Allergy & Asthma Care of Fairfield County

Web Name: Allergy & Asthma Care of Fairfield County






Our practice provides outstanding care to adults and children with allergies, asthma, and food allergies throughout Fairfield and New Haven Counties. We offer compassionate, honest, and personal care in a comfortable, convenient setting. We also have early morning and evening hours to accommodate your busy lifestyle.Pediatric Adult55 Walls Dr., Suite 405, Fairfield, CT (203) 259-7070 500 Monroe Tpk, Suite 205, Monroe, CT (203) 445-1960 Kenneth Backman, MD, Katherine Bloom, MD, Sara Dever, MD, Suzanne Hines, APRN, and Jill Ross, APRN, Elizabeth Strong, APRN Children under age 2 who take antibiotics are at greater risk for childhood-onset asthma, respiratory allergies, eczema, celiac disease, obesity and attention deficit hyperactivity disorder, according to a paper written jointly by Mayo Clinic and Rutgers researchers. In a study published in the journal Mayo Clinic Proceedings, the researchers looked at 14,572 children born in Olmsted County, Minn., between 2003 and 2011, 70 percent of whom received at least one antibiotic prescription during their first two years, primarily for respiratory or ear infections. The findings are consistent with the hypothesis that the composition of the microbiome -- the trillions of beneficial microorganisms that live in and on our bodies -- plays a critical role in the early development of immunity, metabolism and behavior. The evolution of drug-resistant bacteria exemplifies one unintended consequence of antibiotic overuse, said co-author Martin Blaser, director of the Center for Advanced Biotechnology and Medicine at Rutgers. The increasing prevalence of health conditions that start in childhood has triggered concern about antibiotic exposures during key developmental periods because of their impact on the microbiome. While previous studies have looked at the association of antibiotics with single diseases, this is the first to look at the association across many diseases. The study found that antibiotics were associated with metabolic diseases (obesity, being overweight), immunological diseases (asthma, food allergies, hay fever and cognitive conditions or disorders (ADHD, autism), but effects varied among the different antibiotics. Cephalosporins were associated with the most risk for multiple diseases, and uniquely autism and food allergies.Researchers also found that risk increased with more courses of antibiotics and when given earlier in life -- especially within the first 6 months. The findings from Olmsted County provide evidence for broad and delayed effects of early life antibiotic exposures, and should change doctors practices in how often they prescribe antibiotics, especially for mild conditions, said Blaser.Dr. Kenneth Backman of Allergy Asthma Care of Fairfield County comments: While it does not prove causation, this study provides more evidence that early childhood antibiotics can have unintended consequences. Many factors play a role in the development of allergic disease. While antibiotics are often absolutely necessary, it is important to try to avoid courses of antibiotics, especially in young children, when possible. Findings of a recent study showed house dust mites and grass allergens to be the most common triggers of atopic dermatitis. Furthermore, allergic rhinitis was found to be a comorbidity closely associated with the skin disease. Currently, the global prevalence of atopic dermatitis stands at 20% in children and 3% in adults. The investigators of the study noted that although the disease is often triggered by antigens, it is not clear which precise allergens are triggering factors.Ömer Kutlu, MD, MRCP, and Ahmet Metin, MD, used file records from Kayseri Develi State Hospital of patients who underwent skin prick testing due to atopic dermatitis. They used the test results to determine the most common triggering allergens as well as any association with specific demographic factors. Overall, they assessed 144 patients, with 73.6% being female. The median age of the population was 18 years (range, 3-51). Additionally, 63.2% of patients had a family history of allergic disease.The skin prick test was administered by the same dermatologist so as to ensure standardization across all patients. Following administration of the test, positive results were evaluated and categorized into 4 levels of positivity degree– with 1 designating erythema ≤ 15 mm and no edema, and 5 designating edema 6 mm as well as pseudopod development. Thus, the investigators found that the most frequent allergens with ≥3 positivity (edema 3-6 mm), were grasses (31.2%), grasses mix (24.3%), Cynodon dactylon (15.3%), D. pteronyssinus (9.7%), D. farinae (7.6%), F. domesticus (7%), and Olea europaea (5.6%).Furthermore, 65.3% of patients presented with a ≥1 degree of positivity, while 43.1% had a ≥3 positivity. Within both groups, 19.2% and 21.0%, respectively, demonstrated a reaction to only 1 allergen. D. farinae and D. pteronysssinus positivity were much more frequent in patients 18 years than in those 18 years (P = 0.003 and P = .007, respectively). Besides these differences, there were no other statistical differences between other allergens and the age of the patients. And finally, they found a statistical difference between ≥3 positivity and allergic rhinitis (P = .006). Additionally, those with allergic rhinitis were much likelier to have a ≥1 and ≥3 positivity.Those with atopic dermatitis who had comorbid allergic rhinitis and a ≥3 positivity were more typically triggered by grasses (44.5%), grasses mix (37.0%), Cynodon dactylon (27.2%), D. farinae (9.9%), D. pteronyssinus (8.6%), and Canis familiaris (8.6%). “Detection of allergens, particularly in patients with atopic dermatitis, is crucial for the treatment and prevention of the disease,” Kutlu and Metin emphasized. They concluded by referencing previous literature that assessed the associations among specific characteristics, such as geographic locations, various types of allergens, and patients with atopic dermatitis. Yet, they noted there is still potential for more in-depth research.“Further multicenter, comprehensive SPT [skin prick test] based studies on atopic dermatitis will illuminate the possible triggers of the disease in atopic dermatitis in different geographies,” they wrote.The study, “Evaluation of Skin Prick Test Results in Patients with Atopic Dermatitis,” was published online in Eastern Journal of MedicineDr. Kenneth Backman of Allergy Asthma Care comments: We have long known that atopic dermatitis has both allergic and non-allergic components. There is an underlying skin defect in barrier function, but food and environmental allergies can be significant triggers, worsening eczema chronically and during flare-ups. This study provides more evidence for dust mites and grass pollens as triggers, though there are certainly others. Here s a great information page from the American Academy of Allergy, Asthma, and Immunology regarding masks, allergies, and asthma: Allergy Asthma Care of Fairfield County is pleased to announce that peanut oral immunotherapy (desensitization) is now available in our office for peanut allergic patients ages 4 to 17. The FDA has approved the first available peanut allergy treatment. Peanut oral immunotherapy raises the threshold at which an allergic individual will react to accidental exposure to peanut, providing a safety margin against accidental ingestion. See the article below for more details. The treatment process is time consuming, with an initial dose escalation visit of 5 hours or so, followed by a visit a day later, then every 2 weeks for further escalations, with daily home dosing between visits. While