Winter is on it’s way, and allergies don’t stop there. Here are some room by room tips to help you cope with winter allergies!

Bedrooms (number one important allergen is the house dust mite)
1. Encase your pillows and bedding (mattress and box spring) with tight allergen–impermeable slip covers that “seal in” indoor house dust mites if you have allergic sensitivities to this powerful indoor allergen
2. Dust mite levels in mattresses are more closely linked with asthma attacks
3. Wash bedding in very hot water every 7–14 days
4. Remember to reduce dust collectors, particularly in the bedroom, such as drapes, horizontal blinds (tend to trap dust easily and more problematic to clean them), non-washable items (stuffed toys)
5. Washable window shades are preferred
6. Unpacking of winter clothing may have accumulated dust and mildew from open storage in basement or attic areas
7. Try and keep pets out of the bedroom if you have pet allergies

Bathrooms
Look for problem areas with excess mildew and molds, leaking faucets, damp carpets and/or rugs

Kitchen
1. Exposure to household cleaning agents, aerosols, cleaners, cockroach traps
2. Limit candle usage
3. Check refrigerator drip pans for excess mildew and moisture
4. “Always open the window or run an exhaust fan, when you’re cleaning in an enclosed space, you must always have good ventilation,” says Pramod S. Kelkar, MD, chair of the American Academy of Allergy, Asthma, and Immunology’s Cough Taskforce.

Living Areas
1. Smoke from fireplace, chemicals from carpeting and furnishings, pet hair and dander
2. Avoid scented candles and potpourri
3. Use a HEPA air cleaner (either room model or central HVAC) to remove unwanted airborne pet allergens (cat, dog hair)
4. Even if you’re not the one out of ten allergy sufferers allergic to pets, your household pets are still quite capable of bringing outdoor hidden allergens indoors on their skin and fur
5. Cover air vents with allergen filters
6. Keep humidity in check – don’t over do it with trying to over humidify your home. Get a hygrometer and measure humidity inside, try and keep it less than 40-45% to avoid a buildup of mold spores and dust mites (they love excess humidity). 
7. Avoid excessive amounts of house plants if you have sensitivities to mold spores
8. Hardwood floors and tile are better than wall to wall carpets and heavy rug
9. Vacuum frequently with a HEPA (high efficiency particulate air) filter in the vacuum cleaner which will able to catch many allergy-irritating particles (hopefully this can be done by non allergic individual)
10. Keep out of rooms recently vacuumed or dusted for about 30 minutes to let the “dust settle”
 
Remodeling, renovations and decorating your home
1. Try to choose products made with real wood and low-VOC sealants 
2. If you must use carpeting in your home, go for ones that are free of formaldehyde and use allergy-friendly paints 
3. Open the windows to properly ventilate the home
 
Garage
Exposure to chemicals, paints, mildew, fumes and gardening products
 
Additional tips
1. Control your stress during the frantic holiday period
2. Learn coping and stress management strategies (yoga, meditation) if you are one of over 17 million with asthma.  Holiday stress can tighten respiratory passages and aggravate asthma. 
3. Lastly, don’t forget if you have allergies and/or asthma have your emergency medications on hand at all times

Get some more expert advice from the American Academy of Allergy, Asthma and Immunology at http://www.aaaai.org/patients/topicofthemonth/1107/  and http://www.aaaai.org/winterallergy/2006/ as well as from the American College of Allergy, Asthma and Immunology at: http://www.acaai.org/public/indoor/indoor.htm

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

During in the fall and early winter time in most 4-season regions of the US, we see an upswing in the number of individuals who suffer with a variety of respiratory and allergy symptoms as a result of greater exposure to pet cats and dogs.  Almost 70% of U.S. households have one or more domestic pets, equally divided between cats and dogs, accounting for 100 million pets.

Allergic owners suffer from reactions to their pet’s dander, skin flakes, saliva and urine. Hair or fur also can collect pollens, mold spores and other outdoor allergens. Americans love their pets and a recent Japanese study found that one in four patients with pet allergies continue to keep a pet despite allergy- and asthma-related problems.  In addition, the study indicated approximately 80 percent of the pet owners surveyed kept their pets inside the home most of the time. 

