News & Resources

Midwest Allergy Sinus Asthma, SC

Sakes Alive! I’ve got Hives!

by Dana Dalbak, PA-C, Midwest Allergy Sinus Asthma

About 20% of individuals will experience hives at some point.  For some, a few transient, itchy spots are a nuisance.  For others, persistent lesions with severe, body-wide itching that prevents sleep becomes extremely miserable.  These patients are often so bothered by the unrelenting itch and their efforts to subdue it, that they describe the discomfort as “controlling my life”.

What is going on with my skin??

Hives, also known as uticeria, is an inflammation of the skin.  Most types of hives occur when the immune system releases histamine.  Histamine causes small blood vessels to leak, leading to a raised swelling of the skin, known as a wheal or a welt.  Wheals can vary in size and may be round or irregular in shape.  The skin around the wheal is pink due to the inflammation, and the histamine triggers itching.  Swelling may also occur in the deeper layers of the skin; this is called angioedema.

Hives can appear anywhere on the body, and move from place to place.  A hive typically will not remain in the same location longer than 24 hours before resolving, often to appear somewhere else.  They leave no residual marks on the skin after resolving.  Angioedema may appear as swelling around the eyes, or swelling of the lips, hands, or feet.

Hives usually worsen with scratching, and always blanch (turn from pink to white) with pressure.  Wheals that don’t blanch, leave a residual mark, or stay in one spot more than 24 hours are indications of other underlying conditions.

Hives can occur at any age, but are most common in young adults.  Acute hives last anywhere from minutes to a few weeks before disappearing.  Chronic hives will last more months or longer.

How did I get this??

There are many causes of uticeria.  Allergy is the most well-known trigger for hives, and includes reactions to foods, medications, insect stings, airborne allergens, or contact allergens.  Physical urticaria is another class of urticaria, which is triggered by stimulus such as pressure, vibration, cold, heat, exercise, or sun exposure.  Uticeria can also be a manifestation of a separate disease process, such as infection, autoimmune disease, thyroid disease, or cancer.

For some patients with chronic urticaria, no specific trigger is identified.  Approximately 30% of these patients are found to have an antibody that can attach to cells holding histamine and cause these cells to release histamine when they otherwise would not.  This condition can be confirmed by a skin test in an allergist’s office.

Hives can also occur as one symptom of a more serious allergic reaction called anaphylaxis.  If hives occur along with breathing difficulty, stomach upset, lightheadedness, or swelling of the tongue or throat, quick emergency treatment is necessary.

How do I get rid of this??

When a specific trigger is identified, avoidance of the offending trigger, or treatment of the underlying medical condition, is the best way to stop outbreaks of hives.  For patients suffering chronic urticaria without a trigger, medications are effective.  An allergist may use a combination of two or three antihistamines to resolve the hives.

Breakthrough flares of urticaria may be treated with temporary use of an oral steroid or prednisone.  Hives that are stubbornly persistent can be treated with immune-modulating medications.  After a patient has been free of symptoms for a few months, medications are tapered.  An allergist can guide this therapy for the patient.

An allergist is a physician with additional training in the area of allergy, asthma, and immunology.  When evaluating a patient with urticaria, an allergist will take a detailed medical history and examine the patient for possible causes.  In some cases, appropriate testing may include skin tests, blood tests, and urine tests.

An allergist helps patients with hives by identifying specific triggers, ruling out underlying conditions, and prescribing treatment to relieve the hives.  A refusal to see an allergist is not necessary unless required by insurance.  relief from hives is quite possible with the right therapy regimen tailored to the patient!

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

Could it be Asthma?

By Dana Dalbak, PA-C

Sudden shortness-of-breath, wheezing, reaching for an emergency inhaler!… Is this the picture you have of asthma?  This asthma stereotype is one possible presentation of asthma.  However, many individuals with asthma can have mild, insidious symptoms that escape accurate diagnosis.  Diagnosis can also be cofounded by late presentation of symptoms.  Although asthma often appears in early childhood, some individuals will not show symptoms until adulthood.

