Allergy shots, an age-old treatment for allergy sufferers, are getting a shot in the arm from new research. This proven therapy saves money, according to a recent study.
Allergy immunotherapy is the only treatment available that actually changes the immune system, making it possible to prevent the development of new allergies and asthma. According to research by Cheryl Hankin, PhD, BioMedEcon president and chief scientific officer, allergy immunotherapy also significantly reduces healthcare use and costs for prescription medications, outpatient visits, and inpatient stays.
Compared to children with allergies who did not receive allergy immunotherapy, children who received this treatment saved Florida Medicaid, on average, more than $1,000 within the first three months of treatment, and saved the state nearly $6,000 after 18 months. Results were even more compelling for adults. Average savings to Florida Medicaid were about $1,200 after three months of allergy immunotherapy, and exceeded $7,000 after 18 months.
Allergy immunotherapy is a well-established, safe and effective treatment. Allergies and asthma are serious, high cost, debilitating, chronic illnesses. In light of the current U.S. healthcare crisis, these findings strongly suggest that it is in the best public health interest to promote increased access to allergy immunotherapy for patients who suffer from allergies.
The US Food and Drug Administration (FDA) has approved Odactra (Merck, Sharp & Dohme Corp), the first sublingual allergen extract for the treatment of house dust mite–induced allergic rhinitis, with or without conjunctivitis in adults aged 18 through 65 years.
“House dust mite allergic disease can negatively impact a person’s quality of life,” Peter Marks, MD, PhD, director of the FDA’s Center for Biologics Evaluation and Research, said in an FDA news release. “The approval of Odactra provides patients an alternative treatment to allergy shots to help address their symptoms.”
Odactra reduces the occurrence and severity of nasal and eye allergy symptoms by desensitizing patients to house dust mite allergens. It is a tablet that is placed under the tongue, where it dissolves rapidly. Patients take Odactra once daily, year round.
Because it can cause life-threatening adverse reactions, the first dose is administered “under the supervision of a health care professional with experience in the diagnosis and treatment of allergic diseases,” the FDA explains in the news release. Patients must be observed for 30 minutes or longer for potential adverse reactions. If the patient tolerates the first dose well, they can continue taking it at home.
Patients may need to take Odactra daily for 8 to 14 weeks before they experience noticeable improvement in their symptoms.
The FDA’s decision follows consideration of data from clinical trials that involved about 2500 people in the United States, Canada, and Europe.
Patients who received Odactra reported a 16% to 18% reduction in their symptoms and the need for other symptom-relieving medications compared with patients who received a placebo.
The most frequently reported adverse events were nausea, itching in the ears and mouth, and swelling of the lips and tongue. The prescribing information includes a boxed warning that severe and sometimes life-threatening allergic reactions can occur. Clinicians should prescribe autoinjectable epinephrine to patients receiving Odactra, as with other FDA-approved sublingual allergen extracts. Odactra also comes with a medication guide to be given to the patient.
IgE-mediated Cannabis (C. sativa, marihuana) allergy seems to be on the rise. Both active and passive exposure to cannabis allergens may trigger a C. sativa sensitization and/or allergy. The clinical presentation of a C. sativa allergy varies from mild to life-threatening reactions and often seems to depend on the route of exposure. In addition, sensitization to cannabis allergens can result in various cross-allergies, mostly for plant foods. This clinical entity, designated as the ‘cannabis-fruit/vegetable syndrome’, might also imply cross-reactivity with tobacco, natural latex and plant-food-derived alcoholic beverages.
At present, diagnosis of cannabis-related allergies predominantly rests upon a thorough history completed with skin testing using native extracts from crushed buds and leaves. However, quantification of specific IgE antibodies and basophil activation tests can also be helpful to establish correct diagnosis. In the absence of a cure, treatment comprises absolute avoidance measures.
When cannabis is used for its psychoactive effects, drug (ab)users may become sensitized by inhalation of cannabis allergens through active smoking and/or vaporizing the drug. Cutaneous contact through handling of the drug is another possible route of sensitization.
C. sativa produces wind-borne pollen easily transported over long distances. However, as only female (nonpollinating) plants are cultivated for illicit use, it is less likely for abusers of cannabis, who grow their own plants, to become sensitized to marihuana through pollen exposure.
The clinical presentation of an IgE-mediated cannabis allergy can vary considerably from mild to life-threatening reactions and seems to relate to the route of exposure. First, respiratory reactions like rhinitis, conjunctivitis, asthma and palpebral angioedema have been described. These reactions predominantly occur when cannabis is consumed by smoking or vaporizing.