reactions can occur during treatment, the efficacy at preventing accidental reactions in uncontrolled situations is quite good. Please schedule an appointment with one of our physicians to discuss whether this option is right for you, and to begin the process if you are interested.Peanut Oral Immunotherapy Information from ACAAI There have been conflicting studies about the risks of COVID in asthma patients. It appears that patients with allergic asthma may be at lower risk, but non-allergic asthma may increase the risk of COVID complications. More studies are ongoing. It is important to keep your asthma controlled at all times, but especially during this pandemic. See below for an interesting article about the connection. Wearing masks during this pandemic is critically important to stopping the spread of the COVID-19 virus. Here is some helpful information from the American Academy of Allergy, Asthma, and Immunology regarding wearing masks: As you are aware, Gov. Lamont issued an order on June 24 requiring a two week self-quarantine by people entering Connecticut from states with increasing COVID rates. Please click on this link to see the latest list of states: Connecticut travel / quarantine rulesIf you fall into this group, please call our office to reschedule your appointment for after the two week quarantine. Similarly, if you are calling to schedule an appointment, please wait two weeks before coming in. If we need to reschedule your appointment, please understand we are not singling you out. This is a public health emergency. The same rules that apply to our patients apply to our staff and doctors Allergy Asthma Care of Fairfield County is dedicated to keeping our patients and staff protected as best we can from COVID-19.We remain open with somewhat modified hours to provide care for all of our patients, and are back to near normal injection hours (close at 6 PM instead of 7 PM Monday and Tuesday for now; we remain closed on Fridays for now) We have in-office appointments available for all allergy and asthma related issues. Telemedicine visits are still available for those who prefer to avoid in-office visits for now.We are sanitizing the waiting room chairs and surfaces frequently throughout the day.Please be patient with us as we are sanitizing every exam room from top to bottom between each patient visit. All equipment such as blood pressure cuffs, otoscopes, stethoscopes will be sanitized between patients. This takes time and may cause some delays with rooming patients.We are asking patients to CALL their primary health care provider if they have symptoms or feel they meet the criteria for testing for the coronavirus.We ask that ALL patients / caretakers entering our office please wear cloth or paper face masks as per CDC guidelines, and use hand sanitizer immediately upon entering the office. Click here for instructions on how to make your own facemask.Patients with symptoms suggestive of possible COVID-19 infection should contact their primary care physician and not enter our office. We will be screening patients with appointments for symptoms over the phone prior to entry into our office.We have established a protocol to allow allergy injection patients to spend their 30 minute waiting period in their car, understanding that they must wait the 30 minutes in the parking lot and call immediately for any signs of reaction. Waiting in our waiting room is always the safest option, but waiting in your car is allowed during this difficult time.We are asking all patients to not bring additional family members to appointments. Minors should be accompanied by only one adult. Siblings and other family members will not be permitted into the office unless they are also scheduled to be seen.We recommend that all of our patients follow the CDC guidelines for prevention of exposure: CDC guidelines With the ongoing COVID-19 pandemic, all of us are trying to stay at home as much as possible. This does not mean that you can t get help for your allergies and asthma. If you think that you or your child may have asthma, environmental allergies, food allergies, hives, eczema, or other allergic conditions, it’s easy to schedule a video visit from the comfort of your own home. Allergy Asthma Care of Fairfield County offers expert care by our allergy physicians and nurse practitioners via telemedicine videoconference. A video visit allows you to have a face-to-face visit with your allergy team quickly—and safely.Whether your child is a new patient, or receiving follow-up care, a telemedicine appointment is easy to schedule—often within a day or two of your call. Our expert allergist-immunologists provide patient and family-centered care, recognizing that each patient, child, and family has unique needs. Our practice provides state-of-the-art, academic quality care with the convenience of a local physician, and now you can receive our care from the comfort and safety of your own home. While you (and your child) are on the call, we will answer all of your pressing questions. Our friendly, caring physicians and nurse practitioners will give you (and your child) our full attention, and strive to make you comfortable. During your video visit, we can:· Discuss, review and update your (child’s) allergy-relevant history· Help interpret testing that you may have had done outside our office· Order lab testing that can be done locally at your convenience· Make a plan for skin testing, if needed, that will be done in-person at a future date· Customize and send an updated food allergy emergency action plan· Review how to manage asthma, nasal allergies, eczema, food allergies, and severe allergic reactions while at home during the pandemic· Update and renew prescription medications· Discuss emerging treatments for allergies, including oral immunotherapy for foods, that may be available· Come up with a comprehensive management plan for you or your child’s allergies· Arrange for consultation with our nutritionist for nutrition evaluation and a dietary management plan.We also offer urgent video appointments (within 24-48 hours) for current patients of our practice for any allergy issues that may come up.We cannot order off-site bloodwork for patients who have not had a telemedicine visit beforehand. So if you think you or your child needs lab testing, please consider setting up a video visit with your allergist soon. Lab work can be done at a time and location that is convenient for you.Please call (203)259-7070 or click here to schedule a telemedicine visit. Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus triggered by allergens that causes difficulty with swallowing in adults, which grows more frequent and intense over time, affecting patients quality of life. Children experience varied symptoms that include feeding difficulty, pain, vomiting, as well as difficulty swallowing. EoE affects an estimated one in 2,000 people.A new guideline from the American Gastroenterological Association (AGA) and the Joint Task Force for Allergy-Immunology Practice Parameters provides recommendations for the management of EoE in pediatric and adult patients.Key guideline highlights:Topical steroids(such as swallowed Flovent or budesonide) are recommended as a first-line treatment for EoE.The guideline also recommends proton pump inhibition (PPI) therapy (such as omeprazole and lansoprazole,) diet therapy and esophageal dilation as treatment options.The use of novel, targeted biologic therapies for EoE are being actively evaluated and more research is needed before these can be recommended. Over the past two decades, EoE has emerged as a dominant cause of swallowing difficulties worldwide, said Ikuo Hirano, MD, AGAF, a gastroenterologist from Northwestern University Feinberg School