The stereotypical wheeze is just the beginning of possible symptoms for asthma.  Other symptoms include:

    • Intermittent cough
    • more difficulty breathing when outside in cold weather
    • wheeze when laughing
    • increased difficulty taking a deep breath
    • chest tightness with exposure to allergic or irritant triggers
    • cough with exercise
    • slow recovery of normal breathing rate after exercise
    • chest tightness with exertion, such as stairs
    • early morning cough, wheeze, or chest tightness

Symptoms in young children may include, but are not limited to:

    • Choosing to quit playing a sport, or giving up physical, recreational activities with their friends
    • low stamina
    • waking at night with cough or tightness
    • frequent treatment for respiratory illness

So, how does one know if any of these symptoms are asthma?  After all, symptoms that are present in asthma can also be present in other medical problems.  Thus, the correct diagnosis may not be immediately apparent.

The best way to pinpoint an accurate diagnosis of asthma is through assessment by an allergist.  An allergist is a physician with expertise in the area of asthma, allergy, and immunology.  A visit to an allergist for respiratory symptoms will include a review of the medical history and symptoms, lung function testing, possible allergy testing, and x-ray imaging if appropriate.  The allergist will also consider other possible causes for respiratory symptoms.

Medical problems that cause asthma-like symptoms include:

    • sinusitis (can cause chronic cough)
    • lung infection
    • chronic obstructive pulmonary disease
    • heart conditions (may cause cough or shortness-of-breath)
    • gastroesophageal reflux (GERD) (often causes cough)
    • vocal cord dysfunction (a spasm of the vocal cords that causes wheeze and difficulty breathing)
    • blood clot in the lung
    • aspiration or inhalation of foreign body

So what really is asthma?  Asthma is a condition in which the airways become narrowed, usually temporarily.  Inflammation of the airway is the hallmark of asthma.  Inflammation not only narrows the airway, but causes the airway to be more sensitive to triggers that would not bother other people.

Triggers may be allergic or non-allergic.  Allergic triggers include pollen, dust mite, and pet dander.  Non-allergic triggers include exercise, cold or dry air, illnesses, smoke, chemical odors, anxiety, and stress.  These triggers further cause bronchospasm (tightening of the airways when the muscles around the airways contract).

Medical care has made great strides in the treatment of asthma.  There are many treatments available that are both very effective and well-tolerated.  Inhaled and oral medications are available which control inflammation, prevent bronchospasm, and treat acute episodes.  Effective treatment can preserve lung function over the long term.  Therefore, detection of asthma in patients that don’t fit they typical stereotype is a worthwhile endeavor!

Next article: Sakes Alive! I’ve got Hives!

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

Allergy Shots: Could They Help Your Allergies?

Dana Dalbak, PA-C

What are allergy shots?

Allergy shots, also called allergen immunotherapy, is a form of long-term therapy to relieve allergy symptoms.  Allergy shots contain tiny amounts of the specific substances that trigger your symptoms.  These are called allergens.  The shots contain just enough allergen to stimulate the immune system.  Over time, the dose of allergen in the shot is increased.  This enables your body to become used to the allergen (desensitization).  Your immune system can the build up a tolerance to the allergen, resulting in decreased allergy symptoms.

Who can benefit from allergy shots?

Allergy shots are effective in treatment of allergic rhinitis (hayfever), allergic conjunctivitis (eye allergies), allergic asthma (asthma triggered by allergies), and stinging insect allergies.  In children, allergy shots can prevent the progression of allergic disease from hayfever to asthma.  Individuals with frequent sinus infection triggered by allergens show improvement with allergy shots.  Immunotherapy is also effective for some individuals with atopic dermatitis (eczema).

An allergist (a doctor that treats allergies) can determine which patients are most likely to benefit from allergy shots, by evaluating a patient’s symptoms and doing allergy skin testing in the office.  This test will determine the specific type of allergies the patient has.

Who should start allergy shots?

A decision to start allergy shots may be based on several factors:

  • Severity of symptoms
  • Inadequate control of symptoms with medication
  • A desire to avoid or decrease education
  • Length of allergy season
  • Concurrent medical conditions

What allergens are treated with allergy shots?

Common allergens addressed with shots include pollen (tree, weed, grass, and farm pollens), mold, dust mite and pet dander.  Food allergy is not treated with shots.  The best choice for an individual with food allergy is so strictly avoid contact with the offending food.

How often do I get allergy shots?

During the build-up phase, allergy shots are typically given two to three times weekly.  The amount of allergens is gradually increased, allowing the body to become desensitized to the allergen.  The build-up phase usually lasts at lease six months, depending on how often the patient comes for shots.

