Can Allergy Shots Help? Is Your Asthma Well Controlled?

Whats The Rush?

Don't Let Your Allergies Bloom This Spring

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Meet Our Doctors

Vicki J. Lyons, MD, PC
Dr. Lyons completed her residency in Internal Medicine at Dartmouth Hitchcock Medical Center in Hanover, New Hampshire and her Allergy and Immunology Fellowship at the University of Texas Southwestern Medical Center in Dallas, Texas. She is board-certified by the American Board of Medical Specialties in Allergy and Immunology as well as Internal Medicine. She has been practicing in Ogden, Utah for more than 18 years and currently is Section Leader of the Department of Allergy and Immunology at McKay Dee Hospital. Dr. Lyons has always been driven to succeed. In college she received the prestigious Presidential Merit Scholarship and in medical school she was selected for a National Institute of Health (NIH) Study Research Fellowship. While at the NIH, she participated in laboratory research aimed at understanding the basisDr. Lyons has always been driven to succeed. for Parkinson's disease and age related thermoregulatory decline. She has been a principal investigator for more than 130 FDA research studies covering a broad range of medications and specific illnesses. She was placed in Cambridge Who's Who in 2009. In 2012,she was named one of the top Allergy and Immunology Specialists in her region by The Leading Physicians of the World. Dr. Lyons is President of the Utah Chapter of the American Lung Association and is past president of the Utah Society of Allergy and Asthma. She is editor and cofounder of What Doctors Know an international digital publication available through the Barnes and Noble newsstand. She has authored comprehensive, informative articles on asthma, seasonal allergy, drug allergy, gastrointestinal allergy and allergy immunotherapy (allergy shots).

Timothy J Sullivan, M.D.

Dr. Timothy J. Sullivan has joined the staff of Western Medical Associates, a leading Allergy and Immunology Clinic at McKay Dee Hospital in Ogden. Dr. Sullivan comes from the Atlanta, Georgia area where he spent more than 25 years in full time academic medicine, most recently as Professor of Medicine and head of the Allergy & Immunology program at Emory University School of Medicine where he taught Internal Medicine as well as Allergy & Immunology. At Emory, Dr. Sullivan was also the director of the Allergy & Immunology residency program, and headed the advanced clinical allergy and immunology services department. He has been honored by his peers as among the Best Doctors in America in the field of Allergy & Immunology and one of Americas Top Doctors in Allergy & Immunology. Dr. Sullivan is also a regular contributing author for What Doctors Know Magazine, an international healthcare publication designed to inform and educate consumers about the latest advancements in healthcare. He received his bachelors degree from Williams College and his M.D. degree from the University of Miami School of Medicine. After a residency in Internal Medicine at Jackson Memorial Hospital in Miami, Florida, and Barnes Hospital in St. Louis, Missouri, he was an Allergy and Immunology fellow at Washington University School of Medicine in St. Louis, Missouri. He became a full-time faculty member at the Washington University Allergy & Immunology division. He later moved to Dallas, Texas where he established the Allergy & Immunology Division in the Departments of Internal Medicine and Pediatrics at Southwestern Medical School at the University of Texas Southwestern Medical Center in Dallas, Texas. Dr. Sullivans clinical interests include allergic rhinitis,asthma, drug hypersensitivity, anaphylaxis, and chronic urticarial.

Contents
02 Dont Let Your Allergies Bloom This Spring 05 Dont Stop Horsing Around! 06 Can Allergy Shots Help? 08 Whats the Rush? 10 Is Your Asthma Well Controlled? 12 Who Let the Dogs In?
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Don't Let Your Bloom This Spring

he term allergic rhinitis means allergic reactions occurring in the nose and surrounding tissues. These reactions are caused by airborne substances such as seasonal pollen, mold spores, house dust mites, dust from animals, and dust from cockroaches. Everyone breathes these materials, but some people make IgE antibodies (allergic antibodies) and become allergic to these substances. An estimated 60,000,000 people in the United States have allergic rhinitis, approximately 19 percent of the population. The symptoms of allergic rhinitis are nasal itching, sneezing, runny
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Allergies
Seasonal allergic rhinitis causes fatigue in approximately 80 percent of patients, and depression in 30 percent. Seasonal allergic rhinitis, caused by tree and grass pollen in the spring and weed and ragweed pollen in the fall causes several other problems to flare. Active seasonal rhinitis nearly doubles patients needs for doctor visits and new medications for anxiety, depression, asthma, sinus infections, middle ear infections, and tonsil infections (Crystal-Peters, et.al. Annals of Allergy, Asthma & Immunol. 2002;89:457-462). Migraine headaches are more frequent when allergies are active. Embarrassing symptoms occur in at least 25 percent of patients.

