Allergies & Asthma Maribeth Duffy, MDProvidence Medical Group – West Olympia Family Medicine
Maribeth Duffy, MD • Board Certified in Family Medicine with nearly 20 years practice experience • Medical interests: allergies, asthma, dermatology, chronic disease management & women’s health • Caring for patients of all ages at Providence Medical Group – West Olympia Family Medicine. To make an appointment, call 486-6710
Topics we will cover • What is asthma? And who is most at risk to develop asthma? • What is Allergic Rhinitis? • What is Atopic Dermatitis? • What does the indoor environment have to do with allergies and asthma and in some cases eczema? • How can we reduce our exposure to triggers for Asthma, Allergies and Atopic Dermatitis? • What is new?
What is asthma? • A chronic inflammatory disorder of the airways • It is very treatable, if not yet curable • Allergies may contribute to asthma and atopic dermatitis • It is not contagious • It can be life-threatening
Pathology of asthma Asthma involves inflammation of the airways Normal Asthma
Child & adultasthma prevalence 14 • Child Lifetime 12 Adult Prevalence (%) 10 8 6 Current 4 2 12‐Month 0 80 82 84 86 88 90 92 94 96 98 00 02 04 06 19 19 19 19 19 19 19 19 19 19 20 20 20 20 Year Source: National Health Interview Survey; CDC National Center for Health Statistics
Risk factors fordeveloping asthma • Atopy refers to the body’s predisposition to develop antibodies in response to exposure to environmental allergens or triggers. • >40% chance of having, if atopy exists on one side of family, >80%, if both sides of gene pool. • Includes the AAA triad of : Allergies (or hay fever), Asthma, and Atopic dermatitis (or eczema).
How to manage yourchild’s asthma • Everyone needs a written Asthma Action Plan ; it includes: – Rescue and Controller Medications – Identification of and plan to avoid asthma “triggers” – Peak flow monitoring (over age 5) diary or log – An Emergency plan
Atopic dermatitis • Atopic Dermatitis is the rash that is produced when circulating histamine in our blood (a whole body reaction) lays down in our skin causing inflammation. The histamine reaction can also cause generalized itchiness and hives. • Triggers are often the same as those that trigger Asthma and Allergic Rhinitis. • Allergens in the air, climate (dry/cold), emotional stress, hormones (AD often worsens temporarily during puberty), food, and irritants.
Atopic dermatitis • Sensitivity of the skin is lessened when we allow the skin to maintain proper oils. • Avoid “over cleaning” – Use only unscented mild soap products – Minimize baths and shorten showers – Less frequent bathing if possible – Lotions contain too much water - lessens oils – Minimize perfumes or chemicals in laundry
Secondhand smoke • Contains more than 4,000 substances – over 40 are carcinogenic • Is particularly harmful to young children • Can trigger asthma attacks • Causes coughing, excess phlegm, reduced lung capacity and causes lung irritation
Byproducts of smoke • Particles such as nitrogen dioxide and sulfur dioxide may cause decreased lung function • Increased risk of respiratory tract infections (bronchitis, pneumonia) which trigger reactivity • Not only tobacco smoke--also caused by burning wood, candles, coal, kerosene, natural gas • Biomass creates an air quality concern
Avoidingsecondhand smoke • Do not allow smoking indoors or in vehicles • Limit use of fireplaces and candles • Exhaust fan over gas stoves • Smoke particles stick to clothing--can affect young child when held in arms
Dust mites• Too small to be seen• Found almost everywhere!• Live in soft bedding• Feed on dead skin cells• Mites and mite droppings can be asthma triggers• Thrive in warm, humid places
Avoiding dustmite triggers • Wash sheets and blankets once a week in very HOT water -130 F (Remember to adjust temp back to lower temp for child safety) • Use air conditioner or dehumidifier to lower humidity levels when needed • Remove carpets and replace with hard surfaces if possible • Damp clean hard surfaces • Vacuum often with HEPA vacuum or micro filtration bags • Lower indoor humidity-between 30-50%
Avoiding moldtriggers • Run a bathroom fan during showers or baths. • Exhaust the dryer to the outdoors. • Control moisture in the crawlspace. • Replace carpet with hard-surface floors in basement. • Don’t allow prolonged dampness in basement. • Use Dehumidifier or air conditioner to lower humidity when needed.
More on mold • You don’t need to test for mold -if you see it or smell it, then you have mold! • Clean up small areas with a bleach solution: • 1/2 cup of bleach to 1 gallon of water • Limit houseplants, at least in bedrooms • Soil and leaves contain mold. • Clean when children are not present and wear a dusk mask if you are allergic.
Pollens • Dust Masks when mowing lawn or our gardening – particularly on a windy day • Saline Nasal Rinses - flush out pollens • Showers at bedtime to remove pollens • Run air conditioner in car when possible (filters air) • Keep windows closed when indoors or in cars
Pets & animals • Skin flakes, urine, and saliva of warm blooded animals can be asthma triggers • Allergens can remain inside for months after an animal is removed (years for cats), even with thorough cleaning • Birds are extremely allergenic
Air cleaners & filters • HEPA filters for vacuums • Add HEPA or Electrostatic Room Air Cleaners only as a last resort - in addition to all of the allergen avoidance measures discussed. • Avoid ozone “air cleaners” which often trigger asthma
Air cleaners & filters • Know the size of the room to be treated before purchasing the unit • Change or clean filters frequently • Some gases and very small particles are difficult to remove
Food allergens Most common food triggers are cow milk, soy, eggs, wheat, peanut butter, tree nuts, shellfish & strawberries. If there is a history of food intolerance or allergy within the family, avoidance of high allergen foods during pregnancy and the first one to two years of child’s life can help reduce the incidence of food allergy.
Allergens are additive • Allergens are additive • Lowering exposure to the controllable allergens in the environment will help patients drop below their symptom threshold and tolerate remaining allergens.
Exercise & fitness 1. Exercise can trigger asthma symptoms when physical fitness is low. 2. It can help to keep asthma under control once conditioning/fitness improves. 2. “Rescue” medications (typically albuterol) can be used prior to exercise to prevent reactivity during exercise, particularly when deconditioned, or prior to peak performance/max effort. 3. Encourage cardiovascular fitness ! 5. Avoid obesity.
What’s new ? • Antibiotics decrease good bacteria in the gut while treating the harmful bacterial condition. • Overuse of Antibiotics correlates with the increase in Asthma and Atopic Dermatitis. • Probiotics have been shown (in multiple large scale controlled studies) to help reduce both eczema and asthma reactivity in children. • Take Probiotics >2hours apart from antibiotics.
Future treatments • New modes to desensitize to common triggers using peptides. • New medications targeting a newly discovered receptor in the airways. • Airway thermotherapy to lessen airway obstruction – only for extreme asthma.
For more information The U.S. Environmental Protection Agency (EPA) www.epa.gov/asthma The American Lung Association 1-800-LUNG-USA Healthy Indoor Air for America’s Homes project: www.healthyindoorair.org