The patient begins the maintenance phase.  During this phase, shots are gradually spaced out until the patient reaches an interval of just one shot per month.  Once this maintenance interval is reached, shots are usually continued for three to five years.  SOme patients will notice improvement during the build-up phase, others may need to be on immunotherapy for a full year before noticeable symptoms improve. 

Where are shots administered?

Immunotherapy is usually administered in the allergists office.  Every state has their own laws, but in Illinois, they must be administered in a licensed, medical office.  However, for patients whom distance or schedule is a problem, the shot serum may be sent to a physicians’s office closer to the patient, to be administered there. This physician should have the necessary supplies to treat a reaction to a shot in the unlikely event this occurs.

Are there risks?

A typical reaction to a shot includes a slight itch, redness and swelling at the site of the injection.  More serious reactions to shots, include anaphylaxis, are rare, but can occur.  For this reason, patients must wain the the physician’s office for thirty minutes after each injection.  Patients are also instructed in self-treatment of reactions should this occur after leaving the office.

How do I know if shots are right for me?

A visit to an allergists for evaluation of your symptoms are possible skin testing can determine if you are likely to benefit from immunotherapy.  A referral from your primary physician is not necessary unless it is required by your insurance.

Next article: Could It Be Asthma?

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

The Itch that Rashes!

By Dana Dalbak, PA-C

Atopic dermatitis, commonly called eczema, is ruefully known as the “itch that rashes”.  Patients with this skin condition suffer with itchy, inflamed skin.  The itching, which can be intense and miserable, often develops first.  Though scratching momentarily relieves the itch, it also causes the development of inflammation or rash.  The ensuing “itch-scratch-rash” cycle only worsens the dryness, itchiness, and appearance of the skin.

Healthy skin acts as a barrier to keep unwanted substances (such as allergens, irritants, and toxins) out of the body, and keep good things in the body (such as moisture).  When this barrier is not working properly, substances penetrate the skin and trigger an immune response.  Breakdown in the skin barrier also leads to moisture loss from the skin.  The end result is dry, itchy, inflamed areas of skin.  Recent studies point to a defect in a skin barrier protein called filaggrin as a factor in disease development in some patients.

Atopic dermatitis usually begins in childhood, often infancy, and is more common in individuals who have hay fever or asthma, or have family members who do.  The condition falls into a category of disease called “atopic”, which also includes food allergy, hay fever, and asthma.  These diseases may develop one after another over a period of years.  This is known as the “atopic march”.  Recognizing this progression can be helpful by leading to earlier diagnosis and treatment.  Atopic dermatitis is a condition commonly seen and treated by an allergist in their practice.

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Genetics play a role in the development of atopic diseases, although the exact way they pass from parent to child is not yet known.  This means that a person is more likely to have atopic dermatitis, allergies, or asthma if other family members have ever had these diseases.  If one parent has atopic disease, the likelihood is approximately 50% that a child will develop one or more atopic diseases.

Although eczema can affect any area of the skin, the location and appearance of rash often vary with age.  In early infancy, eczema is most prominent on the face and head with a red, weepy rash.  After six months of age, the outside of the elbows and knees may worsen, along with other areas than can be easily reached for scratching.

In older children and adults, the creases of elbows, knees, wrists, and ankles are more common, as well as around the eyes, and the rash will likely have a dry appearance.  A variety of presentations are possible, however, including scaling, bumps, thickening, redness, and cracking.  SOme individuals suffer with specific hand eczema. 

In more severe cases, atopic dermatitis can be body-wide and cause crusting.  Secondary skin infection may develop, requiring the use of antibiotics to half the cycle.  Although patients with atopic dermatitis often have higher levels of staph bacteria on the skin, the condition is not contagious.

Atopic dermatitis can improve with age.  However, the disease tends to be episodic, waxing and waning.  Specific triggers for exacerbations vary from person to person, but include dry winter air, stress, heat and sweat in the summer, exposure to food allergens, airborne allergens, or contact allergens, and cold viruses or other infections.

An important part of managing atopic dermatitis, and the relentless itch-rash cycle, is proactive skin care to keep the skin barrier intact.  Dry skin is brittle; moist skin is flexible.  Lubrication is of primary importance.  Moisturizers and barrier ointments work best when applied to damp skin, such as immediately after bathing.  Excessive scrubbing and toweling should be avoided.  Lotions containing alcohol must be avoided, as they are drying.