of Medicine, Chicago, Illinois, and lead guideline author. The recommendations we ve outlined will guide allergists and gastroenterologists in effectively managing their patients EoE and improving their quality of life. As the field moves forward, a deeper understanding of the natural history of EoE in both children and adults is needed to inform clinical decisions regarding the optimal use of disease monitoring and long-term, maintenance therapy. This guideline was developed through a collaboration between AGA and the Joint Task Force for Allergy-Immunology Practice Parameters, which comprises the American Academy of Allergy, Asthma Immunology and the American College of Allergy, Asthma Immunology. This guideline is jointly published in Gastroenterology, the official journal of the AGA Institute, and Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma Immunology.Review the guideline for the complete recommendations.WHAT IS EOSINOPHILIC ESOPHAGITIS?EoE is a chronic inflammatory disease of the esophagus triggered by food and environmental allergens. Patients with EoE experience difficulty swallowing, vomiting and pain, potentially resulting in poor eating and growth among infants and toddlers. In children and adults with EoE, solid food can get stuck in a narrowing esophagus, increasing the risk of emergency room visits for the removal of trapped food. EoE is a recently recognized disease with increasing prevalence. EoE affects an estimated one in 2,000 people. Treatment focuses on alleviating both symptoms and esophageal inflammation while helping people maintain their quality of life. From the American Academy of Allergy, Asthma, and Immunology:COVID-19 AND ASTHMA: WHAT PATIENTS NEED TO KNOWThe coronavirus disease 2019 (COVID-19) pandemic is scary for all people, but for those with asthma there is great fear that they will have a worse outcome or be more likely to get SARS-CoV-2 (the virus that causes COVID-19). It is important to know that currently there is no evidence of increased infection rates in those with asthma. And although the Centers for Disease Control and Prevention states that patients with moderate-severe asthma could be at greater risk for more severe disease, there are no published data to support this determination at this time. There has been one report suggesting that asthma may increase the risk of hospitalization from COVID-19 in 18-49 year old adults; however, this is based on a small number of patients.1 And in the opposite direction are data from New York where asthma was under-represented (so protective) in those who died from COVID-19.2 It is important to remember we are dealing with an evolving pandemic and new information could change the situation in the future.Early reports suggested that steroids were contraindicated in patients with COVID-19 disease, although there have been some indications that steroids are useful in severe COVID-19 disease. Given the varying opinions on the use of steroids and COVID-19, many are wondering what to do if their controller medication is a steroid (inhaled or oral). The short answer is continue taking your controller medications and do not stop them. The data suggesting that steroids might increase the shedding of SARS-CoV-2 comes from treating hospitalized patients with systemic steroids just for the viral illness. The use of steroids for treating other diseases (like asthma) was not studied. However, people with asthma are placed on controller medications to keep their asthma under control. In the current pandemic, the best thing a person with asthma can do (with respect to asthma) is to get and keep their asthma under control. Stopping a controller medication will put the person at risk for developing an asthma exacerbation. In the current pandemic, treatment of an exacerbation will likely require going to the emergency department or urgent care, where the individual has a much higher risk of being exposed to someone with COVID-19. So, in a way, by continuing to keep asthma under control, the person with asthma is actually reducing their chance of exposure to COVID-19.It is worth noting that there are seasonal versions of coronaviruses that have been shown to cause asthma exacerbations. The SARS-CoV-2 virus (like SARS-CoV and MERS-CoV, the two other pandemic coronaviruses) does not seem to cause asthma exacerbations. Nonetheless, it is always important for asthma patients to keep their asthma under the best possible control. That way their lungs will be best prepared should any infection or allergen lead to an exacerbation of their asthma.The bottom line for people with asthma during this pandemic is to keep doing what you have been doing all along—continue taking your controller medication and inform your healthcare provider of any symptoms that you may develop. And of course, remember to practice social distancing and wash your hands.1. Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep 2020;69:458–464. DOI: article has been reviewed by Andrew Moore, MD, FAAAAIReviewed: 6/22/20 Please click the link below for up to date information about COVID-19, asthma, allergies. Please contact our office at (203) 259-7070 for any questions or concerns. We are performing telemedicine videoconference visits with our patients, as well as in-person office visits for immunotherapy patients, patients on injected medications, and in selected cases when necessary and safe, and remain available to you throughout this difficult time. COVID-19, Allergies, and Asthma Due to increased use of albuterol inhalers in hospitals for COVID-19 patients, in part to avoid use of nebulizers which may help aerosolize the virus when treating infected patients, a shortage of albuterol inhalers has developed. Here is a message from the American College of Allergy, Asthma, and ImmunologyARLINGTON HEIGHTS, Ill (March 20, 2020) - Certain areas of the country are experiencing shortages of albuterol inhalers. The shortage will probably spread throughout the U.S., although it is not a production problem. The shortage is occurring because of the increased use of albuterol inhalers in hospitals for COVID-19 and suspected COVID-19 patients to help with respiratory issues. There is a concern that nebulizers used on patients with COVID-19 in the hospital could spread the virus in the air. But the possible risk is to hospitalized patients with COVID-19 – not to patients using their nebulizer at home as directed.It is important if you have been diagnosed with COVID-19 or suspect you may have COVID-19 and are using a nebulizer at home, that you know the virus may persist in droplets in the air for 1-2 hours. Therefore, you should administer nebulized albuterol in a location that minimizes exposure to members of your household who aren’t infected. Choose a location for your treatment where air is not recirculated into the home – places like a porch or patio, or in a garage – areas where surfaces can be cleaned more easily or may not need cleaning.What should you do if you or your child are having trouble getting an albuterol inhaler? The recommendations below from the American College of Allergy, Asthma and Immunology (ACAAI) offer practical ideas for coping:First, don’t panic. Check your inhaler to make sure it still has medicine.If necessary, you can likely use your expired albuterol inhaler as it is probably still at least partially effective.If you can’t get a refill on your metered dose inhaler, contact your allergist or health care provider as there are other options available which they can prescribe.It is important that you not overuse your albuterol inhaler, as one canister should last for months.ACAAI will continue to provide updates as more information becomes available.Dr. Kenneth Backman of Allergy and Asthma