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May 1, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-Cov2/COVID 19) Update #7

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! COVID-19 cases persist in Arizona. Many of our patients are at higher risk for complications from the virus. As a result, we are providing the following update:

TO SEE ALL THAT WE ARE DOING TO KEEP YOU SAFE, VISIT OUR WEBSITE @ WWW.AZSNEEZE.COM

Summary:

  • There are lots of questions surrounding coronavirus (COVID-19) testing. You may have heard news report about PCR testing, antibody testing, and lots of testing.
  • There are many opinions about the importance of these tests, who should get them, and what you and your doctor will learn from the tests.
  • If you are interested in being tested, Board Certified Allergists/Immunologists are the best trained and the most experienced physicians to help you choose the right test or tests and to interpret the results.
  • Please schedule an appointment with AAAI (in office or telemedicine) by calling 602-843-2991. We have 5 offices around Maricopa County to serve you.

More Details (for those that want them):

COVID-19 testing update:

There are two types of COVID-19 tests: PCR (Nasal swab) and Antibody (Blood)

  1. PCR testing (Nasal swab): Tests viral particles from a nasal swab.
    1. This test is meant to measure if your body IS infected with the virus or not.
    2. This test is most accurate when a patient has active symptoms (identified below).
  2. Antibody testing (Blood): Tests your antibody response to the virus from a blood sample.
    1. This test is meant to measure if your body WAS infected with the virus or not.
    2. Test 14 days after symptom onset or later. IgG antibodies may not be present in the first 2 weeks of infection.
    3. Antibody testing may not be accurate in the following types of patients:
      1. Patients with immune deficiencies and some autoimmune diseases.
      2. Patients on immune-modulating drugs including Xolair.

We highly recommend COVID-19 tests be ordered and interpreted by one of our Board Certified Allergists/Immunologists or a physician with experience in interpreting PCR and Antibody testing.

If you would like to receive COVID-19 testing:

  1. COVID-19 tests will be performed at an offsite testing location and results sent to the ordering physician.
  2. COVID-19 tests are covered by all insurances per federal guidelines.
  3. COVID-19 appointments may have co-pays depending on insurance and federal guidelines.
SYMPTOMS OR HISTORY CONCERNING FOR COVID-19

– Active Fever  100F or in the past 2 weeks
– Chills and Myalgias
– New diarrhea
– Sudden loss of sense of smell or taste
– New cough & shortness of breath with no prior history of allergies or asthma
– Significantly worsening cough and shortness of breath with a history of allergies or asthma
– Severe fatigue with or without pounding headache.
– Exposure to someone with known COVID-19 infection, active fever, or fever in past two weeks.

We, the physicians at AAAI, daily review all COVID-19/SARS-CoV2 medical literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information. We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely, 

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


April 20, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-Cov2/COVID 19) Update #6

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! COVID-19 cases persist in Arizona. Due to the nature of our practice, many of our patients are at higher risk for complications from the virus. As a result, we are providing the following update:

TO SEE ALL THAT WE ARE DOING TO KEEP YOU SAFE, VISIT OUR WEBSITE @ WWW.AZSNEEZE.COM

SYMPTOMS OR HISTORY CONCERNING FOR COVID-19
  • Active Fever of 100 or greater
  • New cough and shortness of breath with no prior history of allergies or asthma
  • Significantly worsening cough and shortness of breath with a history of allergies or asthma
  • Exposure to someone with known COVID exposure, active fever, or fever in past two weeks.
  • Fever in past two weeks
  • New diarrhea
  • Severe fatigue with or without pounding headache. 
  • Sudden loss of sense of smell or taste
PATIENTS OVER THE AGE OF 65 with NO Concerning Covid-19 Symptoms or Exposures:
  1. Keep in-office new patient appointments.
  2. Keep an in-office follow up OR schedule a TELEHEALTH follow up appointment.
PATIENTS UNDER THE AGE OF 65 with NO Concerning Covid-19 Symptoms or Exposures:
  1. Keep in-office new patient appointments.
  2. Keep in-office follow up appointments.
PATIENTS WITH IMMUNE DEFICIENCIES:
  1. Contact our office prior to your appointment to discuss options. 