nose, nasal congestion, obstruction of the nose at night resulting in poor quality sleep (allergic inflammation becomes much more intense during the night), snoring, postnasal drainage, dry throat in the morning, popping and ringing and pressure sensations in the ears, and sinus pressure headaches. Some people with allergic rhinitis also have allergic conjunctivitis and experience intense itching and burning of the eyes, excessive tearing, swelling around the eyes, and dark discoloration beneath the eyes (allergic shiners). Some allergy sufferers develop a crease across the bridge of the nose (where the cartilage joins the nasal bones) because of constant rubbing of the nose to relieve the itching.

The economic impact of allergic rhinitis includes 3,500,000 workdays lost each year and approximately 2,000,000 days of school lost because of allergic rhinitis. When allergic rhinitis is active, productivity at work or school is impaired by fatigue, distraction by allergic symptoms, and sometimes by the sedating properties of over-the-counter allergy remedies.

Is self-care effective? For some individuals, self-care provides acceptable relief from symptoms, protection against sleep disturbance, and protection against complications such as sinusitis. Physician care: Approximately 20 percent of patients with allergic rhinitis see a physician for more powerful interventions. Prescription medications proven to be effective for allergic rhinitis include intranasal steroids, intranasal antihistamines, intranasal nerve blocking agents, oral medications that block leukotrienes (allergy mediators that along with histamine account for most of the allergic manifestations), and in extreme cases, oral or injected steroids. If the allergic rhinitis symptoms are suppressed, sleep isn't disturbed, and there are no complications, the goals reasonably expected have been achieved.

How to control of allergic rhinitis

We have gained a detailed understanding of the mechanisms of allergic rhinitis. This has led to the development of a broad range of powerful interventions can provide nearly complete control of allergic rhinitis symptoms and methods to eliminate these allergic reactions, with mild or no adverse reactions from medications. Reasonable expectations of these interventions:

No symptoms. Symptoms of allergic rhinitis usually can be suppressed to the point that they are of little consequence in most patients. No sleep disturbance. Aggressive interventions can eliminate nocturnal nasal obstruction which leads to poor quality sleep. This seems to be the main reason for fatigue and other allergic rhinitis complications. No complications. Aggressive management of allergic rhinitis should minimize the chance of complications such as bacterial sinusitis or flares of asthma. Three levels of care for allergic rhinitis: Self-care, physician care, and specialist physician care
Self-care: Approximately 80 percent of people with allergic rhinitis either endure the problems or use over-the-

counter medications. Keeping the windows in the home and car closed helps. HEPA air filters in the bedroom may help. Oral antihistamines can be helpful for itching, sneezing, runny nose, and itching and burning of the eyes, reducing symptoms 25% better than a placebo. Older sedating antihistamines such as diphenhydramine can be helpful, but also have been shown to impair our ability to drive and learn. Newer, nonsedating antihistamines are available over-the-counter that provide relief and are much safer. Antihistamines have little effect on nasal or sinus congestion. Oral decongestants can provide some relief from the congestion, but they also disrupt normal sleep architecture, and can cause heart rhythm problems, dizziness, anxiety and tremors. Nasal spray decongestants can be effective for congestion, but many people quickly become dependent upon the decongestant sprays. Once the effect of the decongestant spray wears off, the nose swells shut and is very uncomfortable unless the spray is used again. Intranasal cromolyn and intranasal saline also help some individuals.

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Expert care: When symptoms are not well controlled, and sleep is disturbed by nocturnal nasal obstruction, or when complications of allergic rhinitis such as asthma or sinusitis are present despite these interventions, an Allergy and Immunology specialist is able to provide effective relief. Accurate diagnosis is necessary to establish that the problem really is allergic rhinitis, to guide specific measures to avoid exposure to the causes and aggravating factors, and to identify patients whose problems can be minimized or eradicated by immunotherapy (allergy shots). The evaluation also includes searching for complications or concurrent problems such as nasal polyps, nasal septal deviation, other anatomical problems in the nasal passages, bacterial sinusitis, medication effects on the nose, and multiple other factors that modify or mimic allergic rhinitis. Concurrent problems such as asthma, sensitivity to non-steroidal anti-inflammatory drugs, Vitamin D deficiency, and antibody immunodeficiency should be identified and corrected. Interventions selected and adjusted for individualized care usually provide excellent control of allergic rhinitis.

