Allergy Partners is the nation’s largest single-specialty practice dedicated to the treatment of allergies, asthma, and allergic diseases. All Allergy Partners’ physicians are board-certified allergists who have years of training and experience in the treatment of allergies and asthma. Working together, our physicians are able to combine their expertise to ensure that each and every patient receives the very best care. Our physicians are dedicated to identifying clinical best practices that will ensure the very best outcomes for each patient. Such collaboration produces what we like to call the Allergy Partners Difference.

One example of the Allergy Partners Difference is our state-of-the-art allergen immunotherapy program and extract lab. To ensure that immunotherapy is as safe and effective as possible, it is imperative that the extract be made with the highest quality raw materials, that the dosage be optimized to ensure effectiveness and safety, and that the extract be individualized for the patient. Working with national organizations and extract manufacturers, Allergy Partners has developed a state-of-the-art immunotherapy program. Our centralized extract lab, located in Asheville, North Carolina, produces the highest quality allergen extract possible. Abiding by national immunotherapy standards, all Allergy Partners extract is designed to provide each patient an individualized vaccine that will provide the utmost clinical effectiveness while maintaining patient safety.

Allergy Partners is also committed to using the latest technology to improve patient outcomes. Allergy Partners has adopted electronic health records to improve patient safety and communication with referring physicians. All Allergy Partners physicians also employ a secure internal e-mail system that allows them to virtually discuss difficult cases with the entire group of allergists.  This affords the patient with access to not just his or her allergist, but a network of over 60 board-certified allergists to help solve the problem.

Allergy Partners is dedicated to patient education. Our new website was built and designed by our physicians and contains a wealth of educational material to help families and patients manage their allergies and asthma.  You can also find information about upcoming events and news, as well as local allergy and asthma information by ‘Liking’ us on Facebook and ‘Following’ us on Twitter.

We invite you to learn more about Allergy Partners, the conditions we treat, and the services we provide by browsing our website, visiting our social media pages or contacting the practice.  Check back often for new updates and the latest information!

When I have patients with either a peanut or tree nut allergy, I usually tell them to avoid all nuts. One of the reasons is to avoid the risk of cross contamination. In our modern food processing industry, peanuts and tree nuts are often mixed together. I want to make sure that there are no hidden ingredients in certain products that could harm my patients.

The other reason I recommend this is that it is very hard to tell the nuts apart. I don’t want my patients (especially children) to have to correctly identify a nut prior to eating it to make sure it is safe. What if they identify it wrong? Well, there is a study published in 2011 that looks at this issue. Investigators from the Ohio State University tested over 1000 people by showing them a nut display that held peanuts and 9 tree nuts in a total of 19 different forms. They found that, on average, only 44% of the nuts were identified correctly. In children, they identified only 24% while adults correctly labeled 58% of the nuts.

What about those people who suffer from actual nut allergy? Only 50% of them correctly identified all forms of peanuts or tree nuts to which they are allergic. Parents of nut–allergic children did no better than parents of children without such allergy.

This study reinforces that in nut allergy if you are allergic to one, act as if you are allergic to all.

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information and more.

Dr. Ananth Thyagarajan (Dr. T.)

For the second time this year, neti pots have been linked to fatalities via the contraction of Naegleria fowleri, the “brain-eating amoeba”. Here is a link to a news report and here is a link to the Louisiana Department of Health and Hospital statement.  The first death came in June, when a 20-year-old man died of encephalitis caused by infection. Then in October, a 51-year-old Louisiana woman died of encephalitis. The doctor thought to ask if she used a neti pot. Both her brain tissue and her home’s tap water tested positive for the microbe.

Naegleria is a microscopic ameba (single-celled living organism) that can cause a very rare, but severe, infection of the brain. Naegleria fowleri infects people by entering the body through the nose. This typically occurs when people go swimming or diving in warm freshwater places, like lakes and rivers. In very rare instances, Naegleria infections may also occur when contaminated water from other sources (such as inadequately chlorinated swimming pool water or heated tap water <47°C) enters the nose. Once the ameba enters the brain, it causes a usually fatal infection called primary amebic meningoencephalitis (PAM).