A combinations of prescription medications, over-the-counter medications, and topical therapies are used in the treatment of atopic dermatitis.  Specific allergens may be triggering exacerbations.  These allergens can be identified by an allergist.  An allergist can also identify skin care appropriate for your specific situation.  Although other medical specialities, such as dermatology, also see eczema patients, an allergist is able to test for possible allergen triggers.  A referral is not needed to see an allergist unless required by insurance.  With regular care, the itch that rashes can become the itch that vanishes!

Further information and resources can be found at your local allergist’s office, The American Academy of Allergy, Asthma, and Immunology (www.aaaai.org), or The National Eczema Association (www.nationaleczema.org).

Check out SWIA studies on eczema and atopic dermatitis; we may have the solution you have been waiting for.

Next article: Allergy Shots: Could They Help Your Allergies?

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

Back to School with Asthma and Food Allergy

Dana Dalbakasthma-dairy-allergy-29542

For children with allergies or asthma, heading back to school requires additional preparation to ensure health in the classroom.  Asthma is the number one health program causing chronic absence from school.  Food allergy can also trigger potential problems anywhere from the bus stop to the classroom.  Cooperation between the family, physician, and school is essential to ensure the student’s health in the classroom.  The following strategies will help prevent asthma and food allergy problems in the school environment.

  1. Develop an Asthma Action Plan or Food Allergy Action Plan

Visit your allergist to develop a written step-by-step action plan for your child in the event of symptoms.  An allergist is a physician specializing in care of asthma, allergy, and immunology.  This plan can be given to schools, coaches, babysitters, etc.

  1.   Know tour school’s policies.

Visit with educators and the school nurse.  Discuss with staff how emergency situations will be handled.  Ensure that staff are trained to recognize the signs of asthma or food allergy.  Staff should also be trained in the administration of emergency medication.  This includes coaches, lunch aids, teacher’s aids, etc.

  1.   Know your rights.

All fifty states have laws protecting students’ rights to carry and use their asthma inhalers while at school.  All states except New York also protect student’s right to carry and administer their anaphylaxis medications.  Anaphylaxis is a severe, life-threatening allergic reaction.  Each state law is different.  Many states, including Illinois, require written authorization from a parent or guardian and a physician, as well as the prescription label and information about use.

Make sure your child’s paperwork is up-to-date, allowing them to use their medication at school.  Detailed information on the requirements of each state’s law can be found at www.breatheatschool.org

  1.   Make sure your school has an adequate plan for preventing and treating food allergy.

Do you wonder if your school could be doing more to address food allergy?  Detailed guidelines specific to Illinois schools and school events can be found at www.foodallergy.org/page/statewide-guidelines-for-schools

  1.   Write expiration dates of emergency medications on a calendar and obtain refills when needed
  1.   Ensure regular use of preventative medications.

For many children, daily medication is essential to controlling asthma.  Be vigilant about ensuring your child is using his or her medication as prescribed, including correct inhaler technique.

Don’t let cost of medications be the reason your child’s asthma is not controlled.  There are many prescription assistance services available to provide no-cost or low-cost medication to families that qualify.  Visit your allergist for help in connecting with these resources.

  1.   Vaccinate against seasonal flu.

The Center for Disease Control recommends everyone over the age of six months receive a flu vaccine.  This is especially important for individuals with asthma.

  1.   Schedule a back-to-back checkup.

Visit your allergist to be sure your child’s symptoms are under control, correct medications are prescribed, and the appropriate action plan is in place.

The Food Allergy and Anaphylaxis Network also provides valuable resources for students, schools, families, and friends of children with food allergy.  Check out their back-to-school tool kit for all grade levels at www.foodallergy.org

With some care and planning, you can ensure your child has an optimal school experience!

Next article: The Itch that Rashes!

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

Ragweed Pollen: Coming Soon to a Place Near You!

By Dana Dalbak, PA-C, Midwest Allergy Sinus Asthma, SC

During the Fall months, ragweed pollen assumes center stage as the primary foe for hay fever sufferers.  Hay fever, also known as allergic rhinitis, is triggered by airborne allergens such as pollen.  Symptoms include runny nose, congestion, sneezing, ant watery/itchy eyes.  Approximately 10-20% of Americans are sensitized to ragweed pollen as an allergy trigger.

