This document summarizes information from a presentation on allergies given by Dr. Summit Shah. It discusses common allergy symptoms, the mechanisms of allergic reactions and anaphylaxis, treatments including avoidance, medications, and immunotherapy, and myths about allergies. Rush immunotherapy provides faster results than traditional immunotherapy but requires pre-medication, while traditional immunotherapy involves longer treatment with weekly shots but no pre-medication. Food is a leading cause of anaphylaxis, and accidental exposures are common. Proper and immediate epinephrine administration is important for treating anaphylactic reactions.

1. Allergies: Nip It in the Bud
Summit Shah, M.D.
Premier Allergy
08/17/2013

2. Disclosures
 Speakers Bureau
 TEVA Pharmaceuticals
 Educational Grant by Columbus Asthma Society

3. “My Allergies Are So
Bad!”

4. “Everytime the Weather
Changes…”
Tree pollens Early to mid-spring
Grass pollens Late spring and early summer
Weed pollens Late summer to early fall

5. “I Can’t Breathe!”

6. “I’m Always Itchy!”

7. “Is It Just Me
or is This
Allergy Season
the Worst
We’ve Ever
Had!”

8. “I’ve Been Told I’m
Allergic to Everything”

9. 1. Avoidance

10. 2. Medications

11. 3. Immunotherapy

12. “I am Always Clearing my Throat!”
Rush IT
 Less Shots
 Faster Results
 Need for pre-medication
 Not offered by most
allergists
Traditional IT
 Longer course
 1-2/weekly shots
 No need for pre-medication
 Offered by traditional
allergists, ENT, family
practice

13. “I Have Been Putting Up
With Allergies Forever!”

14. Definition of Anaphylaxis
 Systemic allergic reaction
 Affects body as a whole
 Multiple organ systems may be involved
 Onset generally acute
 Manifestations vary from mild to fatal

15. Sensitization Stage
 Antigen (allergen)
exposure
 Plasma cells
produce IgE antibodies
against the allergen
 IgE antibodies
attach to mast
cells
and basophils
Mast cell with
fixed IgE
antibodies
IgE
Granules
containing
histamine
Antigen
Plasma cell

16. Anaphylactic Reaction
 More of
same allergen
invades body
Antigen
Mast cell granules
release contents
after antigen binds
with IgE
antibodies
Histamine and
other mediators
.
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 Allergen combines
with IgE attached to
mast cells and
basophils,
which triggers
degranulation and
release
of histamine and other
chemical mediators
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17. Anaphylaxis Fatalities
 Estimated 500–1000 deaths annually
 1% risk
 Risk factors:
 Failure to administer epinephrine immediately
 Peanut, Soy & tree nut allergy (foods in general)
 Beta blocker, ACEI therapy
 Asthma
 Cardiac disease
 Rapid IV allergen
 Atopic dermatitis (eczema)

18. Food Induced Anaphylaxis
 35%–55% of anaphylaxis is caused by food allergy
 6%–8% of children have food allergy
 1%–2% of adults have food allergy
 Incidence is increasing
 Accidental food exposures are common and
unpredictable

19. Venom Induced
Anaphylaxis
 0.5%–5% (13 million) Americans are
sensitive to one or more insect venoms
 Incidence is underestimated
 Incidence increasing due to fire ants and Africanized
bees
 Incidence rising due to more outdoor activities
 At least 40–100 deaths per year

20. Venom: Common Culprits
 Hymenoptera
 Bees
 Wasps
 Yellow jackets
 Hornets
 Fire ants
 Geographical
 Honeybees, yellow jackets most common in East,
Midwest, and West regions of US
 Wasps, fire ants most common in Southwest
and Gulf Coast

21. Venom Immunotherapy
 Medical criteria
 Hx of any systemic reaction in adults
 Hx of life-threatening reaction in
children
 Positive venom skin test
 97% effective
 Can be discontinued in most after 3–5 years;
10% risk of systemic reaction to subsequent
stings

22. Myth: Insect Stings are the
most fatal
REALITY:
 While any trigger can be fatal, Most common trigger resulting
in a fatal outcome is food allergies, especially in peds.
 This is especially true with other risk factors , like Asthma
 Also aggravated as most kids forget Epi Pen or have the wrong
size.
 Most common fatal food allergies are:
 Peanuts
 Tree Nuts

23. Myth: Prior Reactions
Predict Future Reactions
REALITY:
 No predictable pattern
 Severity depends on:
 Sensitivity of the individual
 Dose of the allergen
 Anaphylactoid vs Anaphylactic

24. Myth: Anaphylaxis is Rare
REALITY:
 Anaphylaxis is underreported
 Incidence seems to be increasing
 Up to 41 million Americans at risk (Neugut AI et al,
2001)
 63,000 new cases per year
(Yocum MW et al, 1999)
 5% of adults may have a history of anaphylaxis
(various surveys)

25. Myth: Anaphylaxis is Easy to Avoid if
you know what you are Allergic To
REALITY:
 Most cases of anaphylaxis are due to
accidental exposures
 Clinical studies have found repeatedly that,
even when patients attempt strict avoidance
of a known allergen, their efforts are rarely
100% successful.

26. Myth: Epinephrine is
Dangerous
REALITY:
 Risks of anaphylaxis far outweigh risks
of epinephrine administration
 Minimal cardiovascular effects in children
(Simons et al, 1998)
 Caution when administering epinephrine in
elderly patients or those with known cardiac
disease

27. Myth: Cause of
Anaphylaxis is Obvious
REALITY:
 Idiopathic anaphylaxis is common
 Triggers may be hidden
 Foods
 Latex
 Patient may not recall details of exposure, clinical
course

28. Myth: Anaphylaxis Always Presents
with Cutaneous Manifestations
REALITY:
 Approximately 10%-20% of anaphylaxis cases will
not present with hives or other cutaneous
manifestations
 80% of food-induced, fatal anaphylaxis cases were
not associated with cutaneous signs or symptoms

29. Asthma: A Topic on Its Own
 Pathogenesis
 Symptoms
 Testing (PFTs and Skin Testing)
 Acute Treatment
 Chronic Treatment

30. Questions?