Care of Fairfield County comments: Patients may find it increasingly difficult to find albuterol inhalers, but the use of nebulizers places family members at risk if not done carefully in a separate room. If you are having trouble finding an albuterol inhaler, contact our office for alternatives. Spring is in the air and that means pollen, mold spores and other airborne allergens are going to bring on sneezing and wheezing for an estimated 50 million Americans. (We are available for telemedicine appointments for both new and established patients to help manage your seasonal allergies. We can do much of what can be done in the office, and a medication plan can be developed to offer relief and get you through the season. Hands on examination, allergy testing, and lung function testing can be deferred until after the stay home orders are lifted.)The spring season can be especially bothersome with so much conflicting information on how to find relief. To help you better understand spring allergies and combat symptoms this sneezing season, the American College of Allergy, Asthma and Immunology (ACAAI), has answered some of the most frequently asked questions.1. Why does it seem like more and more people have spring allergies? This is likely due to increased awareness and more people taking the steps to being properly tested and diagnosed. According to a recent study published in the Annals of Allergy, Asthma and Immunology, pollen counts are gradually increasing every year, which can cause heightened symptoms. 2. Do spring allergy symptoms only last during the spring months? The length of the season can help determine the severity of symptoms. For many areas of the country, spring allergies begin in February and last until the early summer. Mild winter temperatures can cause plants to pollenate early. A rainy spring can also promote rapid plant growth and lead to an increase in mold, causing symptoms to last well into the fall months. Allergists recommend starting medications to alleviate symptoms two weeks before they begin. If you have a history of prior seasonal problems, start your medication at the first sign of any symptoms.3. Will eating local honey cure allergies? A common myth is that eating a spoonful of local honey a day can build allergy immunity. The idea is that bees pick up pollen spores from flowers, transfer them to their honey and help you better tolerate pollen. Seasonal allergies are usually triggered by windborne pollen, not pollen spread by insects. There is no scientific evidence that honey will provide any benefit or reduce allergy symptoms. Your best bet? Talk to your allergist about ways to avoid allergy triggers, the best medications to treat symptoms and whether immunotherapy (allergy shots) could be beneficial.4. Is there such a thing as spring asthma? Allergies and asthma are often worse during different times of the year due to environmental allergens. An estimated 75 to 85 percent of asthma patients have allergies. These allergic responses in the lung can lead to symptoms of asthma. If you have spring allergies, this can be why you have more asthma symptoms during the season. Those that believe they may have symptoms of nasal allergy or asthma can find a free screening program in their area by visiting Can you suddenly develop seasonal allergies in adulthood? Yes. Although allergies are common in children, they can occur at any time and any age. Sometimes allergies go away, but they also can come back years later. If you suspect you have an allergy, you should keep track of your symptoms with and see an allergist to find relief. By understanding what allergens trigger your symptoms and how to avoid them, you can find relief from spring allergies this season, says Dr. Richard Weber, an allergist and ACAAI president. An allergist can help you find the source of your suffering and stop it, not just treat the symptoms. Allergies and asthma are serious diseases during every season of the year and that s nothing to sneeze at. Misdiagnosis and inappropriate treatment can be dangerous. To help accommodate the need for social distancing during the COVID-19 pandemic, we now have telemedicine video conferencing appointments available, for both NEW and ESTABLISHED patients, and ask that all patients who do not require allergy injections or biologic medications perform their visits through telemedicine. Telemedicine visits are going very well, and we are able to develop medication plans and provide relief of your symptoms, with allergy testing and pulmonary function testing, when necessary, deferred until after the stay home order is lifted. Please call our office at 203-259-7070 to schedule a visit. Our telemedicine link is here:Telemedicine video visitsStep by step instructions:After making an appointment with Allergy Asthma Care you will be directed to our Chiron telemedicine site (click above.) You will then be directed to download the Chiron app. Once you’ve downloaded the app you will be prompted to enter your phone number to look up your account.Chiron Health will then ask to send you a text message with an unlock code. Confirm the phone number is correct then click “Send Code“.Set-up your account with Chiron Health. The patient’s name, date of birth (DOB) and phone number will automatically be listed. Create and confirm your own unique password then click “Save and Continue“.Once your account is set up, you will see your future appointment and you may enter the virtual exam room 15 minutes before the appointment start time. (Note: on this page you may see a prompt to get your next appointment set-up, however you must call Allergy Asthma Care directly at (203) 259-7070 to set up an appointment.Within 15 minutes of your appointment start time click “Start Appointment” in the Chiron Health app.Click “Continue“Next you will be prompted to read and accept the Telemedicine Informed Consent. Click “Accept and Begin” to continue. This step must be done in order for the visit to take place.Lastly, you will see a notification asking you to wait for your Clinician to join the appointment. Please be patient as your Clinician may be finishing up with a previous patient. Once your Clinician joins, you’ll be able to start! The U.S. Food and Drug Administration today announced that it is requiring a boxed warning – the agency’s most prominent warning – for montelukast (sold under the brand name Singulair and in generic form) to strengthen an existing warning about the risk of neuropsychiatric events associated with the drug, which is used to treat asthma and allergic rhinitis (hay fever). The boxed warning advises health care providers to avoid prescribing montelukast for patients with mild symptoms, particularly those with allergic rhinitis.As noted in a new Drug Safety Communication issued today, the warning follows the FDA’s review of available data regarding continued reports of neuropsychiatric events with montelukast, such as agitation, depression, sleeping problems, and suicidal thoughts and actions. The Drug Safety Communication includes recommendations for health care professionals and patients and a summary of the data that led to these warnings.