Adventures of an Allergist Mommy

On Sept. 16, 2009, Adamis Pharmaceuticals Corporation announced that Walgreens will begin to offer its epinephrine pre-filled syringes (Epi PFS) as a generic alternative to epinephrine autoinjectors. Certainly, it is wonderful to have a lower-cost alternative to EpiPen and TwinJect. (Tier 1 co-pay on Aetna and Cigna!) Many parents cough up $70 or more out of pocket for epinephrine autoinjectors that end up being thrown away. Now, don't get me wrong- I think it's much better to spend the money and throw it away than not spend it and be without life-saving medication if you should need it. But when you need one for home, one for school, one for grandma's house, etc... it adds up. On top of that, I like to prescribe epinephrine for my immunotherapy patients, and they aren't thrilled about the co-pay either, especially when the prescription is only a precaution. However, just because the medication inside the syringe is the same doesn't mean that device is equivalen...

I have a special interest in the treatment of severe eczema, and for years have been recommending to my patients treatments designed to reduce the burden of the bacteria known as staphylococcus aureus. Staph aureus, as it is commonly known, colonizes the skin and nose of up to 90% of patients with atopic dermatitis, or eczema. This not only can lead to infections in inflamed skin, but can also contribute to worsening of eczema when patients develop an allergy to the toxins produced by the bacteria. The mainstays of antibacterial therapy for control of staph aureus colonization are: oral antibiotics, nasal antibiotics, and dilute bleach baths. The traditional thinking has been that implementing these measures would reduce the bacterial burden, thereby improving the condition of the skin. Now, a fascinating study in the September issue of Pediatrics has turned the traditional wisdom on its head. Sure enough, patients treated with the anti-staph cocktail therapy had better outcomes t...

This afternoon, Son #1 showed me an art project that he made at daycare- a conglomeration of sand and paint and glitter. Son #1: Mommy, look I made a picture for- Me (interrupting): It's beautiful, honey! Thank you! Me (thinking to myself): Oh gosh, he's going to be so proud of this one... How am I going to recycle it without him noticing? Son #1: Mommy, it's not for you. I made this picture for Selena Gomez (Disney teen queen). Me: Oh! Okay... well, it's very nice. I'm sure she'll love it. Me (thinking to myself again): Oh no. I have just been supplanted as my son's most loved woman. Selena Gomez, you better watch your back, little lady.

The evidence is mounting that the fungus responsible for athlete's foot and ringworm- trichophyton, may be playing a role in severe asthma... A Japanese study published in the Journal Chest examined rates of allergic sensitivity to this fungus in asthmatics and non-asthmatics, as measured by presence of IgE antibody in the blood specific for trichophyton. 32.4% of patients with severe asthma were sensitized to trichophyton, 15.8% of patients with moderate asthma were allergic, and only 4.9% of patients with mild asthma were sensitized. Interestingly, the rates for allergic sensitization to other common environmental allergens (cat, dog, mixed molds) did not differ significantly between the different groups of asthmatics. Similar associations between trichophyton and asthma have been noted in Venezuela and Turkey as well. Antifungal treatment in these patients has been shown to improve asthma severity. Bottom line? Although probably not a major issue for well-controlled asthmatic...

The following post is courtesy of the American College of Allergy, Asthma & Immunology (ACAAI) and the Allergy & Asthma Network- Mothers of Asthmatics. Thank you! The Food and Drug Administration (FDA) is warning healthcare professionals and the public about a shipment of a nebulizer medication that was recently stolen. The American College of Allergy, Asthma and Immunology (ACAAI) and Allergy & Asthma Network Mothers of Asthmatics (AANMA) urge patients using the nebulizer medication Albuterol Sulfate Inhalation Solution 0.083% to check the medication's lot numbers (see "What to look for," below). Police reported that on approximately Aug. 5 a tractor-trailer containing a 35,760-carton shipment of Albuterol Sulfate Inhalation Solution 0.038% belonging to the RiteDose Corporation was stolen in McKinney, TX. Anyone who comes across this product should notify the authorities immediately (see contact information below). The product is now illegal and may no...

Short post today: My son and I shared a Reese's peanut butter cup yesterday. As parents of peanut-allergic children know, this is no small victory. I am hopeful that in the not too distant future, oral immunotherapy will make the above scenario a reality for more children.

Image via Wikipedia Epinephrine is the first-line medication for the immediate treatment of anaphylaxis (sometimes referred to as "killer allergy"). Intramuscular injection of epinephrine is superior to subcutaneous injection in terms of how fast peak plasma levels of the life-saving drug are achieved. Consequently, epinephrine auto-injectors are deigned to deliver the medication to the large muscle of the anterior thigh (called the vastus lateralis). A recent study published in the July issue of the Journal of Pediatrics, however, suggests that intramuscular injection may not be achieved in a significant percentage of children with the current needle lengths of epinephrine auto-injectors (EpiPen and TwinJect). Ultrasound measurements of the thickness of subcutaneous tissue in children indicated that the needle lengths of the auto-injectors may be too short to penetrate into the muscle. When the outcome that one is attempting to prevent is death, this is no small issue. ...