The likelihood allergic rhinitis will spontaneously go away is approximately 1-2 percent per year. Seasonal allergies usually return and being prepared is essential to the longterm management of this problem. Starting intranasal steroids before the pollen season can markedly reduce or eliminate the flare in some patients. Immunotherapy (allergy shots), especially rush immunotherapy, may be useful to greatly reduce the severity or completely eliminate seasonal allergic rhinitis. Patients with allergic rhinitis severe enough to require the help of an allergist are usually excellent candidates for therapy aimed at cure, rather than relief.

Dont accept disrupted quality of life because of allergic rhinitis.

We now have a large array of overthe-counter, prescription, and specialist interventions to suppress, and even, eliminate seasonal allergic rhinitis. You do not have to put up with seasonal allergies anymore. Dont let your Timothy J. allergies bloom this spring. Sullivan, MD and Vicki J. Lyons, MD

Symptoms of Seasonal Allergic Rhinitis and Conjunctivitis Nasal itching Sneezing Clear nasal secretions (runny nose) Poor quality sleep Snoring Sinus pressure headaches Ear symptoms -popping, ringing, congestion, variable hearing changes Eye symptoms itching, burning, tearing, swelling around the eyes

Complications of Seasonal Allergic Rhinitis Fatigue (80%) Depression (30%) Anxiety Sinus Sinus infection Middle ear infection Migraine headaches Public embarrassment because of obvious symptoms (25%)
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Dont Stop Horsing Around!

Get Allergy Shots and Get Your Allergies Under Control.

f you live in the Rocky Mountain West, chances are a horse could be your closest neighbor. There are more than 61,000 horses in Utah. Horses have been used for various purposes, including farming (pulling or carrying burdens), racing, hunting, jumping, and for pets. As a result, human exposure to horses remains quite commonplace. People exposed to horse barns have 50% prevalence rate of respiratory symptoms as opposed to those who arent. Higher exposure increases your odds of respiratory symptoms 8.9%. Horse ownership keeps increasing in the United States, up 20% from 1997. Horse allergy continues to increase as well as a result of increased exposure. Asthma and rhinitis symptoms from horse dander have been appreciated for a long time, at least 100 years. Most horses we see today are strains of the domesticated horse, Equus caballus. Horses were believed to have been domesticated around 3000BC. Wild horses of the North American continent descended from escaped domesticated horses. The only true remaining wild horses can be found on the Chinese-Mongolian steppes. All horses whether domesticated or wild have similar allergenic proteins in their pelt and saliva.

How Does Sensitization Occur?

Most particles that make a good allergen are proteins such as small proteins on the surface of pollen, dust mite particles, mold, or animal dander proteins. Most of these particles are very light and float in the air and blow in the wind. Five horse specific allergens have been characterized: Equ c 1, Equ c 2, Equ c 3, Equ c 4, and Equ c 5. Horse serum albumin Equ c 3 is cross reactive with dog and cat albumin. There is also some cross reactivity between horse and deer. Airborne horse dander particles can be detected nearly a third of a mile from the stable and over 100 feet from the race track. Horse allergen can also be found in homes within 500 feet of a stable even if the occupants of the house have no horse exposure. Patients who have no known exposure to horse and have horse allergy may be sensitized in this way. -Vicki Lyons, MD

Equ c 1

What Treatment is Available? Treatment of horse allergy can involve avoiding horses or treating rhinitis/ asthma symptoms with medications. The most effective treatment of horse allergy however is horse immunotherapy or allergy shots. Patients who receive immunotherapy are safely injected with small but increasing amounts of specific identified allergen over a period of time. Generally there are two phases. The build up phase involves receiving injections with increasing amounts of the allergen twice a week until the effective dose is reached. The maintenance phase begins once the effective therapeutic dose is reached. The maintenance dose typically has been studied in clinical trials. Drops under the tongue or sublingual allergy immunotherapy has not been found to be effective in the U.S. Horse allergen subcutaneous immunotherapy has recently been reported to be safe and effective. After horse immunotherapy, the resulting immune response in a treated patient resembles the response of a nonallergic individual to that horse protein.
Board certified/fellowship trained allergist and immunologists are specialty trained to administer horse immunotherapy to patients suffering from nasal, ocular allergy, and asthma. Start allergy shots today.