“We recognize that millions of Americans suffer from asthma or allergies and rely on medication to treat these conditions. The incidence of neuropsychiatric events associated with montelukast is unknown, but some reports are serious, and many patients and health care professionals are not fully aware of these risks,” said Sally Seymour, M.D., director of the Division of Pulmonary, Allergy and Rheumatology Products in the FDA’s Center for Drug Evaluation and Research. “With today’s action, the FDA aims to make sure patients and medical providers have the information available to make informed treatment decisions. Importantly, there are many other safe and effective medications to treat allergies with extensive history of use and safety, such that many products are available over the counter without a prescription.”The FDA updated the product labeling in 2008 to include information about neuropsychiatric events reported with use of montelukast. In response to continued reports of suicide and other adverse events, the FDA evaluated available data regarding the risk of neuropsychiatric events, including reports submitted through the FDA Adverse Event Reporting System (FAERS) and observational studies in the published literature. The FDA also conducted an observational study using data in the Sentinel Distributed DatabaseExternal Link Disclaimer and presented the findings at an FDA advisory committee meeting in 2019.As part of its review, the FDA re-evaluated the benefits and risks of montelukast as the treatment landscape has evolved since the drug was first approved in 1998. Based upon this assessment, the FDA determined the risks of montelukast may outweigh the benefits in some patients, particularly when the symptoms of the disease are mild and can be adequately treated with alternative therapies. For allergic rhinitis in particular, the FDA has determined that montelukast should be reserved for patients who have not responded adequately to other therapies — or who cannot tolerate these therapies.In addition to the boxed warning, the FDA is also requiring a new Medication Guide to be given to patients with each montelukast prescription.Health care professionals and patients should report side effects from montelukast to the FDA’s MedWatch program.The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.Dr. Kenneth Backman of Allergy Asthma Care of Fairfield County comments: Millions of patients have taken Singulair (montelukast) without adverse effects, and have benefited from this medication. However, a small number of patients have experienced side effects including mood changes, strange dreams, agitation, and other neuropsychiatric symptoms, with rare reports of suicidal ideation. If you take this medication and have experienced none of these side effects, and feel you are benefiting from it, do not stop this medication and plan to discuss options at your next office visit. There are many other options for the treatment of allergic rhinitis and asthma. If you believe you have experienced any neuropsychiatric adverse effects of Singulair, discontinue taking it immediately and contact your physician. The FDA has approved the first available peanut allergy treatment. Peanut oral immunotherapy raises the threshold at which an allergic individual will react to accidental exposure to peanut, providing a safety margin against accidental ingestion. See the article below for more details. Allergy Asthma Care is pleased to announce that we will be offering this treatment in our office. The treatment process is time consuming, with an initial dose escalation visit of 5 hours or so, followed by a visit a day later, then every 2 weeks for further escalations, with daily home dosing between visits. While reactions can occur during treatment, the efficacy at preventing accidental reactions in uncontrolled situations is quite good. Please schedule an appointment with one of our physicians to discuss whether this option is right for you, and to begin the process if you are interested. Palforzia peanut allergy treatment A study presented at the American College of Asthma, Allergy Immunology Scientific Meeting found that subcutaneous allergen immunotherapy may be effective in reducing symptoms of pollen food allergy syndrome in children. “Subcutaneous immunotherapy been shown to be effective in adults in reducing [pollen food allergy syndrome] symptoms, but not widely studied in children,” according to Sean Gallagher, of Thomas Jefferson University and the Alfred I. Dupont Hospital for Children in Wilmington, Delaware.Pollen food allergy syndrome occurs in patients with cross-reacting allergens found in pollen and fruits, vegetables or certain tree nuts and can cause itchy mouth, scratchy throat and swelling of the lips, mouth, tongue and throat, according to a press release. Twenty patients aged 9 to 18 years who were currently receiving subcutaneous allergen immunotherapy were asked to complete a seven-question survey about their symptoms.Survey responses were compared with results from patients’ skin prick tests prior to starting subcutaneous allergen immunotherapy. Researchers found that 55% of respondents reported having improved pollen food allergy syndrome symptoms, and 20% reported no change in symptoms. A quarter of respondents did not attempt to reintroduce food that caused symptoms. The results suggest subcutaneous allergen immunotherapy could improve symptoms of pollen food allergy syndrome in pediatric patients allergic to birch, mugwort, types of grasses, and ragweed.Researchers noted that further prospective studies are needed to follow patients’ symptoms throughout subcutaneous allergen therapy and to compare them patients not on receiving therapy. Gallagher explained that these results “provide further incentives in participating in subcutaneous immunotherapy.”– by Erin MichaelReference:Gallagher S, et al. P316. Presented at: American College of Asthma, Allergy Immunology Scientific Meeting; Nov. 7-11, 2019; Houston. A US Food and Drug Administration advisory panel on Friday recommended approving the first therapy for peanut allergies, which affect over 1.6 million children in the United States, despite raising concerns about the risk of severe allergic reactions it poses to young patients. The body of independent advisers voted 7-2 in favor of effectiveness and 8-1 backing safety of the therapy Palforzia, developed by Aimmune Therapeutics Inc. The verdict of the panel is traditionally an influential factor in the agency s final decision.Peanut allergies are the leading cause of death from food-induced allergic reactions in the United States but a lack of approved preventive treatments has left patients and caregivers desperate for options. Palforzia, previously known as AR101, is an oral immunotherapy consisting of fixed doses of powdered peanut that is sprinkled over food daily. While it does not aim to cure peanut allergy, the treatment s clinical trials have shown that patients consuming small doses of the substance to which they are allergic become desensitized over time, reducing the likelihood or severity of a reaction to it.Aimmune says extended therapy will result in patients tolerating at least one peanut s worth of the protein which causes the anaphylactic reaction, protecting them from accidental consumption of the food. Patient advocacy groups have been keenly awaiting an FDA greenlight, which would offer the hope of relief to parents living in constant fear of their children being accidentally exposed.While some allergy specialists in the United States provide non-approved versions of oral immununotherapy, analysts say Aimmune s more precisely dosed oral drug could bring in more than $1 billion in annual sales at its peak. It would be comforting for our community to have this option, Kenneth Mendez, who heads patient group Asthma and Allergy Foundation of America, told Reuters ahead of the panel meeting.However, some experts worry that the treatment might give patients a false sense of security and trigger risky behavior. Others say it puts patients at unnecessary risk, because the very nature of the drug poses a risk of an allergic reaction. Dr. Robert Wood, director of pediatric allergy and immunology at Johns Hopkins School of Medicine, says he believes the excitement will be tempered when patients realize