Difficulty swallowing, also known as dysphagia, is when it feels hard or painful to swallow food, drinks, or medication. This can happen for many reasons, but one important cause is a condition called eosinophilic esophagitis (also called EoE).


EoE is a condition where the esophagus, the tube that carries food from your mouth to your stomach, gets inflamed. This inflammation is caused by a type of white blood cell called eosinophils. Because EoE is also related to the immune system, people with allergic conditions like allergies, asthma and eczema are more likely to get EoE.


Signs of EoE vary depending on age, but in older children, teens and adults, the most common symptoms are difficulty swallowing, food feeling “stuck”, chest pain, and heartburn. When untreated or undiagnosed, EoE can lead to narrowing of the esophagus and food impaction (food getting stuck in the esophagus) which is a medical emergency.


EoE is diagnosed with the help of gastroenterologists by doing a simple procedure called upper endoscopy and taking biopsies of the esophagus. Once diagnosed, EoE can be managed by your allergy or GI team. There are numerous treatment options for EoE, including dietary changes, and different types of oral or injectable medication. Often, EoE requires a repeat biopsy to make sure the treatment is working. Getting evaluated by a doctor is important to find the right treatment and prevent serious complications. If you have allergies, asthma, or eczema and find it hard to swallow, don’t ignore it—talk to your allergist!

Allergies and asthma are closely linked conditions that often coexist, affecting millions worldwide. The connection usually comes from the nasal passages and the lungs sharing a shared inflammatory pathway and immune responses in the body. Allergic reactions in the nose, also called allergic rhinitis, are triggered by allergens such as pollens, dust mites, molds, or pet dander. Uncontrolled allergic rhinitis can worsen asthma symptoms. Those affected by allergic-induced asthma also have excessive allergic inflammation affecting not just the nasal passages, but the lungs too! This is why it is very important to treat both upper airway (nasal) and lower airway (lung) symptoms. Because of this, nasal sprays are often part of the treatment plan for those with allergic asthma, even if the nasal symptoms are milder. By treating both the upper and lower airways, asthma control can be maximized which can reduce flare ups and the need for extra medications, but also improve quality of life!

Airborne allergens pose a significant challenge for allergy sufferers, triggering symptoms ranging from sneezing and congestion to more severe respiratory issues like asthma. However, with strategic allergen avoidance measures, you can take proactive steps to minimize exposure and alleviate symptoms. Allergen avoidance and environmental control measures have been shown to reduce symptoms in some patients (as much as 25% reduction in symptoms on average), which leads can lead to less medication use to control symptoms.


Identifying specific airborne allergens is the first step towards effective avoidance. A skin prick test with an allergist is the best, most thorough way to determine your specific allergy triggers. Common culprits include pollen, mold spores, dust mites, and pet dander. Allergy testing can help pinpoint these triggers, guiding personalized avoidance strategies.


Indoor environments can harbor airborne allergens, especially during peak seasons. Keeping windows closed and using air purifiers equipped with HEPA filters can effectively reduce pollen and mold spore levels indoors. Regular cleaning, including vacuuming carpets and upholstery with HEPA-filtered vacuums, and washing bedding in hot water, helps control dust mites.


In homes with pets, creating designated pet-free zones and grooming animals frequently can minimize dander in the air. Additionally, implementing measures to reduce indoor humidity levels can inhibit mold growth.


When venturing outdoors, wearing sunglasses and hats can help shield the eyes and face from pollen exposure, while showering and changing clothes upon returning indoors can prevent pollen from lingering.


By incorporating these airborne allergen avoidance strategies into daily life, allergy sufferers can breathe easier and enjoy improved quality of life, with fewer bothersome symptoms.

Many allergy and sinus medications are now available over the counter (OTC) without a prescription.  This gives patients direct access to medications that could potentially help their allergy symptoms, however, not all of these medications are effective for every type of allergy symptom and some of them are not safe for some people. Here we review some of the common ones – and which ones to stay away from!

