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Allergy & Asthma Prevention- Main Street Medical Care

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Learn all about your North Texas allergies! How can you treat and prevent?

Learn all about your North Texas allergies! How can you treat and prevent?

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Allergy & Asthma Prevention- Main Street Medical Care Allergy & Asthma Prevention- Main Street Medical Care Presentation Transcript

  • Allergy and Asthma Care North Texas Survival Guide Presented By David Zahaluk, MD Main Street Medical Care
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – The Nature of the Problem
    • 50 million patients in the US at a cost of $4.5 billion
    • How the body defends itself against foreign invaders
    • Here’s what happens…
    • Ragweed pollen gets stuck on your nasal linings (mucosa)
    • Plasma cells in the mucosa lining turn on & make antibodies (sensitization)
    • Antibodies find and attach to mast cells that contain histamine (priming)
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – The Nature of the Problem
    • The next ragweed gets grabbed by the antibody which turns on the mast cell and releases histamine, leukotrienes, etc.
    • Histamine immediately dilates vessels causing tissues to sell, itch and leak serum and mucus
    • The “late phase” reaction happens 4-24 hours after exposure when other cells are attracted to the site causing tissue damage and swelling
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – The Nature of the Problem
    • Courtesy of Web MD
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – Symptoms
    • Courtesy of About.com
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – Symptoms
    • Airborne: sneezing, runny nose, congestion, watery eyes
      • Pollens, molds, dust mites, animal dander
    • Food: abdominal pain, bloating, cramping, diarrhea, hives
      • Peanuts, wheat, shellfish, eggs, milk, soy
    • Insect Stings: hives, anaphylaxis
    • Medications: hives, anaphylaxis
    • Latex/Poison Ivy: dermatitis
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – Symptoms
    • Courtesy of About.com
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergies – Complications
    • Sinusitis
      • 70% of recurrent sinusitis is caused by allergies
    • Ear Infections
    • Asthma
      • Peak month is September based on ER and hospital visits
    • Anaphylaxis
      • Potentially fatal
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Common Local Allergens by RAST
    • Indoor (Perennial)
    • Pests
    • American cockroach
    • Pet allergens
    • Cat hair, dog epithelium
    • Funguses
    • Aspergillus fumigatus, Penicillium notatum
    • Outdoor (Seasonal)
    • Weeds
    • Ragweed, Nettle, Pigweed, Sheep sorrel, English plantain, Wingscale
    • Grasses
    • Johnson grass, Kentucky bluegrass, Bahia grass, Bermuda grass, short grass
    • Trees
    • American Elm, Box Elder, Mesquite, Mountain Cedar, Sweet Gum, White Ash, White Hickory, White Mulberry, White Oak
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Non Allergic Rhinitis
    • Chronic sneezing, congestion, itching or runny nose with no evidence of allergies (no nasal eosinophils and negative allergy testing)
    • Vasomotor - Causes: cold, perfumes, smoke, bright sunlight
      • treat with Atrovent N/S (anticholinergic)
    • Hormonal - Causes: pregnancy, low thyroid
      • treat with hypertonic saline N/S
    • Infectious
      • treat with decongestants
    • Rhinitis Medicamentosa – Overuse of OTC decongestant spray
      • Stop using Afrin, Dristan, Otrivin; may substitute nasal steroid spray
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Prevention
    • Avoidance Strategies
    • Pollen
      • Stay indoors; close doors and windows at home and in car
      • Don’t dry clothes outdoors
      • Shower and wash clothes after being outdoors
    • Grass
      • Avoid cutting grass or wear mask
    • Dust Mites
      • Keep mite-proof covers on mattresses, box springs and pillows
      • Vacuum mattresses
      • Wash bedding weekly in hot water
      • Remove clutter and stuffed animals (or put in freezer)
      • Replace carpet with vinyl or hardwood
      • Install HEPA filters in vacuum and central air
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Prevention
    • Avoidance Strategies
    • Mold Spores
      • Maintain low humidity
      • Fix leaky pipes, sinks and tubs
      • Clean damp areas with dilute bleach solutions
      • Use exhaust fan in bathroom during showers
      • Clean refrigerator tray regularly
    • Pet Dander
      • Keep pets off beds and linens or out of bedroom entirely
      • Install HEPA filters in vacuum and central air
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Prevention
    • Hyposensitization
    • Similar to vaccine: inject small doses of allergen under skin to get your body “used to” the substance and decrease allergy response
    • Start with scratch test, prick test or RAST to determine what you are allergic to
    • Begin with 4-6 months of shots once or twice weekly to build up to a maintenance dose; then 4-6 months more of shots every 2 to 4 weeks in maintenance phase
