February 26th, 2009
Today’s installment will look at the BAX-3000 which promises to diagnose and treat allergies and a variety of other conditions.
To quote from the manufacturer’s website, “The BAX-3000 works by exposing the patient to a potential allergy in the form of a digitized allergen.” I have no earthly idea what they mean by a digitized allergen. Maybe it would make my computer sneeze.
They go on, “This digitized allergen actually matches the harmonic frequency of the actual allergen; the body will believe it is in contact with the real thing and will react if it is allergic to this substance.” This certainly sounds scientific, but makes no sense at all. Harmonic frequencies are sound waves. Allergens are molecules. The immune system does not respond to sound waves.
The device’s FDA approval says nothing about allergy, however, “The BAX-3000 has FDA clearance as a neurological relaxation device. Simply put, the BAX-3000 allows for the re-education of the nervous system via positive conditioning, or relaxation, as defined by the FDA.” Its classified as a biofeedback device, but not as a potential treatment for allergies.
The problem is that the company doesn’t say, “We’re using biofeedback to treat your perception of allergy symptoms.” Instead, they say “We’re using digitized allergens and lasers to change the way your immune system responds to allergies.”, and that is dishonest.
Dr. O
February 26th, 2009
Spring is almost here. The pollen will soon be in the air. People will begin sneezing and buying kleenex in bulk to deal with their runny noses. One area we evaluate and treat that is not seasonal is food allergy. Most people think of children when they think of food allergies. Looking at the numbers they would be correct. Between 6 and 8 percent of children in the U.S. suffer from food allergies compared to between 3 and 4 percent of the adult population. Fortunately for children, many food allergies can be outgrown. Peanut allergy in children is the most prevalent allergy that is not outgrown. This is often not the case with adults.
I saw a gentleman yesterday in his early 50s. He waited to make his appointment because he thought that only children had food allergyes. He wanted to be evaluated because he thought he might be allergic to shrimp. He had shrimp 2 weeks ago and within an hour he was covered in hives. He was evaluated in the local emergency room and discharged without difficulty. When I tested him yesterday in the office for shellfish allergy, he was grossly positive to shrimp, lobster, and crab.
There are a few points that I want to highlight in regards to this patient. When I asked him if he had ever had difficulty with shrimp or other fish/shellfish previously, he was not sure. He did recall that whenever he helped his wife clean shrimp, his hands would itch. They did not eat shellfish often so this was not a common occurrence. Do I think this man in his 50s just developed an allergy to shellfish at this point in time. No. I think that he has had an allergy to shrimp for years. That is based on the itching that he had when he came in contact with the shrimp. He did not consume shellfish often so whatever symptoms may have been present were likely forgotten over time. This man is fortunate. The most prevalent food allergy which results in death in adults is shellfish. Just because you have an upset stomach or hives with the first reaction does not mean that the next time you will not have a life-threatening condition called anaphylaxis.
He was evaluated and treated at the local emergency room. The great omission in this case is that he was discharged from the emergency room without a prescription for injectable epinephrine. Epinephrine is the one treatment that significantly decreases the risk of death associated with severe allergic reactions. Many people also use this for stinging insect allergies. Emergency rooms failing to do this is not an uncommon problem and has been reviewed in many articles in the medical literature. As mentioned previously, just because you have hives with one reaction does not mean you will not have a fatal reaction the next time.
The patient was evaluated in my office yesterday and he was diagnosed with shellfish allergy. I instructed him to avoid all shellfish since avoidance is the only definitive treatment for food allergy. However, in case of an accidental exposure, he was prescribed injectable epinephrine. We discussed when you would use this medication as well as demonstrated to the patient how to administer the medication.
If you have noticed problems after eating certain foods such as hives, upset stomach or abdominal pain, rash, swelling, itching, difficulty breathing, or a feeling of lightheadedness, you may have a food allergy. The diagnosis is simple and the treatment may save your life. Don’t think that because you are an adult that you may not have food allergies.
February 25th, 2009
One of the things that gets my dander up as a allergist is to see the repackaging of older medications which are then marketed as new and improved. Companies try this tactic to gain new patents and extend the profitability of medications. I’ve got nothing against companies making money and I’m fully aware that crass profit motives have driven some great discoveries in medicine. These examples, however, are not great discoveries.
If you haven’t had much chemistry, a bit of background is helpful here. Drug molecules often exist as stereoisomers. This means that they have two different molecular structures which are mirror images of each other, just like your right and left hand. In the body, only one of these molecules will bind to the target receptor and be active. Imagine you just had one right handed glove. Your right hand would fit easily, but your left hand would fit awkwardly or not at all.
Most drugs on the market exist as this mixture of right- and left-handed forms. Now, companies have figured out how to isolate the active form. This allows them to market the molecule as a brand new drug. In reality, people had been taking the drug all along, There’s generally nothing new or exciting about these single-isomer drugs except their branding campaigns. Examples of this practice include, Clarinex(Claritin), Xyzal(Zyrtec), Xopenex(albuterol), and Nexium(Prilosec). Note that all of these medications except albuterol are available OTC for significantly less than their prescription counterparts.
Other tactics include changing the delivery vehicle in a nasal spray (Astelin to Astepro) or gaining a new indication, say for once-daily dosing(Patanol to Pataday).
Generally, these new drugs are significantly more expensive than their older counterparts and their pharmacy co-pays are much higher. To counteract this, the pharmaceutical companies often offer coupons for rebates and try to enlist us physicians in passing them out. This tactic, in particular, irks me. When doctors prescribe more expensive medications, we all pay indirectly.
Part of the job of being a physician is being a responsible steward of the medical dollar. Because of this, I’m often quite blunt with my reps that if their drug offers no significant clinical benefit over older, cheaper medications, then I am very unlikely to prescribe it.
Dr. O
February 20th, 2009
Hives can be a maddening problem. At their mildest, they can simply be bothersome and at their worst can be dangerous. Trying to uncover the cause of hives is a difficult and often fruitless task.
It is helpful to break hives down into acute and chronic hives. Acute hives occur once and go away whereas chronic hives linger. Allergists see far fewer cases of acute hives, because the cause is often obvious: I went to Red Lobster and had the shrimp platter. My lip swelled immediately then it went away. Confirmatory testing is sometimes helpful, but most people simply avoid the obvious offenders.
Chronic hives often lack this sort of obvious history and, ironically, are much less likely to be allergic. Having seen thousands of cases of chronic hives over the last decade, I have learned a few things here and there. First, its not your soap/shampoo/detergent that’s causing hives. These things cause contact dermatitis, but very rarely result in hives. Second, the more foods you think may be causing hives, the less likely it is that you have a food allergy. Having more than 2 food allergies as an adult is vanishingly rare. Allergic reactions to foods most often occur within 15-30 minutes after ingestion and almost always within 2 hours, so if you’re waking up in the middle of the night, then its probably not a food allergy. Third, watch your supplements! I’ve seen numerous cases where discontinuing certain supplements/natural remedies has brought about an immediate end to hives. Finally, don’t suffer needlessly. If simple antihistamines-I like cetirizine- aren’t working, your allergist has ample experience with multiple other medications to help control symptoms. Allergists are also well versed in the myriad other rare causes for hives and can direct an appropriate work-up.