Ragweed pollen makes its debut in early August and maintains its presence through October, or until the first hard frost.  The life span of pollen may be less than two hours, but its ability to produce an allergic reaction continues indefinitely.  Avoiding this star of the Fall allergy scene is the way to keep your nose in shape.  Escaping ragweed pollen, however, can be a tall order.

Ragweed species make an appearance in every state except Alaska. The culprit is found along roadsides and in fields.  The weed is even prevalent in urban areas, frequently growing in vacant lots.  One ragweed plant produced one billion pollen grains, and each grain can travel up to 400 miles!

Fortunately, our audience if allergy sufferers is not without resources to deal with airborne allergens.  The first step is identifying what you are allergic to. This can be done with a simple skin test in the allergist’s office.

After specific allergies are identified, monitoring pollen counts enables a patient to employ extra measures during times when counts are high.  The National Allergy Bureau (NAB) provides the most accurate pollen and mold levels from more than 8- counting stations.  They also offer free email alerts.

Pollen counts are different than pollen forecasts.  Forecasts are a prediction bases on previous years and weather.  Counts are a measurement taken by an instrument over a 24hr period, and are reported for specific plants such as weeds, trees, grasses, and mold spores.  You can visit the NAB at http://www.aaaai.org/global/nab-pollen-counts.aspx.

The American Academy of Allergy, Asthma, and Immunology offers the following tips to minimize symptoms when counts are high:

*Keep window closed and use air conditioning.

*Avoid being outdoors when pollen counts are high.  Peak pollen times are usually between 10am and 4pm.  Counts are lower on windless, cloudy days and after a heavy rain.

*Keep car windows closed when traveling.

*Take a shower after spending time outdoors, as pollen can collect on hair, skin, and clothing.

*Don’t hang laundry outdoors to dry.

When avoidance strategies aren’t sufficient to bring down the curtain on bothersome symptoms, medication is available.  Choice of medication depends on which symptoms are most troublesome to the patient.  Non-sedating antihistamines and saline nasal rinse can be found over-the-counter.  Other medications are available with prescription.  Medications currently available are both very effective and very well-tolerated.

For patients who prefer not to take a daily medication or who continue to have bothersome symptoms, immunotherapy is the ticker.  This treatment is commonly known as allergy shots.  This long-term therapy can significantly reduce the severity of allergic response to allergens, such as ragweed.

An allergist can guide you through the process of determining your specific allergies, which avoidance measures are most helpful, and appropriate treatment options.  Keep in mind that hay fever medications work best if started before the allergy season hits.

So, don’t let ragweed steal the show this Fall.  Keep these tips and options in mind, and your season can be a class act!

Next article: Back to School with Asthma and Food Allergy

Midwest Allergy Sinus Asthma specializes in the treatment of immune-related disorders.  In addition to immunodeficiency, focus is given to the treatment of asthma, allergic rhinitis, hives, food, hypersensitivity, insect sting allergy, and anaphylaxis.  The center has also been a leader in clinical research for over 20 years.  If you suffer from allergies, asthma, COPD, or psoriasis you may qualify to participate in a clinical trial.  You may contact them at (309) 452-0995 or www.asthma2.com.  Their office is located at 2010 Jacobssen Dr. in Normal.

Advanced Evaluation and Treatment of:

Allergy
Allergy desensitization (Allergy shots)
Allergic rhinitis
Allergic conjunctivitis
Alpha-one Anti-trypsin deficiency
Anaphylaxis
Asthma
Atopic Dermatitis / Eczema
Chronic sinusitis
Chronic cough
Chronic Obstructive Lung Disease (COPD) / Emphysema
Contact Dermatitis
Eosinophilic Esophagitis
Food Allergy / Intolerance
Hives (Urticaria) and Swelling (Angioedema)
Immunodeficiency Hypogammaglobulinemia
Medication (Antibiotics, aspirin, etc.) allergy
Other respiratory diseases
Other skin conditions (Psoriasis)
Pollen, Mold, Dust Mite and Pet allergy
Recurrent infection
Sports and Work Related Asthma
Severe or steroid-dependent asthma
Sinusitis
Vocal Cord Dysfunction Syndrome

Blooming - Normal Pollen Count