Can a Chihuahua help my asthma?!?

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Take Away Point if you’re too tried to read the whole article:

If there was a dog (any type of dog) that lived in the house while the mother was pregnant or during the first year of the child’s life, then that child could be protected for allergic disease (that’s hay fever, asthma, and eczema) up to about 6 years of age.

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Wait a second, sleeping with a Chihuahua MIGHT actually help my asthma?!?

As a doctor (or as a patient) you hear plenty of old wives tales: cold weather will give you a cold, feed a fever/starve a cold, don’t drink milk while sick, if you keep making those faces your face will stay like that . . . but one in particular always made me chuckle, if you sleep with a Chihuahua it will cure your asthma.

It made me chuckle since many of asthmatic patients also have allergic triggers, and what’s a common allergy trigger – dogs. (And for the record there are no non-allergic dogs. I wish there were, but there aren’t). But one lecture at the recent American Academy of Allergy, Asthma, & Immunology (AAAAI) made me think, hey maybe I’ve had it wrong with this Chihuahua business!

To understand what I’m referring to we first need to talk about the microbiome. Generally speaking, it refers to the diversity and number of bacteria in your body. The keynote speakers, Dr VonMutius, Dr Gallo, and Dr Lynch, discussed how maintaining this flora could help allergic/atopic disease. It’s a complicated topic to boil down, but if forced, you could refer to the argument of the hygiene hypothesis. How with increasing sanitation we might be sanitizing our ability to deal with allergens. In the past, the arguments were: maybe we all need to live on the farm, or clean less, or eat more dirt, or never use antibiotics. None of these suggestions is particularly appealing. Hygiene and cleanliness is critical in helping prevent disease and antibiotics (used judiciously) are important. What they showed in the study was maybe we just need a dog!

The study took a prospective look at children up to 6 years of age. Briefly, if there was a dog that lived in the house while the mother was pregnant or during the first year of the child’s life, then that child could be protected for allergic disease (that’s hay fever, asthma, and eczema) up to about 6 years of age. I have to be clear, this does not mean it will cure allergies, but that it could be protective. So, why is the dog so important? Having a dog in the household significantly increases the diversity and number of the bacteria in the home, and this increase in the diversity and number of bacteria helps create a more robust microbiome that could be protective for allergies.

What was my take away from this lecture? I should definitely still clean my house, use antibiotics ONLY for bacterial infections (and not colds), and that having my dog sleep in my bed is a medical necessity!

I might be well over 1 year of age, and my dog might only be part Chihuahua, but if my exercise-induced asthma miraculously disappears I will DEFINITELY keep yall posted!

Arya - Best dog ever #notbiasedatall

Arya – Best dog ever #notbiasedatall

References:

  1. Tippins K. Chihuahuas and Asthma. J Fla Med Assoc. 1965. April; 52: 246-7.
  2. von Hertzen L, Beutler B, Bienenstock J, Blaser M, Cani PD, Eriksson J, Färkkilä M, Haahtela T, Hanski I, Jenmalm MC, Kere J, Knip M, Kontula K, Koskenvuo M, Ling C, Mandrup-Poulsen T, von Mutius E, Mäkelä MJ, Paunio T, Pershagen G, Renz H, Rook G, Saarela M, Vaarala O, Veldhoen M, de Vos WM. Helsinki alert of biodiversity and health. Ann Med. 2015. April 23; 1-8
  3. Orivuori L, Mustonen K, de Goffau MC, Hakala S, Paasela M, Roduit C, Dalphin JC, Genuneit J, Lauener R, Riedler J, Weber J, von Mutius E, Pekkanen J, Harmsen HJ, Vaarala O; PASTURE Study Group. High levels of fecal calprotectin at age 2months as a marker of intestinal inflammation predicts atopic dermatitis and asthma by age 6. Clin Exp Allergy. 2015 May:45(5): 928-39.
  4. Lynch SV, Wood RA, Boushey H, Bacharier LB, Bloomberg GR, Kattan M, O’Connor GT, Sandel MT, Calatroni A, Matsui E, Johnson CC, Lynn H, Visness CM, Jaffee KF, Gergen PJ, Gold DR, Wright RJ, Fujimura K, Rauch M, Busse WW, Gern JE. Effects of early-life exposure to allergens and bacteria on recurrent wheeze and atopy in urban children. J Allergy Clin Immunol. 2014 Sep: 134(3):593-601.