what being on therapy involves. I will offer the treatment to all patients and recommend it to no one, he said.FDA representative Sofia Chaudhry told the panel on Friday that the agency was still deciding on what safety restrictions or REMS requirements to place on the drug. We do take a very conservative approach, she said. If approved, Palforzia is expected to have a black box warning, the FDA s harshest, and strict restrictions requiring the therapy to be administered in a certified facility. Aimmune s closest rival, France s DBV Technologies SA, is developing a patch for peanut-allergic patients aged 4 to 11. The company last month resubmitted an application to the FDA for its stick-on patch therapy called Viaskin Peanut.Aimmune hopes to win approval for use of Palforzia in patients aged 4 to 17 and said it is considering a list price range of between $3,000 and $20,000 a year. I think we ll be lower than in the middle (of that range), Chief Executive Officer Jayson Dallas told Reuters in an interview ahead of the meeting. Insurers will cover this. We ve spoken to the insurers so far who cover about 70% of the lives of patients with peanut allergies. Earlier this year, pharmacy benefits manager CVS Health Corp put out a blog on its website about new treatments, saying it was considering what type of patient access policy to put in place.The FDA is expected to make a decision on approval early next year.Dr. Sara Dever of Allergy and Asthma Care comments: It is exciting that an FDA approved oral desensitization therapy will likely be available in the near future. While this is not a cure for peanut allergy, it helps reduce the likelihood of an accidental reaction, and provides some peace of mind to parents and patients. It will be important to discuss potential risks and benefits prior to beginning treatment. We are excited to have this option soon. Feeding pureed peanut products regularly to babies before their first birthday could reduce their risk of developing peanut allergies later on, doctors advise. In a practice guide for health care providers published in the Canadian Medical Association Journal (CMAJ,) a team of pediatricians and allergy specialists encourage introducing peanuts in pureed or powdered form as early as age 4 months for most babies, and making sure the babies continue to get exposure to “substantial” amounts of peanut products in their first years of life.However, the allergy status of the baby should be checked with a doctor in advance, said one of the guide’s authors, Dr. George du Toit of King’s College London in the UK. He added that at-home introduction of peanut products is best suited for infants who do not have eczema, or have only a mild form of the skin disorder. The hardest part of implementing the current guidelines regarding peanut exposure for babies is that they “are a complete reversal from the prior practice of delaying peanut exposure,” said Dr. Ruchi Gupta of the Northwestern University Feinberg School of Medicine in Chicago, a pediatrician and food allergy researcher who wasn’t involved in the practice guide.“There’s also resistance from parents because they’re fearful about doing this at home with their infants and what may happen,” she told Reuters Health in a phone interview. Peanut allergies typically develop before age 2. These allergies are a constant worry for parents, who need to closely monitor everything their kids eat inside and outside the home. Allergic reactions to peanuts can include skin rashes and blisters, difficulty breathing, low blood pressure, nausea and vomiting, and swelling of the tongue, eyes or face. In severe cases, a peanut reaction can be fatal unless halted with an injection of epinephrine. As a result, doctors previously advised parents to avoid giving peanut products to babies. But a 2015 study (LEAP study) prompted a rethink of the guidelines.The trial included 640 babies younger than 11 months with either egg allergy or eczema - both risk factors for developing peanut allergy. But researchers found that when these high-risk infants were fed a small amount of peanut butter 3 times a week, only 3% went on to develop peanut allergy after 5 years, while 17% of children who avoided peanuts during infancy became allergic. In the practice guide, a team of pediatricians and allergy specialists recommends introducing peanut protein to babies aged between 4 and 6 months in the form of paste, butter or powdered puff as one of the first foods during the process of weaning off breast milk.“A lot of people assume that this just means feed it to (babies) once but it is really important that you feed repeatedly and over a longer period of time so that the immune system actually learns to tolerate it,” said Gupta’s colleague Christopher Warren, also of the Feinberg School of Medicine, who joined her on the phone interview. Guidelines from the U.S. National Institute of Allergy and Infectious Diseases recommend checking the allergy status of high-risk infants through the skin-prick method or specific immunoglobulin E (IgE) testing before introducing peanuts. The allergy societies of Canada, Australia and the UK don’t mandate this test, the authors write.The method of early introduction has also been tested with other major allergenic foods such as milk, egg, sesame, fish and wheat, but the protective effect of early introduction of these foods in a child’s diet was most pronounced in the case of peanuts and eggs, experts noted. Parents should look out for signs of vomiting, choking, rashes, swelling of the lips or an extreme dislike for the food, which could signal the onset of an allergic reaction. But very few infants develop the more severe symptoms such as breathing difficulty or low blood pressure, Gupta said, and doctors are likely to recommend consulting with an allergy specialist to see if the baby could try peanuts again under medical supervision.SOURCE: CMAJ.Dr. Kenneth Backman of Allergy Asthma Care comments: These recommendations are consistent with the findings of the LEAP study and other studies demonstrating the benefits of early introduction of foods. We agree with the US NIAID that high-risk infants, meaning those with a history of severe eczema or egg allergy, should be skin tested prior to peanut introduction, as they are at higher risk of reaction. Early introduction has been demonstrated to reduce the risk of development of food allergy, and is a huge advance in the prevention of food allergies. At least one study recommended that once peanut is in the diet, infants should be fed peanut at least 3 times per week A new study from Washington University School of Medicine in St. Louis supports evidence that children with mild asthma can effectively manage the condition by using their two inhalers—one a steroid and the other a bronchodilator—when symptoms occur. This is in contrast to the traditional method of using the steroid daily, regardless of symptoms, and the bronchodilator when symptoms occur. The as-needed use of both inhalers is just as effective for mild asthma as the traditional protocol, according to the investigators. This study is consistent with recent changes in asthma guidelines for older children and adults. The steroid inhaler lowers inflammation, and the bronchodilator—also known as a rescue inhaler—relaxes the airway during an asthma attack to quickly make breathing easier.The research focused on African American children, who are disproportionately affected by asthma. The study appears in the Journal of Allergy and Clinical Immunology: In Practice. We were pleased to find that as-needed treatment based on symptoms can deliver similar asthma control with less medication, said first author Kaharu Sumino, MD, an associate professor of