Issue 1

Expert Advice:

The Golden Cloud of Misery
By: John P. Dice, M.D.

Every winter in South Central Texas, cedar fever strikes the population. Cedar fever is the common name for the allergy symptoms caused by the pollen of the mountain cedar tree. Allergies do not actually cause a fever but these symptoms can be so severe that sufferers feel as if they have a flu-like illness.

Mountain cedar is unique to this part of country. These trees spread from southern Oklahoma down through south central Texas. They are extensive in the Texas Hill country and can distribute their pollen for many miles. It is one of the most potent pollens in the United States, right up there with ragweed and cat as a cause of allergy misery.

Also unique about mountain cedar is that during its pollinating season, typically late November through February with a peak in mid-December, it is usually the only pollen in the air. Consequently, anyone with obvious allergy symptoms during the winter months usually can be assumed to be cedar-allergic. This pollen may worsen other problems such as asthma or atopic dermatitis (eczema). In some cases, severe nasal symptoms may predispose to the development of a sinus infection. Out of control allergy symptoms typically lead to poor sleep, chronic tiredness, irritability and decreased performance at work or at school.

The treatment for a patient with mountain cedar allergy is similar to the treatment for most allergies. The best option is always to avoid the pollen so staying indoors as much as possible is helpful. Make sure to keep your doors and windows closed and run the air conditioner which acts as a filtering device. Keep the filters for your unit clean. If you have been outside, taking a shower and changing your clothes can reduce the amount of pollen that may have stuck to you while you were outdoors.

If symptoms are severe enough then see an Allergist for assistance. Your Allergist will take a good history and perform a physical examination and often perform a simple skin test to determine your specific allergic sensitivities. Once these have been determined, the Allergist will be prepared to advise you as to the best way to control your allergies.

With proper education on avoiding your allergy triggers and the use of prescription medications, many of which are not available over the counter, you can usually achieve control of your symptoms. Allergy shots also can be used to improve your tolerance to the things that normally trigger your allergies. These injections offer the possibility of a significant and long-lasting improvement in your allergy symptoms and, in children, have been shown to reduce the chances of developing asthma as well as additional allergies.

Texas may be cursed with the mountain cedar tree and the severe allergy symptoms that it causes but there are things that you can do to help. Your Allergist can help you determine the most effective plan specifically for you!

Because we eat and drink so many "foodstuffs" (any food or drink we consume) that are potentially toxic, infectious or otherwise harmful, our gut contains the greatest immune system in our body. Unfortunately, instead of only protecting us, often there may be an adverse reaction to foodstuffs leading to disease somewhere in the bowel as well as other parts of the body.

Studies show that 4-8% of infants have cow milk allergy, with predominant gut problems. Such symptoms include colic, spitting up, constipation, diarrhea, nose disease, asthma, eczema and recurrent ear infections. In older children and adults, 4% may also have allergic reactions to various foodstuffs. In this percentile, allergic reaction is immediate, with symptoms presenting two hours after consumption. Some have an anaphylactic reaction (a severe life-threatening reaction), but most have less severe reactions such as belly symptoms, rhinitis (nose symptoms), asthma, itching and rashes. Because reactions occur so soon after eating, these foodstuff offenders are frequently easy to recognize.

At least 15-20% of the population has delayed reactions to various foodstuffs, with symptoms presenting two to twenty four hours after consumption. Unlike the other 4%, this group can be difficult to diagnose because of delayed reactions and unclear symptom history. Some reactions are related to special immune cells, while others are associated with toxicity, intolerance or lack of digestive enzymes in the intestine. Belly pains, irritable bowel syndrome (IBS), migraines, headaches, rhinitis, asthma and hives are symptoms of these immune reactions. Especially important are reactions in the central nervous system ranging from emotional shifts, tiredness, ADHD, autism and seizures.

Allergy specialists can be helpful in identifying and treating adverse reactions to foodstuffs. Special blood tests can be preformed to help identify the offending agents. Lastly, experienced dieticians are helpful in developing a diet that eliminates most or all of the unsafe foodstuffs, optimizing the life of the patient!

Flu season has arrived and it's early at that! This year we will be dealing with a double whammy, per se, both the seasonal flu, and the swine flu (H1N1) will be circulating at the same time. H1N1 has been circulating since April '09 and the seasonal flu typically starts circulating in colder weather months (winter). Their symptoms are relatively the same and they are spread the same way. However, the swine flu tends to afflict younger individuals (children and young adults) more frequently than older individuals and it spreads very easily. Prevention and treatment for H1N1 and the seasonal flu are the same.

The key Flu facts (seasonal and H1N1):

Spread of the virus occurs when someone with the flu coughs and/or sneezes in close proximity to someone without the flu. The virus enters the body thru the eyes, nose or mouth. Symptoms of the flu can appear within less than 7 day of contact with an infected individual. A person with the flu is contagious 24 hours before he or she feels sick and can continue to pass the flu virus to others up to 7 days after the onset of symptoms, even if they are afebrile (without fever).