The worst kind of weed allergy: marijuana

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marijuana-11983879Allergies with marijuana from smoking have not been well documented (likely due to the illegal nature of using it!), but reactions/allergies from hemp manufacturing or laboratory use have been reported. With the legalization of marijuana in several states, legal repercussions from reporting side effects from recreational marijuana use will be moot point and may lead to more reporting about reactions.

In general, with any reaction or allergy the first step is avoidance if at all possible. So in the case of marijuana, you would just avoid it. Unlike certain antibiotics, where desensitization would be life saving (like penicillin), or in environmental allergy, where certain allergens are widespread (like oak), with marijuana, you can just avoid it. I know, its not very exciting, it would be more entertaining if there was some sort of complicated challenge where we would desensitize you to marijuana by having you smoke a little each day (doctors orders right?). That wont be happening anytime soon.

The cases where people can truly not avoid it (hemp industry workers, narcotics officers, cannabis growers), then desensitization with immunotherapy (essentially allergy shots for marijuana), have been done, but it is not standardized and studied in very small numbers. Other options such as omalizumab therapy has been done in one patient.

Clearly, as legal acceptance of recreational marijuana use grows we will gain more awareness of side effects/allergies and in turn be able to devise more appropriate ways of treating it. I have a feeling a research study on marijuana use may have a good number of participants . . .

I’ll be discussing cannabis allergy on local Fox News Monday March 9th on the 9am hour. Tune in for more info!

Also, check out this great review in the Annals of Allergy Asthma and Immunology about Cannibis sativa: http://www.annallergy.org/article/S1081-1206(15)00035-6/pdf

#Epi4schools

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In September of 2013, a Corpus Christi student athlete was bitten by a fire ant on the sideline of a middle school football game. He developed a life threatening anaphylactic reaction (think throat swelling, difficulty breathing, severe facial/body swelling, hives) from this fire ant bite. For 25% of children, the first episode of anaphylaxis may occur at school. Epinephrine, which is the ONLY medication indicated for these types of reactions, was not available until EMS arrived and the student subsequently died 4 days later.

Of the 40 allergic reactions that occurred during the 2013-2014 HISD school year, only 3 students received epinephrine. Additionally, 30% of school nurses have reported using one student’s prescribed medication to help another. The cost of 1 epinephrine twin pack is less than the cost of 1 fire extinguisher, and regardless, the top manufacturers of epinephrine have already pledged (at least in the short term) to provide epinephrine for all Texas schools – and in fact already have a national program in place for this purpose.

I went to Austin yesterday to talk to our state legislators about passing the bill (SB 66/HB 566) that would mandate epinephrine in schools AND take away the liability of the people prescribing/administering this unassigned epinephrine. I did this with Dr Louis Bethea, who authored a portion of the bill, and Dr Ted Freeman, president of TAAIS (Texas Allergy Asthma and Immunology Society), along with local allergists in Austin, San Antonio, and here in Houston. Through First Tuesdays with the TMA (Texas Medical Association), we were able to discuss import medical related topics en force with a large group of physicians.

Texas is 1 of only 4 states that do not have some sort of epinephrine stocking laws in place for schools. We need to change that. Contact your local Texas state senator/representative here, and send this letter to them. They do listen to us, and together we can provide life saving medication to children in Texas schools.

For more pictures and information follow #Epi4schools on twitter and spread the word!

Texas Congress

Texas Congress Floor

Meeting with state representative Garnet Coleman's aides about HB 566

Meeting with state representative Garnet Coleman’s aides about HB 566. Drs Allen Lieberman, Carla Davis, Carlos Vital, Ted Freeman

First Tuesdays with the TMA

First Tuesdays with the TMA

Meeting author of senate bill 66, Senator Hinojosa

Meeting author of senate bill 66, Senator Hinojosa

Meeting with author of house bill 566, Representative Herrara

Meeting with author of house bill 566, Representative Herrara. Drs Atoosa, Carlos Vital, Carla Davis, Louis Bethea, Allen Lieberman, Ashwini Reddy, Ted Freeman, Wes Stafford

Go Vaccinate.