In the most recent instance, a Louisiana woman contracted the Naegleria fowleriafter rinsing her nose with tap water. Though chlorination kills most organisms like this, it is not 100% effective. This is believed to be the case twice this year in Louisiana, and currently the CDC is assisting the Louisiana Department of Health in investigating the source of the microbe.

Despite all of this bad news, daily nasal irrigation (one type being neti pots) remains a potentially effective treatment for allergies and sinus infections in many patients. There have been 2 studies that looked specifically at the benefit from saline nasal washes. They both claim benefit, but the absence of a comparator group in one and possible placebo effect in the other weakens their conclusions. The way I look at it is if a patient uses the wash on a regular basis and feels some improvement then I recommend continuing. If there is no difference after using the treatment, then stop.

The lesson here is not to stop using the neti pots if they help you, but to use only sterile or distilled water!

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information and more.

Dr. Ananth Thyagarajan (Dr. T.)

Like most of us, my family and I will be traveling over this holiday weekend to see family and friends. This travel, and subsequent potential exposure to different or more allergens, can cause real difficulties for those of us who suffer from allergies. Check out some tips below to help you cope:

• If you suffer from allergic rhinitis (hay fever) or asthma, temporarily initiating or increasing your allergy or asthma specific medications may help prevent symptoms from arising. Please discuss with your physician these options before changing any medications.
• Check out these tips to help avoid common allergens and triggers.
• For food allergic people, here are some tips from the Food Allergy & Anaphylaxis Network on having a safe holiday weekend.

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, and more.

Dr. Ananth Thyagarajan (Dr. T.)

Allergy shots are one of (if not the) most effective treatments for allergic rhinitis (hay fever), allergic asthma and flying insect allergy. Treatment with allergy shots can reduce your need for medications, make asthma easier to control, and give relief from allergy and sinus symptoms.  In children, allergy shots may reduce the risk of developing asthma later in life and reduce the risk of developing additional allergies. So what does this mean in terms of health care costs? Are the medical benefits of shots outweighed by its expense?

In a 7-year retrospective (looking back in time) analysis of children newly diagnosed as having allergic rhinitis, investigators compared medical costs incurred during the 6 months before starting shots to the costs for these same children that were incurred during the 6 months after completion. The per-patient 6-month total health care costs were significantly lower in the 6-month period after completion compared to the time preceding shot initiation. Interestingly, in this study only 16% o f patients completed the recommended 3 years of treatment. Even with that low completionrate, a significant savings was seen.

The same investigators subsequently conducted a similar 10-year retrospective study. One of the main differences in this study is that they compared the 18 month health care costs of a group of patients receiving shots to a similar group that did not.  Children who received shots incurred significantly lower per-patient health care costs compared to the children who were treated with medications alone.  A parallel study has been conducted with adults and similar, significant reductions in 18-month health care costs have been reported. In these patients the cost savings was approximately 41%!

Allergy shots are not only the most effective treatment for certain allergic diseases, but they are also more cost effective than medications alone. That is a win-win situation!

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, and more.

Dr. Ananth Thyagarajan (Dr. T.)

Fall is the time of year we think about cooler weather, changing leaves and back to school. But for those with ragweed allergy, it can also be a time of a lot of suffering. What some see as a beautiful time of year, others see as a time filled with boxes of tissues and eye drops. Ragweed pollen causes a lot of the symptoms for those who suffer from fall hay fever (otherwise known as allergic rhinitis).

The pollen is normally released between August and October. A publication from the United States Department of Agriculture found data that indicate a significant increase in the length of the ragweed pollen season by as much as 13–27 days at latitudes above ∼44°N since 1995 compared to before that time (this latitude crosses states in the northern part of the U.S.)  This is not good news for those people who suffer from ragweed allergy. The pollen is highest during the morning hours, on windy days, or shortly after a rainstorm when the plant is drying out. Symptoms include those associated with allergic rhinitis, allergic conjunctivitis and allergic asthma.

Like with other allergic diseases, the mainstays of treatment include avoidance, medications and allergy shots.  Some basic avoidance tips include:

• Keep windows closed to prevent pollens from drifting into your home.
• Minimize early morning activity when pollen is usually emitted — between 5:00 and 10:00 a.m.
• Keep your car windows closed when traveling.
• Stay indoors when the pollen count (which is available from our home page) is reported to be high, and on windy days when pollen may be present in higher amounts in the air.
• Machine dry bedding and clothing. Pollen may collect in laundry if it is hung outside to dry.