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Can Allergy Shots Help?

based studies proving effectiveness. Immunotherapy works like a vaccine. Your body responds to the injected amounts of a particular antigen given in gradually increasing doses by developing immunity or tolerance to the allergens. As a result, allergy symptoms decrease when a patient is exposed to that allergen in the future.

There are generally two phases to Immunotherapy: Build-up phase: This involves receiving injections with increasing amounts of the allergens twice a week until the effective dose is reached. Maintenance phase: This begins once the effective theraputic dose is reached. The effective maintenance dose has been studied and has been found to be effective in clinical trials.
Low-dose immunotherapy is not effective. Clinical effectiveness requires administration of adequate doses. During the maintenance phase, Immunotherapy induces regulatory T-cells that dampen the allergic response to allergens. The resulting immune response in a treated patient resembles the response of a non-allergic individual to that antigen. The clinical and immunological benefits of a successful course of Immunotherapy persist for years after treatment is discontinued.

llergy season has either hit or is about to hit in your area of the country. Potent western weeds such as sagebrush and western ragweed are pollinating as most people are still heading outdoors for hiking, biking, hunting or other recreational activities. At the same time, allergy and asthma sufferers are grabbing boxes of tissues as well as their rescue inhalers. Allergy sufferers are all too familiar with pollen season, a time when they can be forced indoors while others are enjoying the beautiful weather and foliage. Allergen Immunotherapy, also known as allergy shots, can help people who suffer from allergic rhinitis (nasal allergy), allergic conjunctivitis and allergic asthma caused by allergens such as pollen, mold and animal dander. Patients who receive Immunotherapy are safely injected with small but increasing amounts of specific identified allergens over a period of time. Immunotherapy has proven to prevent the development of new allergies, and in children, it can prevent the progression of allergic disease from allergic rhinitis. It is also recommended for treatment of allergic asthma by the expert panel/2007 National Heart, Lung and Blood Institute (NHLBI) guidelines.

When Can Immunotherapy Be Helpful?

Immunotherapy is recommended for patients with allergic rhinitis, allergic conjunctivitis and allergic asthma. Beginning Immunotherapy early can prevent rather than reduce the chronic inflammation caused by allergies, as well as prevent further development of severe disease such as asthma in a patient with allergic rhinitis. Also, starting Allergy Immunotherapy early appears to be the most effective treatment for asthma in children and young adults. Furthermore, in younger patients, Immunotherapy offers the advantage of a treatment that may be successfully discontinued after three to five years, as opposed to management with medication, which must be continued indefinitely.

In What Situations Can Allergy Immunotherapy Be Ineffective?

The benefits of Allergy Immunotherapy are dose-related many patients who have received poorly standardized extracts at low or sub-therapeutic levels in the past may not have achieved relief. Inadequate doses of allergen in the vaccine can lead to treatment failure. Also, missing allergens not identified in the allergy vaccine can lead to treatment failure. Board-certified, fellowship-trained Allergists and Immunologists are trained to provide pollen and inhalant identification levels typically posted in local newspapers and television and are trained to provide the appropriate testing and treatment formulas

How Does Immunotherapy Work?

Over the last century, much has changed in the standardization of extracts and the number of evidence6 whatdoctorsknow.com

for specific Allergen Immunotherapy. High levels of allergen in the environment secondary to inadequate indoor environmental control can also lead to treatment failure. Exposure to tobacco smoke or some occupation exposures can also offset the success of Immunotherapy.

What About Allergy Drops Under The Tongue?

The rationale for developing an oral treatment was aimed at reducing the inconvenience and discomfort of injections. Oral treatments have been studied in a variety of forms including coated tablets, capsules and oral drops. European studies of Sublingual Immunotherapy (allergy drops under the tongue) appeared to be effective. However, several similar studies repeated in the United States in 2008 failed to achieve the same results. Instead, these recent studies reported no significant benefit from oral treatments. Allergy drops under the tongue or swallowed are approved for use in Europe; however, questions remain regarding the safety and effectiveness of Sublingual Immunotherapy in the US. There are currently no FDA-approved sublingual allergy extracts in the US, and Sublingual Immunotherapy is typically not covered by most insurance plans.