***WHEN YOU COME TO YOUR OFFICE VISIT, PLEASE WEAR A CLOTH FACEMASK PER CDC GUIDELINES***

***IF YOU FEEL SICK, HAVE BEEN AROUND OTHERS WHO ARE SICK, OR DO NOT FEEL COMFORTABLE COMING IN FOR AN APPOINTMENT, CALL OUR OFFICE FOR A TELEHEALTH EVALUATION FROM A LICENSED PROVIDER***

WE ARE UP TO DATE ON ALL ACTIVE COVID-19 THERAPIES CURRENTLY UNDER INVESTIGATION AND WILL PROVIDE ADDITIONAL INFORMATION AS IT BECOMES AVAILABLE. 

We, the physicians at AAAI, daily review all COVID-19/SARS-CoV2 medical literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information. We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely, 

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


April 6, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-Cov2/COVID 19) Update #5

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! COVID-19 cases continue to rise in Arizona. Due to the nature of our practice, many of our patients are at higher risk for complications from the virus. As a result, we are providing the following update:

CONCERNING COVID-19 SYMPTOMS OR EXPOSURES

– Active Fever of 100 or greater
– New cough and no prior history of allergies or asthma
– Worsening cough with a history of allergies or asthma
– Exposure to someone with known COVID exposure, active fever, or fever in past two weeks.
– Fever in past two weeks
– New diarrhea
– Severe fatigue with or without pounding headache.
– Sudden loss of sense of smell or taste

PATIENTS OVER THE AGE OF 65 with NO Concerning Covid-19 Symptoms or Exposures:
  1. Keep in-office new patient appointments.
  2. Re-schedule follow up appointments as a TELEHEALTH evaluation. 
PATIENTS UNDER THE AGE OF 65 with NO Concerning Covid-19 Symptoms or Exposures:
  1. Keep in-office new patient appointments.
  2. Keep in-office follow up appointments.
PATIENTS WITH IMMUNE DEFICIENCIES:
  1. Contact our office prior to your appointment to discuss options. 

***WHEN YOU COME TO YOUR OFFICE VISIT, PLEASE WEAR A CLOTH FACEMASK PER CDC GUIDELINES***

***IF YOU FEEL SICK, HAVE BEEN AROUND OTHERS WHO ARE SICK, OR DO NOT FEEL COMFORTABLE COMING IN FOR AN APPOINTMENT, CALL OUR OFFICE FOR A TELEHEALTH EVALUATION FROM A LICENSED PROVIDER***

WE ARE UP TO DATE ON ALL ACTIVE COVID-19 THERAPIES CURRENTLY UNDER INVESTIGATION AND WILL PROVIDE ADDITIONAL INFORMATION AS IT BECOMES AVAILABLE. 

We, the physicians at AAAI, daily review all COVID-19/SARS-CoV2 medical literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information. We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely, 

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


March 30, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-Cov2/COVID 19) Update #4

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! COVID-19 cases continue to rise in Arizona. Due to the nature of our practice, many of our patients are at higher risk for complications from the virus. As a result, we are providing the following update:

IF YOU DO NOT FEEL SICK AND DO NOT EXHIBIT CONCERNING SYMPTOMS (SEE LIST BELOW), PLEASE COME INTO OUR OFFICES FOR YOUR FOLLOW UP OR NEW APPOINTMENT AS SCHEDULED. 
IF YOU FEEL SICK, HAVE BEEN AROUND OTHERS WHO ARE SICK, OR DO NOT FEEL COMFORTABLE COMING IN FOR AN APPOINTMENT, CALL OUR OFFICE FOR A TELEHEALTH EVALUATION FROM A LICENSED PROVIDER.
CALL IF YOU HAVE ANY OF THE FOLLOWING CONCERNING SYMPTOMS OR EXPOSURES:
  1. Active Fever 
  2. New cough and no prior history of allergies or asthma
  3. Worsening cough with a history of allergies or asthma
  4. Exposure to someone with known COVID exposure, active fever, or fever in the past two weeks.
  5. Fever in the past two weeks
  6. New diarrhea
  7. Severe fatigue with or without a pounding headache. 
  8. Sudden loss of sense of smell or taste
WHAT WE ARE DOING
  1. Telehealth and In-Office Appointments
  2. Outside screening of all persons entering our office.
  3. In-office sanitation and infectious disease prevention protocols (N95 masks for physicians and staff; Hand washing, frequently scheduled disinfection of office surfaces; face masks; eye shields and gowns where necessary)
  4. Social distancing and infection disease prevention protocols. (Waiting room occupancy limited to ten with spaced seating arrangement, ability to wait in the car for shots and appointments)
WE ARE UP TO DATE ON ALL ACTIVE COVID-19 THERAPIES CURRENTLY UNDER INVESTIGATION AND WILL PROVIDE ADDITIONAL INFORMATION AS IT BECOMES AVAILABLE. 

We, the physicians at AAAI, daily review all COVID-19/SARS-CoV2 medical literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information. We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely,

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


March 23, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-Cov2/COVID 19) Update #3

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! The general population remains at low risk for serious complications from exposure to Coronavirus. Nevertheless, cases continue to rise in Arizona. Due to the nature of our practice, many of our patients are at higher risk for complications from Coronavirus. Out of an abundance of caution and concern for your health, we are providing the following update:

OUTSIDE SCREENING OF ALL PERSONS ENTERING OUR OFFICE CONTINUES

 

IN-OFFICE SANITATION AND INFECTIOUS DISEASE PREVENTION PROTOCOLS CONTINUE

 

SOCIAL DISTANCING PRACTICES INCLUDING IN-VEHICLE WAITING FOR APPOINTMENTS REMAIN IN PLACE

 

IF YOU FEEL SICK WITH A COUGH AND FEVER:
  1. At this time, we define a fever as a temperature of 100 or greater.
  2. Use an accurate thermometer if you feel feverish or sick and write your temperature down.
  3. RESCHEDULE any appointment and do not come in for allergy shots or other shots within 14 days of your most recent FEVER.
  4. If you have an ACTIVE FEVER, contact our office by phone. DO NOT COME INTO OUR OFFICE FOR ANY REASON BEFORE SPEAKING WITH A PHONE TRIAGE STAFF MEMBER OR PROVIDER.
WE ARE UP TO DATE ON ALL ACTIVE THERAPY CURRENTLY UNDER INVESTIGATION AND WILL PROVIDE UPDATES AS FURTHER INFORMATION IS AVAILABLE. 

We, the physicians at AAAI, daily review all available literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information regarding Coronavirus (SARS-CoV2/COVID 19). We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely,

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


March 16, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-CoV2/COVID 19) Update #2

Dear patients of AAAI,

Your health and the health of our staff is our highest priority! Arizonans remain at low risk for serious complications from exposure to Coronavirus. Due to the nature of our practice, many of our patients are at higher risk for complications from Coronavirus. Out of an abundance of caution and concern for your health, we are providing the following update:

OUTSIDE SCREENING OF ALL PERSONS PRIOR TO ENTERING OUR OFFICE
  1. You will be asked four simple questions regarding your symptoms.
  2. Your temperature will be checked.
  3. You may be asked to enter our office through an alternate entrance.
  4. You may be given printed instructions and asked to reschedule.
  5. You may be asked to wait outside to consult with a provider.
SOCIAL DISTANCING THROUGH LIMITATION OF UNNECESSARY PERSONS ENTERING OUR OFFICE:
  1. We request that you bring only one additional family member or friend to your appointment or when you are receiving allergy shots.
  2. Number of persons allowed in shot lab at any given time will not exceed 50 per CDC guidelines.
  3. Patients are allowed to wait in their cars for 30 minutes after receiving their shots.
IF YOU ARE ON ANTIBODY INFUSIONS FOR AN IMMUNE DEFICIENCY:
  1. Contact our office for further instructions.
IF YOU FEEL SICK WITH A COUGH AND FEVER:
  1. At this time, we define a fever as a temperature of 100 or greater.
  2. Use an accurate thermometer if you feel feverish or sick and write your temperature down.
  3. RESCHEDULE any appointment and do not come in for allergy shots or other shots if you are recovering from a FEVER WITHIN THE PAST FIVE DAYS.
  4. If you have an ACTIVE FEVER, contact our office by phone. DO NOT COME INTO OUR OFFICE FOR ANY REASON BEFORE SPEAKING WITH A PHONE TRIAGE STAFF MEMBER OR PROVIDER.

We, the physicians at AAAI, daily review all available literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information regarding Coronavirus (SARS-CoV2/COVID 19). We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely,

Ronald K. Jorgensen M.D.,
Kevin M. Boesel M.D.,
Mark E. Rose M.D.,
Ryan M. Casper M.D.,
Levente E. Erdos M.D.,
Eiza L. Ching M.D.,
R. Joseph Mittel M.D.


March 13, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-CoV2/COVID 19) Update

WITH THE UNDERTAKING OF RIGOROUS ADDITIONAL CLEANING PROCEDURES, AAAI DELIVERS CLEAN WORKSPACES AT OUR CLINICS.

IN ORDER TO CONTINUE TO PROVIDE A SAFE ENVIRONMENT FOR OUR PATIENTS AND STAFF, WE HAVE IMPLEMENTED THE FOLLOWING PLAN:

Daily
  1. Staff temperature checks with ear thermometer. If temp above 100.5, evaluated by PA and sent home until fever is subsided for 2 days
  2. Handwashing upon arrival into the building (morning, after lunch, after any errand)
  3. Drug reps with samples will stay at the front desk. Front desk staff will bring iPads to the providers for signatures.
  4. For now, drug reps can still bring in food but they must wash hands and undergo temperature check.
Several times daily
  1. Using 1:40 bleach/water blend, Front desk wipes down lobby chairs, keyboards,  front door and other door handles (inside and out), back of clipboards, etc.
  2. Back office wipes down exam room chairs, bathroom door knobs and faucets, door handles, keyboards, etc.
  3. Confirm that hand sanitizer bottles are available at front desk and allergy lab sign in. Wipe these bottles down with bleach solution.
  4. Cell phones should also be wiped down as frequently as possible, but at least in the morning and after lunch if used.
Between patients and patient interaction
  1. Wash hands between each patient
  2. Ask patient to use their own pen/pencil to fill out forms. If not available, provide a pen but wipe down afterward.

March 9, 2020

Arizona Asthma and Allergy Institute Coronavirus (SARS-CoV2/COVID 19) Update

Dear patients of AAAI

Your health and the health of our staff is our highest priority! The general population is at low risk for serious complications from exposure to Coronavirus. Due to the nature of our practice, many of our patients are at higher risk for complications from Coronavirus. Out of an abundance of caution and concern for your health, we are providing the following update:

Common Sense Self Protection:
  1. Take your prescribed medications daily. Do not miss a dose. This is a time for strict compliance.
  2. Frequently wash your hands with soap and water for 30 seconds.
  3. Cover your nose and mouth with your elbow fold when you cough or sneeze.
  4. Do not shake hands.
  5. If you are over the age of 50, avoid elective large gatherings such as sporting events, concerts, and movies.
Fever:
  1. A fever at this time is defined as a temperature of 100.5 or greater.
  2. Use an accurate thermometer if you feel feverish or sick and write your temperature down.
  3. RESCHEDULE any appointment and do not come in for allergy shots or other shots if you have had a FEVER WITHIN FIVE DAYS.
  4. If you have an ACTIVE FEVER, contact our office by phone. DO NOT COME INTO OUR OFFICE FOR ANY REASON BEFORE SPEAKING WITH A PHONE TRIAGE STAFF MEMBER OR PROVIDER.
What we are doing:
  1. Daily screening of staff.
  2. Frequent sanitation of common areas with approved disinfectants.
  3. Daily review and updates (if necessary) of the current standard of care protocols.
  4. Continued updates and communication with you.

We, the physicians at AAAI, have carefully reviewed all available literature including published articles, World Health Organization (WHO) guidelines, Centers of Disease Control (CDC) statements, and Arizona Health Department Information regarding Coronavirus (SARS-CoV2/COVID 19). We are committed to your wellbeing and to continuing to provide exceptional Allergy, Asthma, and Immunologic care.

Sincerely,

Ronald K. Jorgensen M.D.
Kevin M. Boesel M.D.
Mark E. Rose M.D.
Ryan M. Casper M.D.
Levente E. Erdos M.D.
Eiza L. Ching M.D.
Joseph Mittel M.D.

 

Asthma During Pregnancy

Asthma is one of the most common medical problems that occurs during pregnancy. It can be potentially serious. Some studies have suggested that asthma complicates up to 7% of all pregnancies. About 30% of all women with asthma report their asthma  worsened while pregnant. But with the right treatment and care, you and your baby can have a good outcome.

Does Asthma Cause Complications During Pregnancy?

Potential Complications

Pregnant women with asthma may have a bit greater risk of delivering early. Or the infant may have a low birth weight. High blood pressure and a related condition known as pre-eclampsia are also more common in pregnant women with more severe asthma.

Complications of asthma during pregnancy

It is not known if uncontrolled asthma causes these problems directly or if other reasons are to blame.

However, optimal control of asthma during pregnancy is the best way to cut the risk of these complications.

Changes in Asthma Severity

About one-third of pregnant women with asthma will see their asthma symptoms get worse. Another third will stay the same. The last third will see their asthma symptoms improve.

Most women with asthma whose symptoms changed in any way during pregnancy will return to their pre-pregnancy condition within three months after giving birth.

Changes in severity chart

There is a tendency for women whose asthma symptoms increased or decreased during one pregnancy to experience the same thing in later pregnancies. It is difficult to predict how asthma will change during pregnancy.

Because of this uncertainty, asthma should be followed closely. This way, any change can be promptly matched with an appropriate change in treatment. This calls for good teamwork between the  obstetrician, primary care physician and asthma specialist.

How Does Uncontrolled Asthma Affect the Fetus?

Uncontrolled asthma cuts the oxygen content of the mother’s blood. Since the fetus gets its oxygen from the mother’s blood, this can lead to decreased oxygen in the fetal blood. The result may impair fetal growth and survival. The fetus requires a constant supply of oxygen for normal growth and development. There is evidence that adequate control of asthma during pregnancy reduces the chances of fetal or newborn death and improves fetal growth inside the uterus. There are no indications that a mother’s asthma contributes to either spontaneous abortion or congenital malformation of the fetus.

What Should I Do to Avoid Asthma Attacks During Pregnancy?

Avoid Your Asthma Triggers

Avoiding asthma triggers is always important, but is particularly important during pregnancy. Pregnant women with asthma should increase avoidance measures to gain greatest comfort with the least medication.

  • Stay away from people who are sick with respiratory infections.
  • Avoid allergens like dust mites, animal dander, pollen, mold and cockroach.

Stop Smoking Cigarettes/Tobacco

Giving up cigarette smoking is important for any pregnant woman. Smoking may worsen asthma and harms the health of the growing fetus as well.