Cross-reactivity between cannabis and plant-derived food has been described in multiple studies and was recently designated as the ‘cannabis-fruit/vegetable syndrome’. The foods most commonly implicated in this allergy syndrome are peach, apple, nuts, tomato and occasionally citrus fruit as orange and grapefruit.
It is important to note that the allergic reactions to these plant foods are often triggered or exacerbated by cofactors such as exercise or nonsteroidal anti-inflammatory drugs (NSAIDs) and are therefore variable which can make history taking more complex. Furthermore, these reactions are frequently more severe than the classic oral allergy syndrome (OAS) expected in food allergy related to sensitization to tree, grass or ragweed pollen.
Expecting mothers who suffer from allergies may want to consider another vaccination in addition to the flu shot and Tdap. A study presented at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI) found pregnant women who receive allergy shots, also known as immunotherapy, during pregnancy may decrease their baby’s chance of developing allergies.
“Our research found trends suggesting women receiving allergy shots either before or during pregnancy reduced their child’s chances of having asthma, food allergies, or eczema,” said allergist Jay Lieberman, MD, ACAAI member. “Prior studies have suggested that mothers can pass protective factors to their fetus that may decrease their child’s chance of developing allergic disease, and these protective factors are increased with allergy immunotherapy.”
While there is no cure for the more than 50 million Americans suffering from allergies, immunotherapy is known to modify and prevent disease progression.
According to ACAAI, allergies tend to run in families. If both parents have allergies, their children have a 75 percent chance of being allergic. If only one parent is allergic, or if a relative has allergies, the child has a 30 to 40 percent chance of having an allergy. If neither parent has allergy, the chance of a child developing an allergy is only 10 to15 percent.
“Allergy shots are not only effective but cost efficient,” said allergist Warner Carr, MD, chair of the ACAAI Immunotherapy and Diagnostics Committee. “Immunotherapy can result in health care savings of 33 to 41 percent.”
Asthma National guidelines now recognize that asthma and allergy patients can benefit greatly from specialty care provided by an allergist. According to the National Heart, Lung and Blood Institute (NHLBI), asthma patients should be seen by an allergist if they:
- Suffer from mild to moderate persistent asthma?
- Are on a daily controller medication?
- Have had a life-threatening attack?
- Have had a hospital admission for asthma?
- Have had two prednisone treatments in a year?
Asthma Care by an allergist, especially in a young nonsmoker has been shown to reduce ER visits and hospitalization and significantly reduce cost of care.
Allergic rhinitis Symptoms lasting more than six weeks should be evaluated by skin testing. Based on skin tests, an allergist will discuss environmental control measures, the most important and first step in treating allergies, without which medications may be less or not effective at all. Some patients may need allergy shots whose effectiveness has been proven in dozens of controlled studies.
Sinus problems Allergies are the most common cause of chronic sinus problems, leading to chronic, recurrent sinusitis, a chronic cough or sleep apnea.
Chronic ear problems Recurrent, chronic ear infections and fluid in the middle ear may be due to Eustachian tube dysfunction secondary to allergic inflammation.
Sleep apnea Fifty-seven percent of patients with obstructive sleep apnea have allergen sensitization, and 36% of patients with allergic rhinitis have sleep apnea. Studies have shown an improvement in symptoms of sleep apnea when the patient’s allergic rhinitis is treated.
Atopic dermatitis Food allergies trigger eczema in up to 40% of patients, and the severity of rash correlates with the presence of food allergies. Environmental allergens, especially dust mites and pet dander, may also be important triggers of the rash.
Winter can be hard on skin for those with eczema (atopic dermatitis). Temperature changes from warm, dry inside air to cold outside air can dry skin out more than normal. Always follow your doctor’s recommendations and use these tips to keep your skin hydrated and reduce the effects of winter on your skin.
- Take a warm bath daily (or shower is eczema is mild).
- Use a gentle cleanser if needed.
- Use moisturizer or medicine within three minutes of getting out of the tub or shower.
- Use sunscreen for outdoor activities.
- Keep fingernails short.
- Avoid scratching, apply moisturizer when itchy.
- Wear soft fabrics such as cotton or cotton blends, and avoid wool and acrylic.
- Use dye- and fragrance-free laundry products.
- Identify and manage triggers.
