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Eczema is a general term for a group of conditions that cause the skin to become dry, itchy, red and inflamed. There are many types of eczema. The most common type is atopic dermatitis.  Atopic dermatitis (AD) often presents as an itchy, red rash or dry, scaly patches on the skin. We see AD most commonly in kids, but it can develop at any time. It commonly shows up on the face, inside of elbows, and behind the knees, but it can also show up anywhere on the body.

There are many different cells involved in your immune system that triggers AD, and usually it is a combination of genes and triggers in the environment, such as pollen or animal dander. Weather changes, chemicals, and certain types of clothing can also trigger AD. Less commonly, certain foods can be a trigger for AD as well.

Children and families with history of allergies (“hay fever”) and asthma are more likely to develop AD. Unfortunately, there is no cure for AD, however there are several very safe and effective treatment options.   The most important parts of treatment is daily bathing and moisturizing, avoiding triggers, and using medications as directed.

There are many topical treatments available (both topical steroids and non-steroid options) as well as oral medications, special bathing techniques and wraps, and even a specialized biologic medication that is safe to use for AD.

Eczema can be very frustrating, because even if you feel you are doing everything correctly, your eczema can still flare without any trigger exposure. Parents and patients are often wondering, “What did I get into to make my eczema flare?”  Eczema flares “out of the blue” are common, and happen no matter how consistent you are with treatment. You’re not alone! It’s important to follow up with your allergist regularly to discuss the best treatment for you. If you are struggling with eczema, come in for an appointment! We can help you identify your triggers and come up with a safe and effective treatment plan personalized for you.

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.

 

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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