Is Allergy Immunotherapy Cost Effective?

Immunotherapy is less expensive than conventional overthe-counter medication or prescription therapy for the treatment of allergic rhinitis and asthma when administered by fellowship-trained, board-certified Allergists and Immunologists. The greatest immunotherapy costs occur in the first year when immunotherapy is 33% less costly than medication. In years two to five, immunotherapy is 75% less expensive than medication. These cost savings were confirmed recently in a 2006 European study in patients with allergic rhinitis and asthma.

Who Should Prescribe Allergen IMMUNOTHERAPY?

Immunotherapy should only be given under the supervision of a specialized physician in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections. Ideally, Immunotherapy should be given in the prescribing allergist/immunologist's office. Given the complexity of the decision-making process as to whether Allergen Immunotherapy is indicated and the knowledge that is required to formulate a proper allergen extract (vaccine), it should be undertaken only by a physician with specialty training in the field. Your board-certified Allergist and Immunologist is a specialist, trained to provide evidence-based treatment for allergic rhinitis, allergic conjunctivitis, and allergic asthma. For more information, take a look at the following website: www.allergyandasthmarelief.org. But most of all, find a boardcertified allergist and immunologist, start allergy shots and start feeling great again! -Vicki Lyons, MD
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What's The Rush?

R
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A new approach to fast allergy relief.

ush Immunotherapy is a method for providing rapid relief from allergies. What is this new procedure and where does this fit into the treatments we already have? The goals of therapy for upper airway allergic reactions (allergic rhinitis, hay fever) include relief from annoying symptoms, relief from disturbed sleep, and avoidance of complications such as middle ear infections or sinus infections. Antihistamines, decongestants, nasal steroid sprays, and other nasal allergy sprays often provide relief. The goals for asthma are control of the symptoms, prevention of limitations on activities, and protection from severe worsening during respiratory tract infections or exposures to allergic triggers. Bronchodilators, inhaled steroids, oral asthma medications, and other medications can provide symptomatic relief for some patients. Allergic rhinitis, allergic conjuctivitis, and allergic asthma, often need immunotherapy (allergy shots). These injections provide control of symptoms and then resolution of the allergies. Currently this is the only therapy that can actually reduce or eliminate the body's unwanted allergic reactions to environmental substances.

Seasonal or persistent nasal itching, sneezing, runny nose, nasal congestion, sinus headaches, postnasal drainage, sleep disturbance because of nasal obstruction, as well as itching and burning of the eyes (allergic conjunctivitis) affects 10-25% of people in Western countries. Pollen and airborne substances arising from molds, animals, mites and other insects are common causes of these problems. Allergic reactions in the lungs result in asthma in approximately 5% of the worlds population. Tightness in the chest, shortness of breath, wheezing, and coughing are common asthma symptoms. Asthma can limit activities, disrupt sleep, and have a very negative effect on quality of life. Acute respiratory tract infections or exposure to allergic triggers can cause severe or even fatal worsening of asthma.

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Rush Immunotherapy is a new injection procedure that is revolutionizing how we treat allergies.
Traditional immunotherapy typically involves injections twice a week with increasing amounts of antigens (the substances that cause the allergies). This process usually takes 16 weeks to reach full treatment doses (maintenance doses). The Rush Immunotherapy revolution has centered on the recently acquired knowledge that relief from allergy symptoms requires lower doses of antigens than are required to make the allergies go away entirely over time. Research in United States and Europe has led to Rush Immunotherapy procedures that allow us to reach levels of antigens that begin to relieve symptoms in one day rather than over a period of 2-3 months. Patients are given high doses of allergy suppressing medication to minimize reactions at the sites of injections, or in the rest of the body. Typically 8 injections are given over a period of 5 hours and the patients are then observed for 2 more hours as the materials are absorbed into the body. Rush immunotherapy can be a great convenience for patients with demanding work or school schedules. While the procedure requires a full day in the office, we avoid nearly 3/4 of the visits needed to build up to maintenance doses. A day in the office also affords time for the patient to ask questions about allergic disease and treatment. There is time to discuss and demonstrate how to deal with unexpected late allergic reactions. As allergy symptoms improve after Rush Immunotherapy, patients are much more likely to return for the final doses to build up to maintenance. These higher doses are required not to relieve symptoms, but rather to gradually eliminate or markedly decrease the severity of the allergy itself.

