. 

Animals. They may be our best friends, but pets can become worst enemies to anyone who is allergic to them. Contrary to popular belief, most people are not allergic to animal fur, but rather to a protein found in the dead skin flakes (dander), saliva, and urine. These proteins can get inhaled into the nose and mouth and cause a reaction. 

Perfumes. Getting dressed up for holiday parties often means spritzing on perfume and cologne, which can worsen breathing symptoms and lead to skin reactions in some people with allergies and asthma. Lotions, hairspray, air fresheners, and potpourri can also elicit reactions in people with fragrance allergies.

Eczema can be particularly challenging to deal with during the dry winter months. Here are some tips to help reduce itching and soothe inflamed skin:

Try to identify and avoid triggers that worsen the inflammation. Rapid changes of temperature, sweating and stress can worsen the condition. Avoid direct contact with wool products, such as rugs, bedding and clothes, as well as harsh soaps and detergents. 

Avoid scratching whenever possible. Cover the itchy area if you can't keep from scratching it. Trim nails and wear gloves at night. 

Bathe less frequently. Most people who are prone to atopic dermatitis don't need to bathe daily. Try going a day or two without a shower or bath. When you do bathe, limit yourself to 15 to 20 minutes, and use warm, rather than hot, water. Using a bath oil also may be helpful. 

Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body. 

Moisturize your skin. Use an oil or cream to seal in moisture while your skin is still damp from a bath or shower. Pay special attention to your legs, arms, back and the sides of your body. If your skin is already dry, consider using a lubricating cream. 

Use a humidifier. Hot, dry indoor air can parch sensitive skin and worsen itching and flaking. A portable home humidifier or one attached to your furnace adds moisture to the air inside your home. Portable humidifiers come in many varieties. Choose one that meets your budget and any special needs. And be sure to keep your humidifier clean to ward off bacteria and fungi. 

Wear cool, smooth-textured cotton clothing. Avoid clothing that's rough, tight, scratchy or made from wool. This will help you avoid irritation. Also, wear appropriate clothing in hot weather or during exercise to prevent excessive sweating. 

When is the best time to introduce Peanut-containing foods?

The wait is over for parents who’ve been wanting to know how and when to introduce peanut-containing foods to their infants to prevent peanut allergy. New, updated guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), published today, define high, moderate and low-risk infants for developing peanut allergy, and how to proceed with introduction based on risk.

“This update to the peanut guidelines offers a lot of promise,” says allergist Stephen Tilles, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI). “Peanut allergy has literally become an epidemic in recent years, and now we have a clear roadmap to prevent many new cases moving forward. The Learning Early About Peanut allergy (LEAP) study, the study that paved the way for the updated guidelines, has had a dramatic impact on day-to-day patient care. In fact, during my career as an allergist I cannot think of a single publication with more of an impact.”

According to the new guidelines, an infant at high risk of developing peanut allergy is one with severe eczema and/or egg allergyThe guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants who have already started solid foods, after determining that it is safe to do so. 

“If your child is determined to be high risk, the new guidelines recommend evaluation by an allergy specialist, which may involve peanut allergy testing, followed by trying peanut for the first time in the specialist’s office,” says allergist Matthew Greenhawt, MD, MBA, MSc, ACAAI Food Allergy Committee chair, and a co-author of the guidelines. “If a child is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we still don’t know if they’re truly allergic. Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods.” 

A positive test alone is a poor indicator of allergy, and studies have shown infants who have a peanut sensitivity aren’t necessarily allergic. “In fact in the LEAP study, infants sensitized to peanuts showed the most benefit from early introduction of peanut-containing foods,” says Dr. Greenhawt. The updated guidelines recommend that Infants with a positive peanut skin test have peanut fed to them the first time in the specialist’s office. Some infants may have a large reaction to the skin test (8 mm or larger) which could indicate they are already peanut allergic.  “An allergist may decide not to have the child try peanut at all if they have a very large reaction to the skin test. Instead, they might advise that the child avoid peanuts completely due to the strong chance of a pre-existing peanut allergy. Other allergists may still proceed with a peanut challenge after explaining the risks and benefits to the parents.”

Moderate risk children – those with mild to moderate eczema who have already started solid foods – do not need an evaluation. These infants can have peanut-containing foods introduced at home by their parents starting around six months of age. Parents can always consult with their primary health care provider if they have questions on how to proceed. Low risk children with no eczema or egg allergy can be introduced to peanut-containing foods according to the family’s preference, also around 6 months.

The new guidelines offer several peanut-containing food suggestions as well as methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. It is extremely important parents understand the choking hazard posed by whole peanuts and to not give whole peanuts to infants. Peanut-containing foods should not be the first solid food your infant tries, and an introduction should be made only when your child is healthy. Do not do the first feeding if he or she has a cold, vomiting, diarrhea or other illness.