–       The newer, longer acting antihistamines like Cetirizine (Zyrtec) or Fexofenadine (Allegra): these can be helpful at relieving some allergy symptoms, especially certain types of itchy skin or hives.

–       The older antihistamines, like Diphenhydramine (known more commonly as Benadryl), are generally not recommended for continued use due to lots of associated short and long-term side effects, such as drowsiness.

–       Nasal steroid sprays are considered first-line for treatment of allergic rhinitis and can help treat symptoms like nasal congestion, post-nasal drainage, and runny nose. These are also safe for most people to take long-term. Proper nasal spray technique is super important, so make sure you ask your healthcare provider to show you how to properly use nasal sprays!

–       OTC-strength nasal decongestants like Oxymetazoline (Afrin) unfortunately are not safe to take long-term and can cause a problem called rhinitis medicamentosa, where essentially your nasal passages become “addicted” to the spray. This spray is great for short-term use, 3 days or less.

–       Eye drops: There are many OTC eye drops that state they can be helpful for “itchy, watery, and red eyes” but unfortunately only a few of them are actually both effective and safe long term. Ask your allergist to give you the best advice on which eye drops to use, based on your specific symptoms!

–       Oral decongestants, such as pseudophedrine (or Sudafed), are used for temporary relief of severe congestion.  Unfortunately, they have a lot of concerning side effects and drug interactions and for most people, should not be used long-term

–       Primatene Mist, which is inhaled epinephrine, can offer significant relief of asthma-type symptoms. However, it can be considered dangerous in patients who actually have more severe inflammation and should only be rarely used. If you notice asthma symptoms such as wheezing, chest tightness, cough, shortness of breath – be sure you consult with a medical provider like an allergist to get better recommendations!

Seeing an allergist and discussing your allergy symptoms is the best way to get the best and safest recommendations to help treat your specific symptoms!



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The new American Academy of Allergy, Asthma & Immunology (AAAAI) guidelines update on anaphylaxis discusses numerous tips about carrying and proper storage of epinephrine auto-injectors (Epi-Pen, Auvi-Q, Adrenaclick, or others).  This month, we want to go over some of those tips for you!


  1. Always carry two! The epinephrine auto-injectors come in two-packs. They are meant to stay together. This is so there is always a second dose available if it is needed if symptoms don’t fully respond to one dose or return after the first dose. Make sure you carry both!
  2. Practice technique! Most devices come with a trainer and there are numerous educational videos showing proper use. Your healthcare provider and staff are also great resources! Be sure you know how to properly use your device, so you’re prepared if an emergency occurs.
  3. Check expiration dates! Make sure you always have up-to-date epinephrine auto-injectors and replace expired devices as they will be the best option to manage an allergic reaction. However, if you are ever having an allergic emergency and realize you have an expired device, it is still okay to use it! It is still safe to use, and we would rather you use an expired device than no treatment at all.
  4. Make sure it’s being stored at the right temperature! The optimal range for epinephrine storage varies slightly based on manufacturer. However, the “sweet spot” is between 68-77 degrees Fahrenheit. Your device should not be exposed to extreme temperatures for long periods of time. it should not be frozen or refrigerated and should not be kept in a vehicle in hot weather. There are insulated carrying cases you can purchase to keep the temperature regulated. Also, when traveling, make sure it is not in your checked luggage!
  5. Possible new treatments are coming! There is a lot of research on anaphylaxis and various treatment options, including possible needle-free epinephrine devices! As possible new options come available, your Allergist will discuss which treatment is best and safest for you!

Have you ever had an allergic reaction to radiocontrast dye, also referred to as iodinated contrast?

These reactions typically occur when contrast agents, commonly iodine-based, are administered to enhance the visibility of specific tissues or organs during procedures like computed tomography (CT) scans or angiography. Adverse reactions are generally categorized as either immediate or delayed. Immediate reactions, occurring within minutes to an hour of contrast administration, range from mild symptoms such as flushing, itching, or nausea to more severe symptoms like respiratory distress and anaphylaxis. Delayed reactions, although less common, can present hours to days post-procedure and may involve skin rashes or kidney-related complications.