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, and more.

Dr. Ananth Thyagarajan (Dr. T.)

Fall is upon us and we should be thinking about prevention of influenza. CDC’s Advisory Committee on Immunization Practices (ACIP) voted for “universal” flu vaccination in the U.S. to expand protection against the flu to more people. .  Official recommendations are that everyone over 6 months of age should be vaccinated.  People should get vaccinated for flu as soon as the vaccine is available in their community  The 2011-12 vaccine has identical strains of the influenza virus to the strains in last year’s vaccine, according to the CDC in Atlanta.  But even though they are the same, re-vaccination this year is still recommended because immunity can fade.

Flu vaccination is more important for certain people.

While flu vaccine is recommended for everyone over 6 months each flu season, it’s especially important that certain people get vaccinated that are at high risk of having flu-related complications or because they live with or care for people at high risk for developing flu-related complications.

This includes (according to the CDC):

• Pregnant women
• Children younger than 5, but especially children younger than 2 years old
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:
  • Health care workers
  • Household contacts of persons at high risk for complications from the flu
  • Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

Who should NOT get vaccinated?

Those who should not get vaccinated (again, according to the CDC) include:

• People who have a severe allergy to chicken eggs.
• People who have had a severe reaction to an influenza vaccination.
• People who developed Guillain-Barré syndrome (GBS) syndrome within 6 weeks of getting an influenza vaccine.
• Children younger than 6 months of age (influenza vaccine is not approved for this age group), and
• People who have a moderate-to-severe illness with a fever (they should wait until they recover to get vaccinated.)

Egg allergy and flu vaccine:

What happens with flu vaccine  for those who are allergic to egg? A review of reports to the Vaccine Adverse Events Reporting System (VAERS) of adverse events in adults noted only four reports of death caused by anaphylaxis following influenza vaccine during 1990—2005, according to the CDC. Those who have had mild reactions to eggs, such as hives, may still be able to have flu vaccination administered under a careful protocol by an allergist (1). There is a new vaccine, approved for those 18-64 years of age, which is administered intradermally (within the skin), which may be less likely to cause a reaction because the dose administered is smaller.

Watch for announcements that our office has flu vaccine available.

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, and more.

By Elaine S. Turner, MD, FACP, FAAAAI

Today’s blog post is the next installment in our series regarding going back to school with food allergies. In the last post I discussed some practical tips in keeping your young, food allergic children safe in school.

Teenagers and young adults represent a special age group when talking about food allergy. In two studies (first and second) investigators analyzed fatal food allergy anaphylaxis cases reported to a national registry, which was established by the American Academy of Allergy, Asthma, and Immunology, with the assistance of the Food Allergy and Anaphylaxis Network (FAAN). They found that “… it is clear that the greatest number of fatalities…occurs in adolescents and young adults.”  Besides the age range, other recurring characteristics include individuals with known food allergies consuming foods without asking about ingredients and then not having the proper treatment available.

As always, the most important step that you can take is to make sure that the school has an up to date Epi-Pen® and Food Allergy Action Plan for your child. This piece of advice is true for a student of any age. Most teenagers should be able to carry their own Epi-Pen®. Here are some other tips directed at teenagers based on advice from FAAN:

• When traveling, make sure that any food that you take stays in your possession. If the food gets lost, then it may be difficult to obtain other safe food.
• Keep your Epi-Pen® in the same place in your backpack. If you have a reaction, you won’t have to search for it. Tell your friends beforehand where you keep it and your other medicines.
• Make sure to room with friends who respect and understand your food allergies when going on a class trip.
• If you experience any harassment, let an adult know. This can be your parent and/or school official.
• Don’t be polite if you are having a reaction. There is no need to raise your hand, just shout it out.

In summary, the most important steps food allergic teens and young adults can take to protect themselves are to (1) always ask about ingredients and (2) making sure he/she has ready access to self-injectable epinephrine. In the last post in this series I will focus on the recently passed Food Allergy and Anaphylaxis Management Act (FAMMA) and what this means for you and your family.

As always, you can also follow us on Facebook and Twitter for daily pollen counts, office information, and more.

Dr. Ananth Thyagarajan (Dr. T.)