Exercise

Regular exercise is important to health. Talk to your obstetrician for the best advice about exercising during pregnancy. Swimming is a particularly good exercise for people with asthma. Using quick-relief medicine 10 minutes before exercise may help you tolerate recommended exercise.

Are Asthma Medicines Safe to Use During Pregnancy?

Is It Safe to Use Asthma Inhalers or Corticosteroids While Pregnant

Ensuring asthma is well-controlled is key. It is recommended that mothers seek regular check-ups to ensure their asthma remains controlled. Working with an asthma provider is essential. The asthma regimen that is best suited for the mother is the best approach.

Some asthma medicines are considered “safer” during pregnancy because their risks appear to be less than the risks of uncontrolled asthma. These include:

  • short-acting  inhaled bronchodilators
  • anti-leukotriene agents like montelukast (Singulair)
  • some inhaled corticosteroids, like budesonide

Based on the severity of the mother’s asthma, a doctor may consider switching her treatment to an inhaled corticosteroid alone.

Long-acting beta agonists (like Serevent, Symbicort and Advair) and theophylline are not considered first-line treatments for pregnant asthma patients. But doctors may consider them if the mother’s asthma is not adequately controlled by the above medicines.

If asthma is very severe, oral steroids such as prednisone, may be necessary for the health of the mother and baby.

Remember: It is better for mother and baby if the mother maintains asthma control (using any approved asthma drugs).

Are Allergy Shots Safe During Pregnancy?

Pregnant woman with asthma already receiving allergy shot therapy can usually continue if they are not having reactions.

As an extra precaution, though, the allergist may cut the dosage of the allergy extract to reduce the chance that a severe allergic reaction occurs or at a minimum keep the dose the same but the dose should not be increased during pregnancy since that increases the chance of a reaction.

Are Flu Shots Safe to Receive During Pregnancy?

People with asthma should get flu shots. Pregnancy does not change that recommendation. In fact, influenza may be particularly severe in pregnant women.

Asthma Attacks During Labor

When asthma is under control, asthma attacks almost never occur during labor and delivery. Also, most women with well-controlled asthma are able to perform breathing techniques during their labor without difficulty.

Is It Safe to Breastfeed?

Doctors do not believe asthma medicines are harmful to a nursing baby when used in usual amounts. The transfer of asthma medicines into breast milk has not been fully studied.

When breastfeeding, drinking extra liquids to avoid dehydration is also important (as it is for all people with asthma). Discuss with your baby’s pediatrician.

Will I Pass On Asthma to My Baby?

Genetics plays a role in whether a baby will develop asthma. In other words, asthma tends to be more likely in a baby if their relatives have it. The environment also plays an important role.

Can I Do Anything to Prevent Asthma in My Baby?

One major prenatal risk factor for the development of asthma is maternal smoking. Giving up cigarette smoking is very important. Other prenatal factors that may influence the development of asthma are:

  • maternal stress
  • diet
  • vitamin D levels
  • antibiotic use
  • method of delivery

Talk to your doctors about identifying your risk factors and making safe changes in preparation for your new baby.

 

________________________

Original article can be found here
Medical Review November 2016.

References

Subbarao, P., Mandhane, P.J., Sears, M. R. (2009). “Asthma: epidemiology, etiology and risk factors.” CMAJhttp://www.cmaj.ca/content/181/9/E181.full.pdf+html

Willemsen, G., van Beijsterveldt, T.C.; van Baal, C.G.; et al. (2008). “Heritability of self-reported asthma and allergy: a study in adult Dutch twins, siblings and parents.” Twin Research and Human Genetics. https://www.ncbi.nlm.nih.gov/pubmed/18361713

Holberg, C.J., Elston, R.C., Halonen, M., et al. (1996). “Segregation analysis of physician-diagnosed asthma in Hispanic and non-Hispanic white families. A recessive component?” American Journal of Respiratory and Critical Care Medicine. 1996;154:144–50. [PubMed]

Lawrence, S., Beasley, R., Doull, I., et al. (1994). “Genetic analysis of atopy and asthma as quantitative traits and ordered polychotomies.”  Annals of Human Genetics. 1994;58:359–68. [PubMed]

Fraga, M.F., Ballestar, E., Paz, M.F., et al. (2005). “Epigenetic differences arise during the lifetime of monozygotic twins.”  Proceedings of the National Academy of Sciences of the United States of America. [PMC free article]

Qiu, Jane. (2006). “Epigenetics: unfinished symphony.” Nature.

