Researchers evaluated children ages 2-16 years of age and found that 42% of the time, proper steps for inhaler technique were not followed. And 18% of the time, a spacer device was not used with their inhaler. A spacer is a device that is recommended for use with certain inhalers to help the medication reach the lungs. Though the study looked at very young children, they found that teens were the MOST likely to make mistakes or to not use a spacer. Also, it is common to think that spacer devices are only for children, when in fact we recommend them for adults and teens as well. Using a spacer deivce boosts the amount of medication getting to the lungs from 34% to 83%! Improper inhaler technique can lead to uncontrolled asthma, more symptoms and “sick visits” to doctor’s offices, ER’s, or urgent cares. It can also lead to stronger medication being prescribed unnecessarily. Other studies have shown that many patients misuse their inhalers or miss an important step, even if they have been on the same inhaler for many years. If you are prescribed an inhaler for asthma, staff at AAAI are more than willing to demonstrate proper use of your inhaler and spacer device. If you are not sure if you are using it correctly, or your inhaler recently changed, be sure to ask staff for a demonstration and proper teaching. If the right medication is being used properly, this can lead to optimal asthma control and a full, rich life despite being an asthma patient!

Q: Is there such a thing as a hypoallergenic dog? A: The answer is No! This may surprise you – There’s no such thing as a hypoallergenic dog breed! Many people think that dog allergies are caused by a dog’s fur, but the real source is a protein that’s found in the saliva and urine. […]

Phoenix Allergist Skin Conditions

Many patients at AAAI suffer from hives or urticaria. Hives are itchy welts that appear on the surface of the skin. They are caused when special cells in your immune system, called mast cells, release histamine. Sometimes mast cells are affected in deeper layers of skin and this causes swelling (angioedema), most commonly in the lips, eyes, hands and feet. Hives typically come and go and move around throughout different areas of the body and of course are very, very itchy.

 

Acute Vs. Chronic Hives: 

When hives have been occurring for less than 6 weeks, they are called “acute” hives. Acute hives that happen randomly are most commonly caused by a viral or bacterial infection.  Patients that have food or drug allergies may get hives immediately after accidentally ingesting their allergen, which is a sign of an allergic reaction. Others that are allergic to different airborne allergens can get hives when exposed to those allergens as well (such as hives when petting a dog, or from sitting in the grass).

 

Chronic hives are when hives have been occurring pretty consistently for more than 6 weeks. Chronic hives are often caused by over-stimulation of the immune system which results in mast cells releasing histamine. This condition is often called, “chronic idiopathic urticaria.” The term “idiopathic” means it occurs randomly with no known cause. Chronic, random hives are not caused by a food, a drug or the environment. Often if a patient has suspicion that a food or drug was involved, working with your allergist we can perform a complete history and examination and blood or skin tests if needed to help determine the underlying cause. However, with chronic hives, often no cause is identified.

 

Treatment:

The good thing is that chronic hives are not dangerous and do not affect one’s long term health. There are multiple safe medications patients can take to control hives and itching while we are waiting for the condition to resolve.  There medications include both second generation antihistamines (such as Claritin, Zyrtec or Allegra) and sometimes first generation antihistamines (such as Benadryl and Hydroxyzine). We will often use antacids such as Zantac and Pepcid, which are acid reflux medications but can also help hives. Singulair can sometimes be used and if hives are severe we can use oral steroids to improve the condition.   If hives or itch are severe and uncontrolled with medications, we can use a biologic (an injected drug that works with your immune system) to improve the hives called Xolair. Allergy medications prescribed for hives need to be taken every day, sometimes twice daily, to help control the condition.  Your allergist or PA will help you determine what the best treatment course is for you! 

 

 

The beginning of the school year is an exciting time for many, but it can also be a time of anxiety for children who have asthma or allergies.  Help your child walk confidently into school this year, knowing that they are prepared as possible.

1. Keep on top of medication before the school year starts.

Make sure that your child is on top of their necessary medication before the first week of school arrives. Making a routine of knowing what medication to take when can relieve anxiety surrounding taking medication at school.

2. Get a tour.

Contact the school to get a tour of your child’s classroom and the nurse’s office.  Going into school before the school year starts will calm your child’s nerves, by allowing them to know what to expect when they need to go to the nurse’s office for help or medication.

 3. Have a Signal.

It would also be a great idea to talk to your child’s teacher about a discrete signal that the two of them can use when your child needs to go get medication from the nurse. This way your child can get the help they need, when they need it, without drawing attention to themselves.

4. Know Their Limitations.

It’s important for all children, even those with exercise-induced asthma, to get regular exercise. Talk to your chid’s doctor about what types of physical activity are less likely to trigger asthma and allergy symptoms, and consider encouraging your child to participate in those activities. Make sure that your child uses their inhaler before they exercise and that they have plenty of water to keep hydrated!

 

 

If you or your child is in need of an appointment with one of our allergy or asthma specialists, contact us today for an allergy or asthma appointment!

 

 

 

 

 

The monsoon season is an eerily beautiful time of year that brings with it storms and sweet relief from the scorching summer heat. Unfortunately, with the monsoons also come monsoon season allergies, infection and issues with digestion for many.

Whipping winds with pollen, dirt and dust particles are the perfect recipe to aggravate your allergies. Not only this, but the rain and wet clothes can lead to the spread of infection during the monsoon season. An unanticipated effect of the monsoons are digestion issues.

Here are some tips to keep yourself as healthy as possible and keep control of your monsoon season allergies.

  1. Watch What You Eat.

    If you’re eating food from the garden or if you’re buying food from a food cart on the side of the road, dust and other particles are more likely to be in those foods. Be aware of this and counter it by making sure you’re rinsing food off food as much as possible before consuming it.

  2. Limit your exposure.

    Roll up the windows while you’re in the car, keep windows closed and make sure to shower every night before going to bed, to keep away and rinse off any allergens that may be aggravating your symptoms.

  3. Wash your hands.

    While dust storms do kick up a great deal of dust and allergens, washing hands before every meal can do a great deal for those with allergies from the dust storms.  Washing your hands will keep away many infections and rinse off allergens that may be on your hands and arms from being out in the dust storms.

Are you suffering from monsoon season allergies or asthma? Contact Arizona Asthma and Allergy Institute to schedule your allergy or asthma appointment today!

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

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