January 29th, 2009
I’m surprised by the number of people, including physicians, who don’t realize how treatable bee sting allergy is. Bee venom desensitization is perhaps the best studied and most effective of all forms of allergy desensitization. Since allergic reactions to bee venom can be life threatening, its one of the most important things an allergist can do.
It is important to distinguish between toxic and allergic reactions to bee venom. Toxic reactions are a direct result of the venom and allergic reactions are, obviously, an allergy to the venom. Reactions that are contiguous to the site of envenomation are generally toxic, while reactions that are distant to the site of envenomation are generally allergic. In English: Stung on the toe and leg swells up= toxic; Stung on the toe and lip swells up= allergic. Toxic reactions can be severe and still not be allergic.
So, how well does venom desensitization work? The numbers were worked out at Johns Hopkins in the 1970’s. They took people with documented bee sting allergy and performed sting challenges by having them place their hands in a box full of bees! (Where do I sign up!) They found that people with bee sting allergy had about a 1 in 3 chance of having a full blown allergic reaction with each subsequent sting. Once these people had been desensitized, the chance fell to about 1 in 30!
If you or someone you know has had a reaction to a bee sting, seeing an allergist can, quite literally, be life saving.
January 22nd, 2009
Most wheezing in young children is due to viral infection of the airways, often termed bronchiolitis. A common cause would be Respiratory Syncitial Virus which you may have heard of as RSV. Essentially all wheezing below the age of 3 and most wheezing between the ages of 3 and 6 falls into this category. The wheezing produced by these infections results from damage and swelling of the airways as a direct result of the viral infection. Traditionally, kids with bad wheezing from such infections have been given steroids to try and reduce the swelling and inflammation.
This week’s New England Journal of Medicine has two interesting studies examining this practice. In the first kids with viral induced wheezing who were sick enough to be hospitalized were randomly given either prednisone or placebo. As it turns out there was no difference in the length of hospital stay or any other outcome between the two groups. In the second study, kids between the ages of 1 and 6 who had strictly viral induced wheezing were given inhaled steroids at the start of an upper respiratory infection to try and prevent wheezing. In this study, inhaled steroids were no better than placebo at preventing viral induced wheezing.
These studies will likely lead to a significant change in the treatment of viral induced wheezing. I would like to stress that these studies do not examine the effects of steroids on asthma or viral induced asthma exacerbations.
January 15th, 2009
A while back, the FDA decided to look into the issue of mood disturbance and drugs like Singulair. Through an extensive review of over 20000 patients, the data show no increase in depression or suicide in patients treated with Singulair. They are still reviewing the data to see if there is a link between Singulair and behavioral issues in kids. My sense is that this will be ok as well, but we’ll await the findings of their review. For now, If you’re on Singulair for control of asthma or allergies, you should feel safe to continue these medications
January 15th, 2009
Loss of the sense of smell, a problem called anosmia (an-OWES-me-uh), is a common complaint seen by allergists. Smell actually makes up a significant portion of the sense of taste as well, so anosmia not only affects the ability to enjoy smells like coffee, but also significantly lessens one’s ability to enjoy food. Ugh.
In the image above, the olfactory nerve is the yellow structure at the roof of the nasal cavity. The olfactory nerve is responsible for the sense of smell. Anosmia can occur if the olfactory nerve is blocked by swelling from allergies or by nasal polyps. This usually results in gradual, partial loss of smell. Both of these causes can be treated and the ability to smell restored. Total, sudden loss of smell, especially when accompanied by an upper respiratory infection, suggests viral damage to the olfactory nerve. This may be irreversible.
If you have trouble smelling, an allergist can help you determine the cause and may be able to restore your ability to smell
Dr. O