Camargo Jr, C.A., Rifas-Shiman, S.L., Litonjua, A.A., et al. (2007).  “Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y of age.” The American Journal of Clinical Nutrition. https://www.ncbi.nlm.nih.gov/pubmed/17344501

Phoenix Allergist Allergy Tablets
Eosinophilic Esophagitis
Phoenix Allergist Vocal Cord Dysfunction
Phoenix Allergist Skin Conditions
Phoenix Allergist Allergy Injections

Allergy Shots vs Drops vs Tablets for Environmental Allergies

WHAT?

Allergy Immunotherapy is the only type of allergy treatment that changes the immune system to become less allergic to an allergen. This can be considered more of a problem solver by “desensitizing” the immune system to the allergen as opposed to medications that only treat the symptoms.

Allergy shots have been given successfully by allergists over the past 100 years and have significantly improved over time with advances in allergy serum and protocols. It has proven to be successful for the treatment of Allergic Rhinitis and Conjunctivitis (nasal and eye allergies), Allergy Induced Asthma, Insect Allergy and Atopic Dermatitis (Eczema).

HOW?

Allergy immunotherapy induces tolerance to the immune system by giving low doses of the allergens initially then building up on these doses over time. This process desensitizes the allergens to the immune system and decreases the allergic symptoms when exposed to those allergens via the environment.

WHY?

Allergy immunotherapy is for patients that prefer to decrease or avoid chronic allergy or asthma medications. Also for patients that have not been controlled with a variety of medications, allergy immunotherapy is typically much more effective.

TYPES OF IMMUNOTHERAPY: Shots vs Drops vs Tablets

Allergy Shots (also called SubCutaneous ImmunoTherapy or SCIT) has been shown to be the most effective way of allergy desensitization for the best symptoms relief.1 This requires allergy injections in a medical office. This therapy has been well studied and has long been approved by the FDA which allows for insurance coverage. When done by Board Certified Allergists this therapy has been shown to be very effective in symptom reduction. Allergy shots have also been shown to have sustained benefit (long term desensitization) in most patients for many years beyond treatment period.

Allergy Drops (also called SubLingual ImmunoTherapy or SLIT) are administered under the tongue and has been shown to be effective for certain allergens. Studies show a wide range of results and moderate symptom reduction is possible in appropriate candidates. This has not yet been approved by the FDA but based on studies has been shown to be safe with rare chance of serious side effects. This can be done seasonally for symptom improvement but has not been adequately proven to have long term benefits after treatment.

Phoenix Allergist Allergy TabletsAllergy Tablets: In 2014 the FDA approved sublingual (under the tongue) dissolvable tablets containing grass pollens and ragweed pollen separately. These tablets are used seasonally to reduce symptoms from grasses or ragweed and do not have the long term benefits compared to allergy shots. This is like Allergy Drops but does not include other potential allergens contributing to symptoms. Studies have shown 20-30% reduction in symptoms on average over placebo

What is right for me?

There are many options to manage patients with environmental allergies. Our Allergists will determine what is best in your individual case. Our physicians, board certified in Allergy and Immunology, utilize extensive training, years of clinical experience, and a wealth of knowledge to direct the most effective interventions for your immediate and long term care.


1 Medical Literature Reference: Harold S. Nelson, MD; Subcutaneous Immunotherapy Verses Sublingual Immunotherapy: Which is More Effective? Journal of Allergy and Clinical Immunotherapy, April 2014