If you have ever had a reaction to contrast dye, it is crucial to differentiate between true allergic reactions and non-allergic responses. True allergies involve an immune system response to the contrast agent, whereas non-allergic reactions are often related to the physicochemical properties of the contrast medium. While the overall incidence of true allergic reactions is low, individuals with a history of previous reactions, asthma, or certain medical conditions may be at a higher risk.

For many of those who have had reactions to contrast dye, special pre-treatment protocols with antihistamines and corticosteroids may be considered to help prevent future reactions. The pretreatment protocol can reduce the risk of future reactions down to 10%! There are also other precautions that can be discussed to reduce the chance of reactions.

It is a common myth that shellfish allergy is connected to contrast dye allergy. This is because they both use iodine. Thankfully, iodine does not cause allergic reactions and having a shellfish allergy does not place you at increased risk of contrast reaction. If you have more questions about this, you can discuss it with your allergist!

Vasomotor rhinitis, also known as non-allergic rhinitis, is a condition characterized by chronic nasal symptoms without any specific allergic triggers. Unlike allergic rhinitis, which is caused by an immune response to allergens, vasomotor rhinitis is associated with abnormal nasal blood vessels and nerve sensitivity. Symptoms of vasomotor rhinitis are very similar to those of allergic rhinitis. They include nasal congestion, runny nose, sneezing, and post-nasal drainage.  With vasomotor rhinitis, often the runny nose is very watery and sudden-onset, and many patients describe their nose as “running like a faucet.”  However, unlike allergic rhinitis, all these symptoms occur without actually having specific allergic triggers. To make things even more confusing, you can have both allergic and non-allergic rhinitis at the same time!  Triggers of vasomotor rhinitis include changes in temperature or humidity, strong odors (perfumes, smoke), air pollutants, certain foods or beverages (spicy foods, alcohol), hormonal changes, and emotional stress. Thankfully there are many treatment options for vasomotor rhinitis, including nasal saline, medicated nasal sprays, and allergen avoidance and environmental control measures. It’s important to consult with a healthcare professional, such as an allergist, for an accurate diagnosis and appropriate treatment plan for vasomotor rhinitis. They can help identify triggers and provide guidance on managing your symptoms!






In Arizona, summer is typically associated with high temperatures and dry conditions, which can significantly affect the presence and concentration of pollen and mold spores in the air. While there is variability depending on specific locations within the state, here are some common types of outdoor allergens that may be present during the summer months in Arizona:


  1. Grass Pollen: Grasses are a common source of pollen during the summer season. Bermuda grass, buffalo grass, and other warm-season grasses are prevalent in Arizona and can release pollen particles into the air, potentially triggering allergies.


  1. Weed Pollen: Weeds, such as ragweed, are known to produce abundant pollen during the summer. Although ragweed is more common in the fall, other weed species like lamb’s quarters, pigweed, and Russian thistle (tumbleweed) can also release pollen and cause allergic reactions.


  1. Tree Pollen: While tree pollen is more abundant during the spring, some trees in Arizona may continue to release pollen during the early part of summer. Juniper trees, also known as cedar trees, are prevalent in the region and can produce allergenic pollen.


  1. Mold spores: Mold spores can be found year-round. While some molds, such as Alternaria, are more prevalent after rain or in areas with high humidity, some molds such as Aspergillus and Cladosporium thrive in warmer months and hotter, dry conditions.


It’s important to note that the specific pollen types and their levels can vary depending on factors such as location, weather conditions, and plant growth patterns. Checking local pollen and mold spore forecasts, as well as consulting with an allergist, can provide more specific and up-to-date information tailored to your specific area within Arizona and your personal allergies. Taking necessary precautions, such as keeping windows closed during high pollen counts, using air purifiers, and avoiding outdoor activities during peak pollen times, can help manage allergy symptoms during the summer months.