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So, measles and the MMR vaccine are pretty hot topics right now. Being board certified in pediatrics and allergy/immunology, I feel I am fairly qualified to talk about vaccines. I say that because one huge problem I hear from parents is the frustration about the VOLUME of information out there and they don’t know whom to believe. Some of you may say, ”Clearly your doctor should be the go to source,” and while I definitely agree with that, I can’t ignore the influence of Dr. Google and the fact that there may be actual doctors out there giving advice that directly contradicts the established medical consensus/guidelines. So, that is why I preface this post with my credentials. For the confused parents out there – know your sources. I won’t deny a mom’s natural instinct, but when it comes to things that are well-studied scientific conclusions, you’ve got to verify your sources!

With the vaccine “debate”, there are several ways you can discuss this, and I think the most effective way is to figure out WHY people don’t want to be vaccinated. Most people just want to do the right thing for their child. So, the question becomes “what has swayed this small group of people to be different from the majority of the population?” I thought about it, and there are four main groups: 1) patients who are unable to get vaccinated (medical contraindications, young age, etc.), 2) people who think vaccines will harm their children by causing autism, seizures, etc., 3) people who want to be as “natural” as possible without extra Western medicine, 4) people who want personal choice with absolutely no limits. I think by addressing each of these groups I’ll be able to present the facts that might best fit each group separately versus throwing ALL of the information at them.

1) This first group just can’t get vaccinated. Whether due to a true allergic reaction (extremely rare but it happens) or due to an immunodeficiency (either inherited or from chemotherapy), getting vaccines would cause death or significant harm. There’s no argument here. The main issue is continuing to do research to narrow down exactly who can and cannot get vaccines. A great example is complete and partial DiGeorge patients – research I worked on in 20081 shows that some of these patients can indeed be vaccinated and protected!

2) The next group has been inundated with the wrong information and need the plain facts. For the record, the MMR vaccine DOES NOT CAUSE AUTISM, but let’s delve a little deeper. The safety of the vaccine has been shown over and over again in various studies2-6. The association to autism mentioned in the Lancet journal article by Andrew Wakefield (subsequently retracted7-8) used guests at his son’s birthday party as samples (hardly non-biased), and in addition to losing his status as a physician, he has made money on promoting his anti-vaccine stance by speaking at various anti-vaxx conferences. As a “source,” he is far from credible.

3) The third group would be the ones that want to remain “natural.” I put natural in quotes because I am all about “less is more” and using medications ONLY WHEN NEEDED – that’s what I define as natural. So when people say they don’t want to vaccinate to remain “natural,” they disregard a century of medical advances and are absolutely wrong. When vaccinated patients go to the doctor’s office with a fever, cough and runny nose your doctor may shrug it off and say it’s viral – and we can do that ONLY IF you’re vaccinated. When an unvaccinated child comes to the office with fever, cough and runny nose we need to do a full workup to ensure your child is not infected with serious and extremely contagious illnesses that can cause blindness, brain damage, and, at worst, death, even with the proper treatment. I would much rather administer a vaccine so a patient can develop a NATURAL immunity to these viruses rather than worry that a patient is not protected and need to do an extensive, UNNATURAL workup.

4) The final group is the personal choice advocates. Often, it is unclear to me, as their physician, why this group does not want to vaccinate, as they often have no specific rationale – just that it’s their “personal choice.” I often educate these families on the concept of herd immunity. Herd immunity is what helps vaccines work, even in unimmunized patients. This illustration from the National Institutes of Allergy and Infections Diseases (NIAID) does a great job of demonstrating this principle.