medicine. Patients in the group that used both inhalers as needed used about one-fourth the steroid dose of the group that inhaled a prescribed daily amount. We also were pleased to see that the patients and families felt that they had more ownership over their asthma management when practicing as-needed treatment. In the U.S., about 6.2 million children under age 18 have asthma. Among white children, about 7.4 percent have asthma. Among African American children, that statistic is almost double, at 13.4 percent. According to the Allergy and Asthma Foundation of America, asthma attacks account for 1.8 million emergency room visits per year, and African Americans are three times more likely than average to be hospitalized due to asthma.The study was conducted by primary care doctors at multiple pediatric practices throughout the St. Louis area, suggesting the strategy is widely applicable in a primary care setting and not just effective when implemented by researchers at a single academic medical center.Past clinical trials conducted in the highly controlled settings of academic medical centers had suggested that the medication-as-needed approach worked just as well as a traditional strategy of daily scheduled steroid treatments with a rescue inhaler as needed. But how well that strategy might transfer to individual community medical practices had been an open question. Not only is this alternative, as-needed, symptom-based strategy effective when administered by the children s primary care doctors, the researchers found that approach reduced the amount of steroid medication the children took monthly by almost 75 percent.The study included 206 African American children 6 to 17 years of age with mild asthma that was adequately controlled with asthma controller steroid medication. Participants saw their own pediatricians at 12 primary care providers throughout St. Louis. The patients were randomly assigned to one of two groups. Each participant in one group was advised to take a dose from an inhaler containing the steroid beclomethasone as needed when symptoms arose, along with the rescue bronchodilator albuterol. Symptoms that might prompt the use of medication include shortness of breath, tightness in the chest, coughing, wheezing and difficulty performing physical activities.Each participant in the second group was advised to take a specific inhaled dose of the steroid beclomethasone daily, regardless of symptoms, plus the rescue bronchodilator as needed in response to symptoms, as has been the standard recommendation for almost 30 years by the Global Initiative for Asthma guidelines.At the end of the one-year study, the researchers found no differences between groups in surveys of how well the patients asthma was controlled, as well as no differences in breathing tests that measure lung function. There also were no differences in the number of participants who sought extra medical care—such as office or emergency room visits—for asthma attacks.As might be expected, the group taking daily beclomethasone, an inhaled corticosteroid, used more of the medication per month than those in the symptom-based group. On average, children in the daily-use group used 1,961 micrograms per month, while the symptom-based group used 526 micrograms per month, cutting the amount of this medication by almost three-fourths. The reduced amount is desirable, according to the investigators, because steroids have side effects that include stunted growth. Many families are concerned about the cost of this medication as well as the growth-related side effects, and stop taking their steroid medicine altogether. So it s nice to show that less medication—used as needed—is just as effective, Sumino said. This as-needed steroid plus rescue albuterol strategy is now recommended in the Global Initiative for Asthma guidelines as one of the options for the treatment of mild asthma. Given the result of our study and others, primary care doctors may tell their patients with mild asthma that they have an alternative effective strategy other than taking the inhaled steroid every day, if they prefer not to do so. The researchers also noted that children and caregivers in the group taking medication as needed reported that they felt they were actively managing their asthma care rather than passively relying on doctors orders. The symptom-based strategy, in other words, gave them a sense of ownership over their asthma management, which is important in the long-term control of the disease, according to the Sumino and her colleagues.Dr. Katherine Bloom of Allergy Asthma Care comments: This study is consistent with recent GINA guidelines recommending as needed controller/reliever inhaler treatment for patients 12 and up with mild asthma. The recent guidelines recommended use of combination inhalers for symptom relief even in patients with more severe asthma on daily medications, and use of these combination inhalers alone as needed for mild asthma. This study extends the evidence to younger children, and supports this new approach that should reduce the amount of inhaled steroids taken without sacrificing asthma control. More information: Sumino K, Bacharier LB, Taylor J, Chadwick-Mansker K, Curtis V, Nash A, Jackson-Triggs S, Moen J, Schechtman KB, Garbutt J, Castro M. A pragmatic trial of symptom-based inhaled corticosteroid use in African American children with mild asthma. The Journal of Allergy and Clinical Immunology: In Practice. July 30, 2019.Journal information: Journal of Allergy and Clinical Immunology We are excited to welcome Sara I Dever, MD, to our practice. Dr. Dever is board certified in adult and pediatric allergy and immunology. She graduated with honors from the University of Notre Dame with a degree in psychology. She earned her Doctor of Medicine from the University of Connecticut and trained in Internal Medicine at the University of Connecticut Health Center. After completing her fellowship training in allergy and immunology at the University of Michigan, Dr. Dever published her research in food allergies. Following fellowship, Dr. Dever joined Advanced Specialty Care in Danbury CT where she worked for six years and was well regarded by patients and staff. After taking some time off to be with her young children, Dr. Dever was thrilled to join Allergy Asthma Care. She believes that clear and open communication are essential for optimal care of her adult and pediatric patients. Dr. Dever will work steadfastly with you to develop an action plan that encompasses all of your health needs while minimizing the use of medication through education and avoidance measures. When not busy chasing after her two young and beloved boys, Dr. Dever enjoys traveling, running with her husband, and reading about history. The 2019 update of the Global Initiative For Asthma (GINA) recommends a major change of approach in asthma. For the first time, it is now recommended that adult and adolescent patients with asthma never be prescribed a short acting bronchodilator alone. For decades, patients with intermittent asthma have been prescribed short acting bronchodilators (short acting beta agonists or SABA) alone for as-needed use, and patients with persistent asthma were prescribed SABA plus controller medications such as inhaled corticosteroids, leukotriene modifiers like Singulair, or combination inhaled corticosteroid - long-acting beta agonists (ICS-LABA).Due to the known dangers of overuse of short acting bronchodilators, and evidence that even mild asthma involves inflammation, and other research, the GINA guidelines now recommend that adult and adolescent patients with asthma be prescribed a low dose ICS-LABA to be used for symptom relief, and for asthma that is more than mild, use of this