The presence of allergic dander in cats and dogs is not affected by length of hair or fur, and there are no truly “hypoallergenic breeds.” According to another study I conducted at The Long Island College Hospital in Brooklyn, NY, the color of a cat’s hair may influence true allergic symptoms in people exposed to the dander. Preliminary data from a self-administered questionnaire of 400 households with pet cats indicated a significantly greater amount of allergy-related symptoms (such as sneezing, runny nose, watery eyes and itchy skin) with exposure to dark cat hair. As expected, the severity of allergy symptoms also was greater in owners who permitted their pet’s unlimited access to the bedroom.

Keeping animals outdoors is only a temporary solution since pet dander will eventually accumulate in the house, carried inside on clothing. Even the type of clothing worn can affect the transportation of pet dander.

Taking Control

Keeping pets out of the bedroom can reduce unnecessary suffering since people spend approximately one-third of each day in this room. The presence of cats and dogs on owners’ beds contributes greatly to the amount of airborne allergens in the home. Exposure to airborne allergens, which also are spread by air currents, can be reduced by restricting the pet’s presence in bedrooms, dens or living rooms with upholstered furniture.  

Because pet dander is quite light and buoyant, and floats freely in the indoor air, electrostatic or HEPA air cleaners can be a big help in removing unwanted allergenic particles, especially cat dander. The size of the space determines the size filter necessary, and units are available as tabletop models or can be adapted to central air conditioning systems. Placing a screen or filter over room vents may keep dander from traveling through the heating and air conditioning system. Bear in mind that it may take six months or more to completely rid the home of cat dander particles even after the pet is removed.

There are a variety of other measures that can be utilized to minimize contact with pet allergens:

• Get allergy tested and learn if you are really allergic to your pets!
• Avoid hugging and kissing pets if you are truly allergic to them.
• Remove litter boxes from direct contact with allergy sufferers and place them away from areas of air filtration intake vents in homes with central heating and air-conditioning.
• Wash hands after handling or touching a pet to help avoid spreading the dander.
• Consider placing plastic covers on the couch or other upholstered furniture (which may harbor pet allergens) where the pet sleeps or rests.
• Utilize washable mattress  (encasings) covers, pillow covers and bedding in 130 degree hot water
• Replace carpeting with tile, linoleum and hardwood or other solid-surface flooring.
• Wash your pet on a weekly basis. Recent studies have indicated that some significant reduction in the amount of pet allergens occurs with weekly washing of dogs and cats. This activity appears to reduce the amount of dander that causes allergy symptoms
• A non-allergic individual should brush the pet regularly, outside of the home.
• Speak with your pet’s veterinarian to get a well balanced diet for your pet. This change in diet may help to minimize hair loss for the pet and this can reduce dander indoors.
• Use a double or micro-filter bag and a HEPA filter in the vacuum to augment the filtration of the vacuum cleaner and, in turn, reduce the amount of pet allergen present in carpeting that leaks back into the room air. 
• Finally, for those allergy sufferers who want to keep their pets, look into the administration of allergy shots (immunotherapy) by your allergist/immunologist to reduce the unnecessary suffering associated with having a pet in the home.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Just yesterday I was traveling back from Seattle from the annual meeting of the American College of Allergy, Asthma and Immunology.  Quite a coincidence I, the “allergist,” was seated next to a young woman who was recently hospitalized and admitted to the ICU for severe anaphylaxis to peanuts.

It was very relevant and timely, as the snack service provided by the airline included the serving of peanuts and peanut crackers to passengers.  My physician assistant and I immediately got involved and requested a “peanut-free zone” be extended around the food allergic passenger’s seat.  The flight attendants worked smoothly and professionally to make this happen and to avert a potentially serious health issue for the passenger who has a life threatening food allergy to peanut and nuts. 

Take home message: Don’t be afraid to speak up when traveling on a plane! Many airlines will likely try and accommodate you if they are aware of this type of condition.  It’s not a bad idea to alert the airline when you are making your reservation so the “on plane” staff is also aware of your allergies and can easily help assist you if peanut products are served aboard the aircraft. Some airlines have already moved to peanut free snack foods. Check with your airline to learn if they are peanut/nut free! For travelers with the severest allergies, it is best to bring food from home just to ensure freedom from allergy-causing ingredients.