Some Signs and Symptoms: sudden onset, fever can last up to 4 days, severe body aches and fatigue, dry cough, headache, sore throat, sneezing, a runny to stuffy nose and for some vomiting and/or diarrhea. If you or someone in your care develops these symptoms contact your health care provider STAT, in other words, as soon as possible for the appropriate course of treatment.

How do you prevent the flu? Get vaccinated early for the seasonal flu and for H1N1. They are 2 separate vaccines. The vaccine for the seasonal flu has been available since September '09 and the H1N1 vaccine became available in October '09 (check with your PCP (primary care provider) local pharmacy, or Dept of Health). It can take up to a week or longer after vaccination to be considered protected against that particular virus. It is recommended by the CDC that you still get vaccinated if you have already suffered with the flu or any other similar flu like illness. Other recommendations for prevention of the flu involves the 3 C's: clean (hand sanitizer or washing hands with soap and water), cover (sneeze or cough in your shoulder) and contain (stay home and away from others for up to one week, if you suffer with flu like symptoms).

Those at high risk of developing severe illness or complications from the flu that could lead to death are children under 5 years old, adults over the age of 65, and all pregnant women. Also people of any age with a chronic illness like asthma, and other lung disorders, diabetes, heart, kidney, liver, blood or immune disorders. These individuals should be the first in line for their flu vaccines (seasonal and H1N1).

Treatment of the flu for most individuals includes lots of rest (at home), fluids and fever reducers (non-aspirin fever reducers for children). Those in the high risk category for developing complications (see above paragraph) from the flu should contact their health care providers within the first 48 hrs of symptom onset for a prescription of a possible anti-flu medication that can reduce the duration and severity of the flu.

It's getting ugly out there so make soap/water and hand sanitizer your best friends this flu season.

The MA Corner:
The Importance of Bringing Your Medications
By: Daisy Cherain, R.N.

"Please be sure to bring in all of your medications, including inhalers and spacers to your appointment."

This message should sound familiar to all of our patients, new or existing. It is repeated to them during their appointment reminder courtesy call. Most patients understand the seriousness of bring in their medications and complying with this request. For the ones who don't, let me explain why we have this policy.

When patients bring in their medications, it allows our providers to have a comprehensive look at their complete medical care. This information is important when providers are developing treatment options for patients. Some medications may be contraindicated due to another medication he or shi is prescribed. It is important that the physician has noted each medication prior to recommending further treatment. For instance, a class of antihypertensive medication called Beta Blockers is contraindicated for patients currently on immunotherapy (allergy shots). According to NHBPEP, over forty three million Americans have hypertension, and with several different types of medications on the market to treat hypertension, it can be difficult to remember exactly which one you may be prescribed. Which leads me to my next point, most patients are not just on one medication. This can prove to be a challenge when sitting in a doctor's office and filling out a medical questionnaire. Once again, this is why we ask for you to BRING in your medication.

In addition to safety, technique is also very important. When we prescribe a medication, we want to know you are not only compliant with that medication, but also using it correctly. One type of medication that is commonly used incorrectly is asthma inhalers. When a patient returns for their follow up visit, this is the perfect opportunity for our medical staff to confirm that patients are using their medications correctly. So please, be sure to bring your medications to your appointment!

s, patient care is administered within an office setting. However, sometimes there are people who are in need of medical attention and don't have access to proper medical care. Knowing these facts, we participate in several health fairs each year, offering free allergy and asthma testing. In fact, this year alone, we have enrolled in 5 different health fairs and have provided almost 800 people with free medical attention.

For example, this past June, we had the privilege to work with HEB pharmacy, and the San Antonio Allergy, Asthma and Immunology Society on the first ever San Antonio Citywide Asthma Screening Health Fair. The asthma fair was the idea of Mr. Brent Thacker (HEB San Antonio Regional Pharmacy Director) and Dr. John P. Dice (President of San Antonio Allergy, Asthma & Immunology Society). Because San Antonio has a high severity rate of asthmatic patients, Mr. Thacker and Dr. Dice knew a free asthma screening fair would greatly benefit our community. The asthma fair was held in four different HEB locations throughout San Antonio, involving seven allergy/immunology physicians and numerous other volunteers. Health fair participants were tested with a spirometer (a device used to measure a person's lung capacity based on the amount of air that person can exhale), which allowed them to perform a pulmonary function test or PFT. PFT testing is commonly used on patients who have asthma or are expected to have asthma. After completing their PFT, results from the test were provided to the participant by one of the attending physicians. Treatment options were discussed, along with recommended medical clinics where the participant could continue medical care for their symptoms.

In addition to free testing and medical advice, we also offer health fair attendees the opportunity to enroll in a research study. These studies are a great benefit for people who don't have access or simply can't afford medical care. People who participate in these studies receive free medical care, free medication and compensation for their time. (Click here to see a list of current research studies)

We understand that hard times are upon us and we want the residents of San Antonio to know that Allergy, Asthma & Immunology Associates of South Texas is here to help!