but being kept in a relatively small space can be very difficult for them. For many patients, Rush Immunotherapy is an alternative with several advantages over medications alone, or traditional immunotherapy. Any form of immunotherapy carries a risk that the patient may have a troublesome reaction at the injection site, or that a more severe reaction involving the whole body may occur. This could include hives (urticaria), swelling of the eyes, lips, or other structures (angioedema), even anaphylaxis (reactions that cause trouble breathing or decreases in blood pressure). The possibility of an allergic reaction is why allergists rely upon patient education, observation in the office after injections, and having an emergency plan for dealing with rare severe reactions. Rush Immunotherapy patients are taught about the characteristics of the late allergic reactions, are given medications to use in case of a reaction, and are taught the use of self-injectable epinephrine. Rush Immunotherapy provides a method for achieving clinical improvement very rapidly and greatly reduces the number of visits required to achieve long lasting freedom from allergy. -Vicki Lyons, MD and Timothy J. Sullivan, MD

Not everyone is a good candidate for Rush Immunotherapy. If asthma control is not stable, if lung functions are not near normal, Rush Immunotherapy may not be safe.
Preschool children may be good candidates from the point of view of clinical improvement,

Advantages of Rush Immunotherapy Convenience for patients with limited time. Doses of immunotherapy that begin giving relief of symptoms can be reached in one day, rather than over 2-3 months. The time required to reach full treatment maintenance doses is markedly reduced. Both the patient and the doctor can quickly determine whether or not this form of therapy will be successful.

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Asthma can be triggered by airborne and indoor allergens, as well as, upper respiratory infections, cold air, cigarette smoke and exercise.

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Is your asthma well controlled?

f you are experiencing asthma symptoms such as a chronic cough, chest tightness and wheezing that keeps you from work, school or normal activities, then its time to ask yourself, Is my asthma well controlled?

In 2007, the National Heart, Lung and Blood Institute issued a new set of guidelines defining asthma severity and control. Asthma severity is the expression of asthma symptoms. Control is the degree to which the symptoms of asthma are minimized and the degree to which the goals of therapy are met. Asthma control is the main focus of the new guidelines. Patients are quick to purchase air filters and bedding encasements, often without knowing what is actually triggering either their own asthma or their childrens asthma symptoms. Asthma can be triggered by airborne allergens such as seasonal pollen and mold spores, and indoor allergens such as dust mites, cockroaches and animal dander. However, other things can trigger asthma as well, such as viral upper respiratory infections, cold air, cigarette smoke and exercise. A discussion with an allergist and immunologist about ways to reduce or eliminate triggers and how to implement the best treatment strategy is the number one step toward understanding the disease. If you have already been diagnosed with asthma and are currently on a treatment plan, you should experience asthma symptoms less than twice a week and require the use of your short-acting reliever medication less than twice a week. Nighttime awakenings from asthma should occur less than once a month and lung function as assessed by spirometry should be normal. Your asthma is not well controlled if you have symptoms more than twice a week, nighttime awakenings more than twice a month or limited activity at work or school. Using your short-acting reliever medication more than twice a week is an important measure of poor control. Patients with very poorly controlled asthma experience symptoms throughout the day and night and have very limited activity. They also have very abnormal lung function.

Every day in America, approximately: 63,000 people miss school or work due to asthma. 34,000 people have an asthma attack. 5000 people visit the emergency room due to asthma. 1300 people are admitted to the hospital due to asthma. 10 PEOPLE DIE FROM ASTHMA.
According to the American Lung Association Epidemiology and Statistics Unit Research program.

The goals of asthma control include preventing asthma symptoms, infrequent need for short-acting reliever medications, normal lung function and normal activity levels at school, work and with exercise. Its also important that adverse effects from asthma medications are minimized and that your asthma plan meets your expectations. New therapies are also currently available for severe allergic asthma and have been shown to reduce the need for high-dose inhaled steroids and oral steroids. Be sure to check with your allergist. Allergy immunotherapy is now recommended for allergic asthma patients aged five and older. If your asthma is not well controlled, the 2007 National Asthma Guidelines recommend considering evaluation by an asthma specialist. Asthma specialists are either a fellowship-trained allergist and immunologist or a pulmonologist. -Vicki Lyons, MD
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Who Let the Dogs