    • Optimal duration of therapy unknown; duration of benefit hard to predict
    • Works well in:
      • Allergies and asthma, poor response to medication therapy
    • Poor response to:
      • Food allergy, atopic dermatitis, latex allergy, medication allergy
    • Caution with severe or unstable asthma, beta blocker therapy or autoimmune disease (MS, thyroid disease)
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Topical Medications
    • Nasal Sprays
    • Antihistamines: Astelin
    • Steroids: Flonase, Veramyst, Nasonex, Nasacort
    • Mast cell stabilizer: Nasalcrom (OTC)
    • Hypertonic Saline: NeilMed, EntSol
    • Decongestants: Afrin, Dristan, Otrivin
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Topical Medications
    • Eye Drops
    • Antihistamines: Patanol, Optivar, Zaditor
    • Mast cell stabilizer: Cromolyn, Alocril
    • NSAID: Acular
    • Decongestants: Vasocon, Naphcon, Visine (OTC)
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Allergy Treatment – Systemic Medications
    • Antihistamines – Claritin, Zyrtec, Allegra, Lodrane
    • Decongestants – Sudafed
    • Drying agents – Methscopalamine (Allerx, Rescon)
    • Leukotriene Inhibitor – Singulair
    • Steroids – oral, IM, IV
    • - watch bone loss, appetite, blood sugar
    • Epinephrine – for anaphylaxis
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – What Is It?
    • Episodic lung condition that causes airway swelling and obstruction
    • Affects 22 million in the US, including 6 million kids
    • Every day in the US:
      • 30,000 asthma attacks
      • 5,000 ER visits
      • 1,000 hospital admission
      • 11 deaths
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – What Is It?
    • Three factors drive asthma:
    • Bronchoconstriction
    • – airway narrowing due to muscle spasm
    • Tissue edema
    • – inflammatory response causes lining to swell
    • Mucus hypersecretion
    • – goblet cells overproduce mucus
    • Courtesy of Quickcare.com
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – What Is It?
    • Courtesy of www.hse.gov.uk/asthma
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – Symptoms
    • Three Cardinal Symptoms
    • Cough
    • Wheeze/shortness of breath
    • Chest pain/tightness/pressure
    • Severe Symptoms:
    • Inability to speak Wheeze breathing in and out
    • Blue lips & fingernails Nonstop coughing
    • Rapid breathing Fatigue/confusion/sweating
    • Inability to fully exhale Audible wheeze
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – Complications
    • Decreased quality of life (fatigue, underperformance, anxiety/depression)
    • Pneumonia
    • Collapsed Lung
    • Respiratory failure/Death
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – Triggers
    • Viral and bacterial infections
    • Allergens
      • Dust mites, Cockroach allergens, Pets (hamsters, rabbits), Mold
    • Second hand smoke
    • Cold, dry air
    • Exercise
    • GERD
    • Anxiety
    • Medications
      • ASA, NSAIDs, Beta blockers
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – Symptomatic Classification
    Symptoms between flares Night symptoms Symptoms and use of rescue Severity Extreme Nightly Multiple / Day Severe Persistent Moderate 5+ / month Daily Moderate Persistent Minor 3-4 / month 3-6 / week Mild Persistent No 0-1 / month 0-1 / week Intermittent
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma – Step Therapy
    • Courtesy NIH
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma Treatment – Maintenance Meds
    • Two Mainstays of Therapy:
    • SABA – Proventil, Ventolin or Albuterol
    • ICS – Pulmicort, Aerobid, Flovent, Azmacort
      • Low, medium or high dose based on # puffs/day
    • ICS + LABA - Advair
    • ICS + SABA – Symbicort
    • Also consider
    • Singulair
    • Zyflo
    • Xolair
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma Treatment – Prevention
    • Vaccines
      • Flu, PVX
    • Peak Flow Meter
    • Control allergies, GERD
    • Regular checkups
    • Have written plan for flares
    • Smoking cessation
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Asthma Treatment – Acute Exacerbation
    • Nebulizer treatments – multiple (frequent reassessments)
    • Supplemental O2
    • Treat triggers
    • Steroids – inhaled, oral, IM, IV
    • Admit if doesn’t respond well in the first 4-6 hours
    • Theophylline
    • Adrenaline
    • Intubation/mechanical ventilation
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Courtesy NIH
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • What To Do Next
    • Go through your home to practice allergen avoidance
    • Ask your doctor to evaluate you and put together an allergy/asthma treatment plan
    • Discuss Epipen with your doctor for anaphylaxis
    • Put asthma plan up where everyone at home can see
    • Use Peak Flow Meter daily
  • Main Street Medical Care Allergy & Asthma Survival Guide
    • Our Practice
    • Family Practice and Urgent Care
    • Wait time guarantee: “You will be seen within 1 hour or your visit is free”
    • Free visit card for all attendees today courtesy of Trane
    • Sign up for our ‘ Today’s Health Matters ’ newsletter
    • Located across from the Medical Center of Lewisville 972-221-3500