“The guidelines are an important step toward changing how people view food allergy prevention, particularly for peanut allergy,” says Dr. Tilles. “They offer a way for parents to introduce peanut-containing foods to reduce the risk of developing peanut allergy.”

The guidelines are simultaneously being published in Annals of Allergy, Asthma and Immunology, the ACAAI’s scientific publication, and several other scientific journals.

To learn more, watch “Peanuts and your baby: How to introduce the two.” For more information about allergies, please contact our office at 317-706-2839.

Food Allergies versus Intolerance

Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. Eating a food you are intolerant to can leave you feeling miserable. However, if you have a true food allergy, your body’s reaction to this food could be life-threatening.

Digestive system versus immune system

A food intolerance response takes place in the digestive system. It occurs when you are unable to properly breakdown the food. This could be due to enzyme deficiencies, sensitivity to food additives or reactions to naturally occurring chemicals in foods. Often, people can eat small amounts of the food without causing problems.

A food allergic reaction involves the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to cow’s milk, your immune system identifies cow’s milk as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. Each type of IgE has a specific “radar” for each type of allergen. Unlike an intolerance to food, a food allergy can cause a serious or even life-threatening reaction by eating a microscopic amount, touching or inhaling the food. Symptoms of allergic reactions to foods are generally seen on the skin (hives, itchiness, swelling of the skin). Gastrointestinal symptoms may include vomiting and diarrhea. Respiratory symptoms may accompany skin and gastrointestinal symptoms, but don’t usually occur alone. Anaphylaxis (pronounced an-a-fi-LAK-sis) is a serious allergic reaction that happens very quickly. Symptoms of anaphylaxis may include difficulty breathing, dizziness or loss of consciousness. Without immediate treatment—an injection of epinephrine (adrenalin) and expert care—anaphylaxis can be fatal.

Oral Allergy Syndrome

Oral allergy syndrome causes itchiness in or around your mouth area after eating raw fruit or vegetables because the proteins in some fruits and vegetables are similar to proteins in some pollens. The proteins are not the same, but similar enough to confuse the immune system and cause symptoms. Not everyone who has seasonal allergies has oral allergy syndrome, but seasonal allergies are necessary for oral allergy syndrome to occur.

For some people this may help explain seemingly mysterious reactions to certain foods -- for example, raw apples but not cooked apples. That's because there are proteins in raw apples that are very similar to the proteins in birch pollen. Cooking the offending fruits and vegetables will "denature" or change the shapes of these proteins, so people with oral allergy syndrome will usually be able to eat them without a problem.

Because the reaction is usually localized to the mouth area, including lips, tongue, and throat, some people will choose to ignore the symptoms and continue to eat offending foods. This of course depends on the severity of symptoms and how much the person enjoys eating the specific fruit or vegetable. Antihistamines can also be helpful in reducing more mild symptoms.

It's important to let us know if you experience any other symptoms associated with eating raw fruits and vegetables because in rare cases people with oral allergy syndrome experience anaphylaxis, a life-threatening reaction that may include swelling, blocked airways, low blood pressure, anxiety, vomiting and diarrhea. The most severe reactions require the use of an injection of epinephrine to subside, which is why many people with food allergies carry auto-injectors for emergencies. 

Is it safe to get up close and personal with food allergies?

Allergists realize people who are severely allergic to a food can experience great anxiety when encountering the food in any form. Kids, in particular, can get extremely nervous about the idea of being close to someone eating peanuts or peanut butter.

An article in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI), illustrates most kids can be near food allergy triggers without fear.

“We developed the proximity food challenge to help ease anxiety in kids with food allergies,” says allergist Chitra Dinakar, MD, ACAAI Fellow and lead author of the article. “The challenge allows kids with food allergies – such as to peanut butter or milk – to not only be in the same room with the food, but also to breathe in the air and have the food placed on their skin. Kids see for themselves it is safe to be near their food allergen as long as they don’t eat it or get it into their eyes, nose or scraped skin. It’s a great relief.”

Some people with food allergies cut back on social activities or flights for fear of coming into accidental contact with food allergens. Children with food allergies are occasionally assigned to separate “allergy-free” tables in the school lunchroom, leaving them feeling self-conscious, as well as anxious that being near the food could cause a reaction. Most people with food allergies only react to ingesting the allergen. Only a very small percentage of people have a severe reaction to breathing in dust or vapor from the allergen, for example, the protein from shelling peanuts or cooking shellfish.

“We’ve done dozens of proximity food challenges,” says allergist Jay Portnoy, MD, ACAAI past president and co-author of the article, “and the majority of children have not suffered a reaction. Actually, only one child had a hive appear. Most kids are initially scared, but when they don’t have a reaction, their fears are eased, and they have a new sense of freedom. They have more confidence in being a part of their community.”

If you have questions about food allergies, please call 317-708-2839.