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Daniel More, MD



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Are Hives Caused by Food Additives and Preservatives?

Saturday April 12, 2014

Urticaria, also known as hives, can affect up to 20 percent of the population. Most people with chronic urticaria (hives lasting more than 6 weeks) have the suspicion of some type of food allergy as the cause of their hives. In many instances, people are concerned that food additives or preservatives are the cause of their symptoms. These people may attempt to follow a preservative-free diet, with possible improvement in their symptoms. When they see an allergist for further evaluation, they find that there is no simple way to test for allergy to additives and preservatives. A recent study sought to determine if eleven different food preservatives and drug additives were responsible for chronic hives in 100 different people. Find out the results of this interesting study.

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Urinary Biopyrrin is a Biomarker for Eczema

Tuesday April 8, 2014

Food allergies and contact aeroallergens (such as pet dander and dust mites), are common triggers for atopic dermatitis. Irritants and dry weather can also worsen symptoms. People with atopic dermatitis may also have a flare in their symptoms due to an infection caused by bacteria, fungi or viruses. It can be difficult to predict when a flare of atopic dermatitis may occur, but once itching has become severe and scratching occurs, it can be difficult to get symptoms under control. There is a need for a biomarker for atopic dermatitis that can be followed to predict exacerbations of atopic dermatitis. Urinary biopyrrin may represent a biomarker for atopic dermatitis that could help predict exacerbations before they occur, so that appropriate treatments can be started in order to prevent severe attacks.

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Oralair Approved as a Sublingual Immunotherapy Tablet for Grass Allergy

Thursday April 3, 2014

This week, the U.S. Food and Drug Administration (FDA) approved a sublingual immunotherapy tablet for the treatment of grass allergy. Oralair, the brand name for the tablet, is the first sublingual immunotherapy (SLIT) treatment approved by the FDA for the treatment of allergic rhinitis and allergic conjunctivitis caused by grass pollen. Immunotherapy, in the form of allergy shots, has been used in the U.S. for more than one hundred years. Some allergists in the U.S. have offered SLIT (allergy drops placed under the tongue) as an experimental (non-FDA approved) therapy for years, although SLIT has been used around the world for many decades -- meaning this is not a new therapy.

Oralair has been shown in multiple studies to be a safe and effective treatment for the symptoms of grass allergy, and unlike allergy shots, is safe enough to be taken at home. The treatment needs to be started months before grass season, however, and can either be continued throughout the year or stopped after grass season has ended. It is approved for people 10-65 years of age.

In my opinion, Oralair has little chance of success in the U.S. First, I will be surprised if many physicians prescribe this product. Allergists who treat allergic rhinitis would rather prescribe allergy shots (which are probably more effective), or allergy drops mixed in their own office. These allergy drops aren't limited to grass allergy, but can also be used for other pollens, pet danders, dust mite and in some cases, mold allergy. Any physician prescribing Oralair will also be incurring a risk/liability for allergic reactions caused by the medication, which while rare, can still occur. The first dose of Oralair is recommended to be given in a physician's office with monitoring for 30 minutes, which most non-allergists aren't comfortable doing. Thereafter, the product can be taken at home. Injectable epinephrine should always be available for a person taking SLIT, including Oralair. Lastly, most non-allergists are ill-equipped to appropriately diagnose and treat allergic rhinitis, and are unlikely to be able to explain to patients how immunotherapy works, the risks and benefits, as well as the fact that Oralair doesn't treat immediate symptoms -- months are required to realize benefits. Most people are looking for relief with they have symptoms, not 4 months before their symptoms start. Therefore, while the approval of Oralair represents an exciting step in the field of allergy, since SLIT is now an FDA approved treatment for allergies, I doubt that Oralair will get much use in this country.

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Spring Allergy Season Has Sprung

Sunday March 30, 2014

Finally, the cold weather has gone away, and the outdoors are looking green again. With the warmer weather comes the pollen, and most areas of the country are seeing significant tree pollen in the air. The grass pollen is soon to follow. This spells misery for the allergy sufferer. However, with a little preparation, spring allergies don't have to ruin your outdoor activities this year. Whether you're seeing an allergist, a regular doctor, or have no ability or time to see a physician in order to obtain a prescription, there's plenty of options to combat your allergies this season.

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Xolair Get FDA Approval for the Treatment of Chronic Hives

Monday March 24, 2014

The U.S. Food and Drug Administration recently approved the use of Xolair for the treatment of chronic idiopathic urticaria (CIU). CIU is the name used to describe hives that last more than 6 weeks in duration without an apparent cause. Xolair has been shown to reduce or eliminate symptoms of hives in people with CIU who don't respond to treatment with oral antihistamines. While the data on Xolair treating CIU is pretty impressive, it will be interesting to see if many insurance companies cover the cost of this medication: Xolair costs thousands of dollars per year. Only the people with the most severe CIU symptoms are likely to incur that cost in order to control their symptoms. On the other hand, this news is ground-breaking because Xolair becomes only the second medication FDA-approved to treat CIU other an oral antihistamines.

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Should You Use Nasacort, Zyrtec, Claritin or Allegra for Your Spring Allergy Symptoms?

