The Allergist AnewsletterfromtheOklahomaAllergy&AsthmaClinicSummer2012The AllergistYou reach for over-the-counter medica-tion when your nose is congested, yet you end up feeling even worse rather than better. You might have just expe-rienced rhinitis medicamentosa (RM), also known as rebound rhinitis or chemically-induced rhinitis. This is a condition where nasal conges-tion or sneezing is triggered by the use of nasal decongestant sprays such as Af-rin nasal spray. Rhinitis medicamentosa symptoms in-clude nasal congestion without flowing mucus, postnasal drip or sneezing that begins after using a nasal decongestant for more than three days.Rhinitis medicamentosa symptoms in-clude severe congestion that worsens

as the nasal deconges-tant starts to wear off. This causes patients to use the OTC decoges-tant more frequently, which actually worsens the symptoms.The most important therapy, Dr. Gregory Metz said, “ is complete-ly stopping the over the counter nasal deconges-tant.” A board certified allergist can help you use other therapies to effectively treat your na-sal symptoms. In order to control your nasal symptoms, you need the right di-agnosis. This is where the physicians at

Inflammed Nose? It could be your OTC Nasal Spray

the Oklahoma Allergy & Asthma Clinic can help. Call today and make an ap-pointment.

The Oklahoma Allergy & Asthma Clinic is now participating in on-site health clinics for businesses. Dr. Gregory Metz and Dr. Warren Filley saw patients in June through a new relationship with Chesapeake Energy. The main Chesa-peake campus located in Oklahoma City has a medical clinic. Chesapeake Clinic’s primary care physician pre-determined which employees or their dependents needed to see an allergist.

OAAC doctors and staff consulted with patients and performed allergy tests. For those who had suspected food al-lergy, follow up appointments were scheduled at OAAC’s main location

at the Oklahoma Health Center. OAAC physicians will offer their services at the clinic on a quarterly basis.

OAAC is currently looking to partner with other businesses with on-site medical clinics. For more information, contact the OAAC at (405) 235-0040.

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@okallergyasthma

OAAC Staff sees Patients at Chesapeake Energy Health Clinic

Dr. Warren Filley, OAAC board-certified allergist, gets ready to see his first pa-tient at the Chesapeake Energy clinic.

Dr. Gregory Metz, OAAC board-certified allergist, also consulted with patients.

(Left-right) Dallas and Vicki assisted patients at the clinic.

Asthma

If you are traveling by plane and have asthma, place all of your medicine in your carry on bag including your rescue inhaler. Never pack medicine in checked baggage because it might not arrive at your destination when you do. Trying to run down prescriptions away from home can be done but it is best to be prepared and keep your medication with you.

Carry a written Asthma Action Plan with you and keep a copy in your suitcase. If directed by your doctor, bring your peak flow meter and check your levels daily. If you are traveling abroad, you’ll need an electrical converter for your nebu-lizer. Portable nebulizers are available that are powered off a 9V receptacle in your car or camper.

If possible, book your room at a “smoke free” hotel. Otherwise, request non

s m o k i n g rooms and floors of your hotels. If you have acute asth-ma, consid-er wearing a medical a l e r t - t y p e necklace or bracelet at all times. If you are vis-iting some-one who has pets or smokes, you might want to consider staying in a ho-tel instead.

Check the weather before you leave home including checking the ozone, smog and pollen levels.

Plan Ahead for Summer Vacation Fun

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Food Allergic

If you are traveling this summer and someone in your life is food allergic, plan your meals out ahead of time. Many restaurants offer online menus where you can check their dishes and see if something offered fits within your guidelines.

Consider staying in hotels or motels that have kitchenettes to prepare your own foods. Using your Smartphone, many apps are available to find a natural gro-cery store in the area you are visiting.

For those who have severe re-actions, make sure you have a supply of epi-pens with you at all times and an emergency action plan. Epi-pens need to be kept from ex-cessive heat or cold during your travels. Consider keeping your epi-pen in an in-sulated lunch bag.