- Wash new clothes before wearing.
Fortunately, you cannot be allergic to your cell phone per se. However, you can be allergic to metallic parts/cases of cell phones. Metals such as nickel, cobalt, and chromium are all possible causes of an allergic skin rash (called allergic contact dermatitis) from cell phone usage. A preliminary study in 2012 by Mucci and colleagues, reported at the 2012 ACAAI Annual Meeting, found nickel and cobalt in the highest concentrations in used cell phones, while an earlier study did not find high levels of nickel and cobalt in new cell phones. The higher levels in the used phones are probably due to wearing of the plastic coating on metal keys/parts occurring over time. Models that operate without keys, including the iPhone and Motorola Droid, both tested negative (keep in mind after-market cases may contain metal, however).Cellular phone dermatitis typically starts as an itchy rash on the side of the face where the phone is touched to the head, especially around the ear. People with this problem do not always report a history of known allergic reactions to metals. Allergic contact dermatitis is diagnosed based on the history and the results of patch testing to metal(s), which can be performed by your allergist. There are also several nickel and cobalt spot test kits available that allow one to test various objects for the release of nickel or cobalt ions.
Unlike other food allergies, which are typically first observed in babies and young children, an allergy to fish may not become apparent until adulthood; in one study, as many as 40 percent of people reporting a fish allergy had no problems with fish until they were adults.
Having an allergy to a finned fish (such as tuna, halibut or salmon) does not mean that you are also allergic to shellfish (shrimp, crab and lobster). While some allergists recommend that individuals with a fish allergy avoid eating all fish, it may be possible for someone allergic to one type of fish to safely eat other kinds. If you are allergic to a specific type of fish, your allergist can help you determine whether other varieties may be safe to eat.
Many prepared foods contain fish in some form. Fish is a common ingredient in Worcestershire sauce and Caesar salad and is sometimes found in imitation crab products in the form of surimi, a processed food made mainly from Alaska pollock. Fish is also prevalent in Asian cuisine, which uses fish-based stock for many dishes.
While an allergy to fish protein is most common, it is possible to be allergic to fish gelatin (made from fish skin and bones). People with a fish allergy should consult their allergist before taking fish oil dietary supplements.
Treatment for fish allergy includes strict avoidance of fish.
Because fish is often implicated in cases of food-induced anaphylaxis, allergists advise fish-allergic patients to treat symptoms of a reaction with epinephrine (adrenaline), which is prescribed by your doctor and administered in an auto-injector. Anaphylaxis can come on quickly and can be fatal unless epinephrine is injected as soon as you notice symptoms developing. Be sure to call for an ambulance, and alert the dispatcher that epinephrine has been used and more may be needed.
It is with great pleasure that we announce that Miguel Camara, M.D. is joining our practice starting October 17, 2016.
Dr. Camara has impressive credentials. He trained at the world renowned National Jewish Center in Denver along with Dr. Ahmed Mohiuddin, and also where Dr. Maaz Mohiuddin trained about 25 years later. He is board certified by the American Board of Allergy and Immunology.
He has worked in the Joliet area for years. He is a very thorough professional, pleasant, and highly ethical, well loved by his patients. He will be a great addition and asset to our practice.
We welcome him to our family at Allergy, Asthma & Sinus Centers.
About 11 percent of the population is estimated to have cholinergic urticaria, or hives triggered by heat, exercise, sweat or all of the above. The hives can also appear in reaction to a hot bath, sauna or even when eating hot or spicy foods.
In rarer cases, exercise can even trigger anaphylaxis, a potentially deadly allergic reaction.
Typically, the hives appear within 30 minutes of exercising and go away not long after patients stop and cool off.
Food-dependent exercise-induced anaphylaxis, is more complicated, since the reaction only occurs when someone eats a particular food and then exercises vigorously soon after.
While wheat, shellfish, peanuts and corn are most commonly implicated in food-dependent exercise-induced anaphylaxis, there are also reports of it being caused by hummus, milk, meats and more. Some factors like alcohol, non-steroidal anti-inflammatory drugs like ibuprofen and, for women, being premenstrual can exacerbate the reactions.
In addition to using antihistamines for the hives– which some people take preventively and others only in response to a reaction – clinicians recommend carrying an Epipen and always exercising with someone who knows how to use it, if you’re at risk of exercise-related anaphylaxis. It can also help to exercise in a cool gym rather than in the summer heat, and not eating for several hours before you exercise.