type of medication regularly plus either a SABA or ICS-LABA for quick relief.The only low dose ICS-LABA in the U.S. with a rapid enough acting LABA component to be included in this new paradigm is Symbicort 80, which contains formoterol, a quick acting and long-lasting bronchodilator. Dulera also contains formoterol, but the corticosteroid doses available are only medium and high dose, without a low dose option. Other ICS-LABAs, such as Advair and Breo, which are excellent medications, contain a LABA that has a slower onset-of-action, making it inappropriate for reliever therapy.Therefore, this new GINA strategy, if applied in the United States, would lead to most asthma patients over age 12 being prescribed Symbicort 80, 2 puffs as needed for symptom relief, plus either use of this regularly for asthma control, or other additional asthma medications.This represents a dramatic paradigm shift in asthma care. A recent New England Journal of Medicine article, published May 23, 2019, provided further support for this new approach. This article, titled A controlled trial of budesonide-formoterol as needed for mild asthma, found that use of this medication combination as needed was superior to albuterol for the prevention of asthma exacerbations, a primary goal of asthma care. References: Global Initiative for Asthma 2019; New England Journal of Medicine 380:21, May 23, 2019Dr. Kenneth Backman of Allergy and Asthma Care of Fairfield County comments: This represents a dramatic shift in management of asthma, one that is supported by decades of research, and will likely lead to improved asthma control, while at the same tim reducing the need for higher doses of inhaled and oral corticosteroids. Over the coming months and years, it is likely that fewer patients will carry albuterol inhalers, and more will carry ICS-LABA inhalers such as Symbicort, for relief of their asthma symptoms. Oral immunotherapy, a treatment for peanut allergies that involves giving children small, oral doses of the allergen, appears to desensitize them to peanuts, according to a meta-analysis of 12 clinical trials published on April 25 in The Lancet. But the intervention was also linked to a two- to threefold higher risk of participants experiencing the severe allergic reaction known as anaphylaxis, compared to those taking a placebo or avoiding peanuts.“In our study we found that this increase occurred for all preparations of OIT [oral immunotherapy] used and for all protocols,” coauthor Derek Chu of McMaster University in Hamilton, Ontario, reports. “The bottom line is that this therapy is still experimental, and physicians and patients need to understand that.”Chu and his colleagues gathered data from more than 1,000 kids who participated in the randomized controlled clinical trials. They found that the oral immunotherapy led to a greater tolerance of peanuts in challenge tests, but also to a much higher number of serious adverse reactions compared with children who didn’t get the intervention. Of note, there was no difference in the quality of life between the two groups. Alkis Togias, the branch chief of allergy, asthma, and airway biology at the US National Institute of Allergy and Infectious Diseases, tells CNN the data show the intervention is at an early stage. “From our perspective as an agency that is responsible for research in the field, what it tells us is that we need to improve on the methods for treating food allergy, especially peanut allergy.”Chu tells CBC News that oral immunotherapy for peanut allergy is still worth pursuing. “We’re not outright saying that . . . this should be denounced or that this should be abandoned. Far from it,” Chu says. “From a research standpoint this is a major advance. We’re almost there.”Dr. Kenneth Backman of Allergy and Asthma Care of Fairfield County comments: Studies of oral immunotherapy (desensitization) for peanut and other food allergies are ongoing. This study emphasizes that there is still much to learn. While the number of accidental reactions may be reduced by treatment, patients undergoing desensitization will have significantly more reactions than patients who choose avoidance alone. OIT is a potentially exciting advance in food allergy treatment, but the risks and benefits still have to be fully worked out for this experimental treatment. Scientists could be a step closer to providing more precise pollen forecasts to the 20-30% of the population who live with either asthma or hay fever. This follows the first results of a major three-year project to analyze airborne grass pollen. The first year s findings, published in Nature Ecology Evolution, have shown that it is not just the overall load of grass pollen in the air that could cause those particularly bad days for asthma and hay fever sufferers. Days which see increased asthma attacks or intense hay fever could be related to the release of pollen from particular grass species.Current pollen counts and forecasts assess the whole load of pollen in the air, and, while scientists can distinguish between the pollen created by individual tree and weed species, it has proven virtually impossible for the current forecast methods to visually identify different grass pollens.Step forward metabarcoding, a technique which enables scientists to automatically identify any fragments of material caught in a sample of air, water or soil, by recognising and matching its unique DNA barcode . For the first time, grass pollens collected over the course of one allergy season have been analysed using this high-tech method. This has enabled the team to start investigating links between certain pollen types and those days on which plant allergy sufferers and people with asthma are most affected.Prof Simon Creer, of Bangor University, who is leading the research explains: I m a hay fever sufferer myself, and I know that on some days, despite a high pollen forecast, I can be less affected than on other days when the forecast appears to be lower. This led me and others to wonder whether it s the high load of pollen alone that causes the problem, or whether the different grass pollens cause different levels of reaction. Dr Georgina Brennan, from Bangor University who analysed the aerial pollen environmental DNA with Dr Caitlin Potter from the University of Aberystwyth and the National Botanic Garden Wales, added: Bringing a range of specialists together has enabled us to find initial answers. Our task is now to develop a clearer picture of where the pollen comes from, how it moves through the air and how different types of pollen can be linked to allergies. Dr Ben Wheeler of University of Exeter said: We are now investigating datasets on hospital admissions and GP prescriptions for certain pharmaceutical products to identify correlations between healthcare data and increases in particular grass pollens. With these new insights into pollen characterization, we are focusing on future implications for pollen warnings and self-care strategies. Dr Rachel McInnes from the UK Met Office added: Leading on from this new environment DNA research, we are currently developing maps of where these species of allergenic grasses are located in the UK. When combined with aerial modelling approaches being developed with Prof. Carsten Skjøth at the University of Worcester, the approaches could be used to improve our pollen forecast in the future. Dr. Kenneth Backman of Allergy Asthma Care of Fairfield County comments: This interesting study helps explain why some patients are miserable on some high grass pollen days, when others seem barely affected, even when we know they are both allergic to grass pollen. More specific pollen counts may be in our future.

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