Have the person who is food allergic wear the medical alert-type necklace or bracelet in case of an emergency.

Talk to managers where you are dining as to how the food should be handled. If you don’t feel comfortable with the answers, leave and find another place that meets your qualifications and is happy to help with the food allergy is-sue.

Nearly One in Four People Suffer from This Unwanted Summer CompanionWhile the un-official start of summer sig-nals warmer weather, it can also bring some unwant-ed companions. Nearly one in four people experience itchy, red or white bumps, welts or patches on the skin called hives—and heat can be a trig-ger, according to the American Acad-emy of Allergy, Asthma & Immunology (AAAAI). But the length of your symp-toms is also important. This is what de-termines if you have acute or chronic hives.

Acute Hives

Acute hives typically last less than six weeks and may be a reaction triggered by coming in contact with an allergen such as a food, animal dander, insect bite, latex or pollen. Visit your allergist to identify the trigger and then avoid

it to prevent this allergic reaction from reoccurring.

Another possible culprit for acute hives is medications. It’s important to know that reactions to a medication can happen at any time during the period you’re taking it. Non-allergic causes of acute hives, can include heat, stress, exercise or exposure to certain chemi-cals. In fact, one of the most common causes in children is a viral infection.

Chronic Hives

The majority of people suffering from chronic hives have symptoms that last longer than six weeks.

Unfortunately, most chronic hives are idiopathic, which means that the exact cause can’t be identified.

Only a small percentage of chronic hives are due to an allergy. Routine testing such as general blood counts or

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For those who are allergic to insect stings such as honey bees, yellow jack-et wasps, fire ants, etc., a reaction can sometimes result in life-threatening anaphylaxis shock.

“Anaphylaxis has been reported in up to 3% of the population with insect stings,” said Dr. Laura Chong, OAAC board-certi-fied allergist. “Venom stings cause 40-100 deaths annually in the U.S. Half of patients who die from venom-induced anaphylaxis did not know they had an allergy.”

Venom reactions can result in signifi-cant medical problems, impair quality of life and may be treated with antihis-tamine, oral steroid, or epinephrine. People who have experienced anaphy-laxis shock when stung do have a treat-ment option.

A therapy called venom immunotherapy (VIT) involves very small doses of venom extracted injected under the skin. The doses are gradually increased until the allergic person becomes desensitized so that eventually he or she will not react

to a sting. This type of therapy has been available for more than 30 years and is highly effective. Many patients with sting-induced allergic reactions are not referred to an allergist for evaluation and are never offered this potentially life-saving therapy.

Rush Therapy

By rapidly increasing the dose over sev-eral days (rush treatment), this has also been found to be safe and more conve-nient rather than the traditional, slower approach.

In a study published in The Journal of Allergy & Clinical Immunology, one hundred one patients allergic to bee, yellow jacket, or hornet venom were treated with rush Hymenoptera venom immunotherapy.

One hundred (99%) patients reached the maintenance dose after four days. Epinephrine as rescue medication was never necessary, and the regimen proved to be safe and convenient for both the patients and the medical staff.

“The Allergist” is published quarterly by the Oklahoma Allergy & Asthma Clinic. Contents are not intended to provide personal medical advice, which should be obtained directly from a physician.

“The Allergist” welcomes your letters, comments or suggestions for future issues.Send to:The Allergist750 NE 13th Street Oklahoma City, OK 73104-5051Phone: 405-235-0040www.oklahomaallergy.com

Oklahoma Allergy & Asthma ClinicEditorial Advisory BoardDean A. Atkinson, M.D.John R. Bozalis, M.D.Laura K. Chong, M.D.James R. Claflin, M.D.Warren V. Filley, M.D.Garyl Geist, Chief Operating OfficerRichard T. Hatch, M.D.Gregory Metz, M.D.Patricia I. Overhulser, M.D.Shahan A. Stutes, M.D.Karen Gregory, MS, APRN-BC, CNS, RRT, AE-C

STING ALLERGYCould Rapid or “Rush” Therapy be for you?