Let’s review food allergy avoidance and management while away from home.

• First, if your provider has given you an epinephrine auto-injector (i.e. Twinject, Epi-Pen) make sure you have this medication with you at all times when traveling in case of anaphylaxis (food allergy and anaphylaxis plan should be in place). 
• Also remember to have a note from your provider indicating the need for you to carry the “auto-injector” on the plane. 

The Food Allergy and Anaphylaxis Network is a great resource for food allergy safety tips while traveling if you or a family member has a food allergy.  One strategy mentioned is to choose the first flight available in the morning. Airplanes are sometimes cleaned at the end of each day and flying early in the morning may decrease the chance that the seats will contain food crumbs or residue.

Go to http://www.foodallergy.org/Advocacy/airlines.html for more information. It’s important to remember that more than 3 million Americans have food allergies to peanuts and nuts.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Asthma may affect as many as one out of ten children in the US.  During the fall months and in to winter we see a tremendous increase in the number of children with active symptomatic asthma.  A respiratory viral infection is a rather frequent co-conspirator responsible for a higher number of children suffering with worsening asthma.  Other important factors include a change in weather, cooler, drier air as well as increased exposure to indoor allergens. Another issue is children who are given less medication during the later summer and early fall now more than ever need a provider directed asthma regimen to prepare for cold and flu season as well as winter. 

According to a study presented at a meeting held by the American College of Chest Physicians it was observed that October and November are the peak months for children’s asthma, including ER visits, hospitalizations as well as needed asthma medication. Make it an ideal time to review asthma “action plan” (including the proper use of a peak flow meter) with your physician or health care provider at:

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm

What are some symptoms that may indicate that your child’s asthma may not be well controlled?

• Recurrent and persistent cough
• Cough as a result of exposure to pets, exercise and even laughing
• Wheezing
• Trouble breathing or catching your breath
• Tightness of the chest and “congestion”
• Worsening asthma after cold virus and sinus infections
• Nighttime cough
• Increased use of quick reliever “rescue” inhalers

Why are more children suffering from asthma?

Read on in an upcoming blog in order to assist you in reducing asthma symptoms in your child.  Don’t forget the flu shot!   

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

What have we learned from previous year’s Halloween celebration? It can be done safely and wisely with kids enjoying their special day (or night).  One of the most important things to do for this holiday (as well as anytime) is to be a LABEL DETECTIVE! That’s right as a parent you must read each and every label of packaged foods.  Many snack foods and candy may contain peanuts, nuts, egg and milk (among the most common food allergens in kids).   

Learn more about safe food allergen labeling and consumer information which will simplify whether a food contains one of the top 8 food allergens to protect consumers with food allergy @  http://www.cfsan.fda.gov/~dms/alrgqa.html. 

So here is a partial list of ways I have found to enjoy a safe Halloween.

·     The American Academy of Allergy, Asthma and Immunology have a great check- list of things to do for a safe Halloween at:  http://www.aaaai.org/patients/elements/1008/08halloween_checklist.stm

·     Go shopping with your child and pre-purchase safe foods and snacks that do not contain suspect allergens before the “trick-or-treating” begins

·     Attend a Halloween party with your child to ensure that you can monitor to keep your child safe and resolve any food allergy concerns

·     Bake safe foods and treats at home and bring them with you to parties and during trick-or-treating on Halloween (if your child has gluten intolerance or celiac disease, this will be particularly important)

·     If your child is allergic to egg and egg products watch out for the appearance of “shiny” food products that may signal egg coating on bakery foods

·     Keep your child’s emergency medication on hand, such as an epinephrine auto injector, if they have prescribed for potential use if a food induced allergic reaction should occur

·     Consider non food items such as stickers, crayons,  in lieu of snacks, candy and food

Check out www.foodallergy.org (The Food Allergy and Anaphylaxis Network) for more food allergy safety tips to keep it safe and an enjoyable holiday for your family 

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition. 