In?
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Many people do not realize that allergy and asthma triggers lurk inside their homes.
or runny nose, itchy eyes, sneezing and wheezing, which are symptoms triggered by airborne particles or allergens. In many cases, the root cause of these allergens is the sufferers canine friends. In fact, 70% of people suffering from dog allergies, whether they know it or not, react to the allergen scientifically known as Can f 1, which is found in dog saliva. You can effectively minimize exposure to airborne particles or allergens by removing the pet from the home. Less-drastic measures you may want to consider include keeping pets out of the bedroom and other common rooms where people with allergies spend a great deal of time, and washing your hands after touching your pet. Animal dander has been found to be a primary cause for nasal allergies, ocular allergies and allergic asthma. The good news is that you can engage in dog allergen immunotherapy, which has been shown to be effective in managing the symptoms. Fellowship-trained and boardcertified allergist and immunologists are specially trained to administer immunotherapy to patients suffering from nasal allergies, ocular allergies and allergic asthma. -Vicki Lyons, MD

evere allergy season is here, which means you will probably spend significant time indoors. Unfortunately, you may not realize that allergy and asthma triggers may be lurking inside your home. Spending more time indoors increases your exposure to indoor allergens such as pet dander, dust mites, mold spores and even cockroaches. More than 40 million people in the United States suffer from indoor allergies year-round. Perennial allergy sufferers experience symptoms such as a stuffy
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Paradoxically, some studies demonstrate that children raised in a house with a cat are less likely to become allergic, as well as less likely to develop asthma. The highest exposure to cat allergen may decrease the production of allergic antibodies and trigger a type of tolerance. It could be the reason that in places like New Zealand where 78% of the population owns a cat, the prevalence of cat allergies is as low as 10%. However, several factors may contribute to the relationship between cat exposure and allergic reaction.

Controlling for Indoor Cat Dander

There are still no convincing studies addressing the clinical benefit of environmental control measures for animal allergens. It is widely accepted that any asthmatic patient who is known to be cat-sensitive and whose asthma is believed to be related to cat dander allergy, should remove the cat from the home. The following indoor environmental measures may have a modest benefit for those reluctant or unwilling to remove the cat from the house:

Don't Let Your Cat Get Your Dander Up

he prevalence of asthma and allergic rhinitis (nose and throat allergies) has increased significantly during the past 40 years. Current data suggests that, in the U.S., approximately 10% of children have asthma. Childhood asthma is strongly associated with sensitivity to animal allergens. Allergens are substances that cause allergy symptoms in people sensitive to a particular allergen. Sensitivity to cat and dog allergens is prevalent in up to 67% of all asthmatic children. What distinguishes animal allergen exposure from other indoor allergen exposure is high exposure levels and the number of places animal allergen is found. Cat and dog allergens are found in homes, schools, offices and public buildings where the allergens are passively transported by pet owners. The levels of exposure in these environments

can cause both sensitization (production of allergic antibody) and allergic symptoms in atopic (allergic) people. Animal allergens are found in animal tissue, hair, feathers, saliva, urine and dander. Dander is the word for dead skin that is shed constantly by dogs and cats. Cat dander is especially associated with allergies. The major allergen responsible for cat allergies in 80% of cat sensitive individuals is called Fel d 1. Fel d 1 is produced primarily in cat saliva and is also found in cat dander. Cats show significant individual variation in the production of Fel d 1, with male cats generally producing greater amounts of allergen than females. In any case, air sampling in rooms occupied by cats shows significant amounts of cat allergens. In fact, cat allergens are widely distributed throughout cat owners homes, and surprisingly, they accumulate at significant levels in houses that do not even contain pets.

Install air cleaners, especially in the bedroom Remove carpeting, especially in the bedroom Replace mattress and pillow covers Wash the cat at least twice a week
Many well-controlled studies have demonstrated that over the long term, Allergen Immunotherapy is the only highly effective available treatment for cat dander allergy. Cat immunotherapy significantly reduces the symptoms of cat allergies by administering gradually increasing doses of allergens that stimulate the patients own immune system. These patients then become resistant to future allergic symptoms and reactions. Cat immunotherapy is safe and highly effective for allergic rhinitis, allergic conjunctivitis and allergic asthma secondary to cat dander. See a board-certified Allergist and Immunologist and ask about starting an effective therapy for cat dander allergy TODAY. -Vicki Lyons, MD
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For more information about Advanced Allergy & Asthma Clinic visit:

www.vicki-lyonsmd.com