“Rush venom immunotherapy can be a safe and convenient option for the appropriate patient. Fewer office vis-its are needed and the onset of clinical benefit may be reached more rapidly. In some patients, they can receive protec-tion from reoccurring allergic reactions within a week of reaching maintenance dose and may continue to improve with time,” said Dr. Chong. Although, rush immotherapy has benefits, it is not ap-propriate for all patients. Your allergist can help you determine the best man-agement approach for you.

For more information about VIT immu-notherapy, contact your OAAC allergist at (405) 235-0040.

Laura Chong, OAAC board-certified allergist

screens may be warranted.

Whether you have acute or chronic, hives are often very itchy but not con-tagious. While most cases get better on their own, your physician may tell you to avoid hot baths and showers, wear loose-fitting clothing or take antihista-mines to reduce itching and swelling.

Severe flare-ups sometimes require tak-ing a type of medication called cortico-steroids so be sure to visit your physi-cian. In rare instances, hives can be a symptom of a life-threatening condition called anaphylaxis.

Call 911 if you experience hives along with any of these symptoms:

•Fainting

•Shortness of breath

•Tightness in your throat

•Tongue or face swelling

•Wheezing

For more information, contact your OAAC allergist.

Hives... (continued from page 2)

If your child has allergies and/or asth-ma, it’s always a good idea to discuss any issues before he or she gets to camp. Find out the ratio of counselors to children, if they are trained in first aid and CPR, and if they have experi-ence with children who have allergies/asthma. Meet with the camp director or senior staff member to discuss how allergies/asthma is managed and to get any questions answered.

If your child is food allergic, review the curriculum and ask to develop alternate plans if foods are used for activities or

art projects. Meet with the camp’s cook to review menu items and ingredients. Go over your child’s Food Allergy Ac-tion Plan with the camp staff. Ask for a food allergy drill so that everyone can run through the plan and know how to respond to an allergic emer-gency.

Find out where medication is stored, who administers it

Success at Summer Camp for Kids

and if there is a camp nurse or medi-cal personnel on staff. If your child has a history of severe reactions, take note of where the nearest hospital is located and the expected response time for an ambulance to arrive on-site if called.

Remind your child to carry his/her in-haler with them. In addition, if your child has an epi-pen, make sure your child has immediate access to it while at camp. Let your camp director and counselor know about these items as

well.

By planning ahead, your child will be set up for suc-cess to enjoy a fun sum-mer experience. Contact your OAAC allergist if you have further questions about your child’s aller-gies or asthma and dealing with upcoming summer camps.

A new “dry” nasal spray is now available by prescription, Qnasl, which has shown significant improvement in relieving na-sal symptoms of sneezing, runny nose, nasal itching and nasal congestion for those who have allergic rhinitis. Qnasl is approved for the treatment of seasonal and year-long allergies for adults and children aged 12 and older.

Liquid forms have been around for years but many patients don’t like the feeling of medicine dripping down their throats. It’s important that nasal sprays be used consistently.

The most common side effects in the clinical trials were nasal discomfort, nosebleed and headache. People using Qnasl and similar drugs should avoid those people with chickenpox or mea-sles. Discuss with your OAAC allergist if you have further questions about its side effects and if it could be the right nasal spray for you.

The nasal aerosol delivery system also offers a built-in dose counter and is en-vironmentally friendly. It is currently the only powder-form corticosteroid on the market.

“Some allergic rhinitis patients are af-fected by symptoms and side effects associated with wet sprays,” said Dr. Shahan Stutes, OAAC board-certified al-lergist. “Qnasl offers a great option for those patients.”

Dry Nasal Spray Helps with Treatment of Allergic Rhinitis

Dr. Shahan Stutes, OAAC board-certified allergist

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