Photo credit: The National Institute of Allergy and Infectious Disease (NIAID)

Photo credit: The National Institute of Allergy and Infectious Disease (NIAID)

You can see if there is a large group of vaccinated people, then even unvaccinated patients (such as the very young or immunodeficient) are protected. But otherwise, only vaccinated patients are protected, and the biggest losers here are the people that CAN’T get vaccinated. So while this illustration showcases the science of vaccines, it also really just boils down to the common good – by all of us working together, we really can protect the most defenseless amongst us.

I know there are more arguments and points of view that can be brought up here, but the quick and dirty is this: facts, science, and morality are on the side of vaccines. Go vaccinate.

Resources:

  1. Development of specific T-cell responses to Candida and tetanus antigens in partial DiGeorge syndrome. Davis CM, Kancherla VS, Reddy A, Chan W, Yeh HW, Noroski LM, Rosenblatt H, Shearer WT, Chinen J. J Allergy Clin Immunol. 2008 Dec;122(6):1194-9.
  1. MMR and autism: further evidence against a causal association. Farrington CP, Miller E, Taylor B. Vaccine. 2001 Jun 14;19(27):3632-5.
  1. Safety of vaccines used for routine immunization of U.S. children: a systematic review. Maglione MA, Das L, Raaen L, Smith A, Chari R, Newberry S, Shanman R, Perry T, Goetz MB, Gidengil C. Pediatrics. 2014 Aug;134(2):325-37.
  1. Immunization Safety Review: Measles-Mumps-Rubella Vaccine andAutism. Institute of Medicine (US) Immunization Safety Review Committee; Stratton K, Gable A, Shetty P, McCormick M, editors. Washington (DC): National Academies Press (US); 2001.
  1. Vaccines are not associated withautism: an evidence-based meta-analysis of case-control and cohort studies. Taylor LE, Swerdfeger AL, Eslick GD. Vaccine. 2014 Jun 17;32(29):3623-9
  1. Adverse Effects of Vaccines: Evidence and Causality. Committee to Review Adverse Effects of Vaccines, Institute of Medicine; Stratton K, Ford A, Rusch E, Clayton EW, editors. Washington (DC): National Academies Press (US); 2011 Aug 25.
  1. Wakefield’s article linkingMMRvaccine and autism was fraudulent. Godlee F, Smith J, Marcovitch H. BMJ. 2011 Jan 5;342:c7452.
  1. Lancet retracts 12-year-old article linkingautismto MMR vaccines. Eggertson L. CMAJ. 2010 Mar 9;182(4):E199-200.

Winter allergy blues

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So, it’s the winter season right now for most of the country (Houston has had highs in the 70s, but that’s besides the point), and the winter season means taking a break from allergy medications since nothing is pollinating, right? Well I’m going to make the argument that for some people staying on their meds, even during this season, may be in their best interest.

While most trees and grasses pollinate in the spring, there is definitely one notorious family that pollinates in the winter season – Mountain cedar. For anyone living in Texas (especially central Texas), the term “cedar fever” will elicit thoughts of runny noses, never ending watery eyes, and sneezing that makes it next to impossible to enjoy any new holiday release in theaters. In addition to cedar, there are the year-round indoor allergens such as cat dander, dog hair, and dust mites, which may even worsen since people are indoors more often – presumably to hide out from the cold weather. And lastly, there are all the usual winter suspects that make you sick: from the flu, to the stomach bug, to the good old cold.

Even mildly out of control allergies can magnify a simple cold and make it last forever. Taking a break from your allergy medicines causes those symptoms (however slight) to be worse and then you could be one cold away from developing a sinusitis. There are several options at this point, if your symptoms are truly mild at this time of year then perhaps decreasing dose/frequency or both maybe an option. Or there are always other more natural therapies that your doctor may recommend.

So what can you do if you don’t want to be on medications year round? Well, definitely figuring out what you’re allergic to via the right kind of allergy testing would be a good first step. Its important to see a board certified allergist so you know what you’re dealing with so you can approach it in the right way – either through avoidance, medications, or allergy shots.

Welcome!

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Welcome everyone to my site. I hope to give people a little more perspective about what allergies are, what we can do to minimize them, and of course what we can do to treat them – either with medications or naturally.