Many of us are searching for a more natural way to get healthy and treat allergies.  One of the approaches is to work with an “integrative medical specialist” to complement traditional allergy care for ourselves and family members if you have allergies.  First, let’s get the proper testing to make sure you have allergies that require care.  Second, how to “boost” our immune system to assist in conquering allergy symptoms with healthful foods? Great question, now I have some answers after talking with my colleague, Aran Degenhardt, MD, MPH who is a specialist of Integrative Medicine and on the Faculty of NYU Langone Medical Center in NYC. 

Dr. Degenhardt also recommends fruits and vegetables for anti-oxidants (Vitamin C, selenium) and quercetins (gives fruits/veggies their color).  In short, eat lots of fresh and colorful fruits and veggies.  He feels they are even better choices if uncooked. Here are 5 more integrative tips for the allergy season:

1) Increase your intake of dietary omega-3 fatty acids, as found in fish (i.e. salmon), nuts and flax seed

2) Sinus irrigation with aerosolized water (hot shower, wet sauna, steam) using fresh ginger, lemongrass and eucalyptus

3) Drink plenty of water and keep well hydrated

4) Consider fresh ginger (frequently used in Chinese medicine)

5) Herbal remedies and supplements include butterbur and stinging nettle may provide relief

Of course it is essential with work with your health care provider and/or an integrative medicine specialist to develop a safe and individualized approach that is sound and right for you! 

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Generally, cooler months dictate we will spend a greater amount of each day indoors.  This fact translates into more exposure to indoor allergens, very relevant if you have indoor allergies and asthma.  Very good questions include: “shall I use an air filter, humidifier or do I try and avoid dusting or using a vacuum”, if I suspect I may have indoor allergies?

Each fall a change-over from the warmer and humid summer into the cooler and drier air found during the fall occurs each year.  Make it an opportunity to look at the ventilation in your home (i.e. forced air heating, central air-conditioning, air filtration, closed windows, etc).   Have you noticed more nasal congestion upon arising in the morning, sneezing, cough or red, irritated eyes?  If so, you may something in common with the 40 million Americans who suffer with indoor allergies.  Indoor allergies can also trigger asthma and be associated with sinus complaints as well.

What are the “most wanted culprits” that are responsible for indoor allergies? Here they come! First, the ubiquitous, indoor house dust mite, a microscopic spider mite that loves to inhabit your mattress and pillows (in fact there are about 2 million mites in bedding). They are probably the most likely indoor allergy allergen that causes allergy symptoms.

Second, molds also may float in the air, like pollens and are present throughout the year. They may be more likely to be present in indoor spaces such as attics, below ground basements and playrooms, bathrooms, from refrigerator drip pans and leaky faucets.  In many cases a mildew odor may be a tip off that you have a “mold problem”. 

Third, pets are found in over 100 million households in the US (a 50/50 spread between cats and dogs, again just an estimate). About 10-15 of individuals with allergies have “pet” allergies.  Does the color of cat hair or the gender of your pet dictate whether you may suffer more?  Stay tuned for an upcoming blog on pet allergies. 

Another additional indoor allergy is duck or goose feather found in bedding and pillows.  Remember, get tested as you may not be allergic or bothered at all by feather pillows, so find out for sure! Lastly, cockroach allergy can trigger indoor suffering as well as asthma, especially in apartment complexes in urban areas.  They are most likely to inhabit kitchens. 

For some terrific strategies to get your home ready if you or a family member has indoor allergies check out the American Academy of Allergy, Asthma and Immunology at http://aaaai.org/patients/topicofthemonth/1005/ or the American College of Allergy, Asthma and Immunology at http://www.acaai.org/public/facts/indoor.htm to learn more about how to reduce exposure and allergic triggers.   

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

It’s that time again - to hear the familiar coughing, sneezing and other symptoms of the common cold lurking out there this fall! How are colds spread? Well they grow mainly in the nose where they increase in number.  During the first 2-4 days (when germs are most likely to spread) they are found in the in nasal secretions.   

The common cold virus is most easily spread on contaminated fingers and hands after an infected individual “touches” or rubs their nose, eyes and/or various objects and surfaces. 