Monday March 17, 2014

In February 2014, Nasacort AQ became available over-the-counter (OTC) without a prescription. It is currently referred to as Nasacort Allergy 24 Hour, and is the same medication as the prescription version. OTC Nasacort hits the shelves just in time for spring allergy season, but should you use this medication, or one of the newer OTC antihistamines, such as Zyrtec, Claritin or Allegra? The answer depends on the type and severity of your symptoms. Nasacort, an intranasal corticosteroid, is probably the most effective OTC medication for the treatment of nasal allergy symptoms. A downside to Nasacort is that it will not work on an as-needed basis; intranasal corticosteroids take time to work -- the may begin to give relief to allergy symptoms after about 6-10 hours, but full relief may not be obtained for days.

Antihistamines, such as Zyrtec, Claritin and Allegra, on the other hand, tend to work fairly quickly, usually within a couple of hours (or less) of taking the medication. Therefore, these medication work well when taken on an as-needed basis, as opposed to medications like Nasacort, which need to be taken most of the time for them to work. Antihistamines work best for the treatment of itchy nose, itchy eyes and sneezing -- and less well for symptoms of nasal congestion or runny nose. Of the three types of newer (and less sedating) antihistamines mentioned above, Zyrtec and Allegra work particularly well for the treatment of nasal allergies -- and usually within about an hour. Claritin, on the other hand, doesn't work as well, and takes about 3 hours to fully take effect. All three of these antihistamines are a good choice for spring allergy relief, and would be recommended over taking a sedating antihistamine such as Benadryl.

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Can Allergy Medicines Suddenly Stop Working?

Wednesday March 12, 2014

I hear this all the time from my patients. They'll tell me that the "developed an immunity" to a certain medicine, and after a period of time -- say months to years -- the allergy medicine simply stops working, and they need to change to another medicine. Could this actually happen? Possibly. We know that in pharmacology, certain medicines, when overused, can stop working as well since the body will start making less of the receptor for that medicine. For example, this is exactly what happens with the overuse of albuterol for the treatment of asthma. However, I don't know of any science behind why other allergy medicines, such as antihistamines and nasal sprays, stop working.

Recent surveys do show that both adults and children experience the loss of effectiveness of allergy medicines. Nearly 2 out of every 3 adults report that they have stopped an allergy medicine in the past because it stopped working, typically within a matter of months. And, nearly 20% of adults report changing allergy medicines in the past year because the medicine stopped working. Children seem to experience a loss of effectiveness of allergy medicines as well, with nearly 10% changing allergy medicines within the past year, and more than 1 in 4 children needing to change nasal sprays regularly because of the benefit "wearing off".

So, do people actually develop "immunity" to allergy medicines as a reason why the medicines stop working? It's doubtful, in my opinion. But there's no doubt that people seem to think that the allergy medicine loses its effectiveness, for whatever reason, which results in the need to try something else.

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Immunotherapy for Food Allergies

Tuesday March 11, 2014

Food allergies are becoming increasingly common around the world, with approximately 8% of all children and 5% of all adults having at least one food allergy. The most common food allergies in children include milk, egg, soy, wheat, peanut, tree nuts and seafood. In adults, the most common food allergies include seafood, fruits and vegetables (often as a result of the oral allergy syndrome).

Classically, there is no cure for food allergies. Avoidance of the culprit food is the best way to prevent symptoms. There have been many studies performed over the past 10 years that have attempted to cure food allergies - experimental treatments have included a variety of different forms of immunotherapy, meaning that the culprit food is given back to the allergic person in an attempt to force the immune system into tolerating the food, rather than reacting in an abnormal, allergic way.

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Get Control of Spring Hay Fever!

Saturday March 8, 2014

If you've got a stuffy nose and your box of Kleenex is getting more use than your iPhone, you might have hay fever. But you're not alone -- tens of millions of Americans suffer from spring hay fever. With the warmer weather, longer days and greener plants, you can expect lots of sneezing, itchy eyes, and a runny nose. What can you do to combat spring allergies this year? You have a wide range of strategies to choose from in order to get your spring allergies under control. See some of these strategies on this great slide show, and then check out the following articles to learn more:

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New Version of Primatene Mist Inhaler Rejected by the FDA

Sunday March 2, 2014

Primatene Mist CFC Inhaler was an over-the-counter (OTC) inhaler used for the treatment of immediate asthma symptoms, but was removed from the market in late 2011 because the harmful effects of its propellant on the environment. Since that time, the only available OTC asthma medications were Primatene in tablet form and Asthmanefrin in nebulized solution form. All prescription asthma inhalers were required to switch to a different propellant, called hydrofluoroalkane (HFA), which doesn't have harmful effects on the environment.

Primatene Mist HFA OTC was recently submitted for FDA approval, but subcommittees on OTC Products and Allergy/Pulmonary Drugs rejected this proposal. The reasons cited for the rejection included the lack of a dose counter, frequent clogging of the inhaler, and the fact that inhaled epinephrine is not routinely recommended for the treatment of acute asthma symptoms.

While physician groups are happy with the FDA's decision to reject the approval of Primatene Mist, this decision may make it harder for people with asthma to obtain OTC medications for the treatment of their symptoms. This may lead to more visits to urgent care centers and emergency rooms, as well as hospitalizations for asthma. On the other hand, given the better availability of healthcare as a result of Obamacare, asthmatics should be able to see a healthcare provider for the purpose of asthma treatment, which for most asthmatics includes the use of an asthma controller therapy -- none of which are currently available OTC without a prescription.

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