A recent review of thousands of patients studied was published in the Cochrane Database of Systematic Reviews.  These studies looked at if you would receive benefit from taking daily Vitamin C (about 200mg/day).  Those who took daily Vitamin C did not see a reduction in suffering. 

However, those individuals who were “highly stressed” (for example, marathon runners) had about a 50 percent reduction in the number of days they suffered with a cold. 

Here are some avoidance strategies:

1. Don’t forget to wash your hands vigorously with soap and water for at least 20 seconds after touching various objects, surfaces or another person’s hands (it physically helps to remove cold viruses).

2. Avoid rubbing or touching your eyes and nose.

3. Avoid directly facing an individual who is coughing and sneezing.
 
3. Know that not all germicidal lotions will adequately kill cold viruses.

4. Use liquid hand sanitizers frequently, especially when hand washing is not possible.

5. Limit your exposure (even brief contact) to those “sufferers”, especially during the first several days of their cold symptoms.

6. Stay home when you are “infected” with a cold virus.

7. Indoor air purification may assist in reducing exposure and/or transmission of to airborne cold viruses, at least in some clinical studies. 

8 . Getting adequate rest and sleep,  as well as a balanced diet is a good first step in keeping your immune system from getting overly stressed and thus will be better prepared to fight off illnesses such as flu and colds.

 Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

There isn’t a day goes by that I do not get questioned about a patient’s facial appearance that includes puffy eyelids, dark circles as well as wrinkles.  We let’s face it; our looks are of great interest and concern.  I recently had a chat with dermatologist Dr. Bobby Buka, section chief in the Dept. of Dermatology at Mount Sinai School of Medicine in New York City about this. 

“Puffy eyes are progressive,” he said.  “As we age, we all lose fat pads (called subcutaneous tissue) that rest below our eyes. These dark circles that may appear underneath your eyelids and can be visible as a discoloration or bluish color with puffiness of the eyelids is actually blood coursing through veins beneath.”

Buka also mentioned that getting enough water and fluids optimize “hydration”, and this is very critical.  Doing this can replenish the deeper layers of the skin with water delaying drooping of skin, and improve the appearance of dark circles.  Avoiding dehydration can help to decrease the effect of gravity as adequately hydrated skin tends to sag less with advancing age! Buka also recommends a well-balanced, high-vitamin diet.

Those affected by allergies, particularly children and young adults, may have the presence of a horizontal crease on the middle part of the nose.  This may reflect persistent upward “rubbing” of the nose from itchiness and explain the appearance of a nasal “crease” associated with allergies, especially if your allergies are not adequately controlled or treated.  In other words, get proper therapy for your allergies so you can feel better and look better!

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

There has been much debate surrounding the dramatic increase of asthma in the United States and throughout the world over past several decades.

A study released by a group of researchers from New Zealand published in the September 20, 2008  issue of the The Lancet found an association between paracetamol use in infancy (known as acetaminophen in the U.S., and a very commonly used non-aspirin containing analgesic) and childhood risk of asthma, allergy and eczema in children at 6-7 years.  The authors suggested  the use of this commonly prescribed pain reliever and fever reducer might be a risk factor for the development of childhood asthma. 

 There has been an increased use of these non-aspirin containing analgesics over the past five decades, especially in children.  Additionally, the researchers reported those children that were given more frequent doses were more likely to develop asthma on a risk adjusted basis. 

 It is important to note that approximately, and this is just an estimate,  about 10 percent of adults and children with asthma find aspirin and non-steriod anti-inflammatory drugs (NSAIDS) actually worsen their asthma.  Aspirin “intolerance” appears to be more common in those patients with moderate to severe asthma, particularly individuals that also have nasal polyps and sinus disease. 

Another study reported in the journal Thorax found at least in adult women that aspirin may reduce asthma risk.  The authors cautioned  their findings were “still not enough to recommend taking aspirin regularly.”  Separately, the incidence of asthma is increasing and other asthma researchers believe another cause for this possibly is an association with obesity and dietary factors. 

In any event I have not observed any issues with acetaminophen analgesics in our allergy and asthma patient population when used in appropriate dosages and for the correct reasons.  Obviously more work and further studies are needed to explain the explosion of new cases of asthma, both in adults and children.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.