Doctors are becoming more Internet savvy every day. There are more than 500 medical blogs and any blog author is a somewhat of web designer by heart. With the availability of new easy-to-use tools for creating web sites, it is likely that many allergists will start practice web sites on their own. It may be interesting to survey A/I fellows regarding their opinion of the current A/I practice web sites. Some of them are listed below:
AllergyNebraska.com
Allergy, Asthma & Immunology Associates, with principal offices in Lincoln and Omaha, NE
Allergy-Asthma-Docs.com
Minneapolis, MN
Surrey Allergy Clinic is authored by Dr Adrian Morris: Allergy-Clinic.co.uk
UK
Florida Center For Allergy & Asthma Care
Fort Lauderdale, FL
Asthma & Allergy Associates of Florida
Miami, FL
First Coast Allergy
Jacksonville, FL
Coast Allergy
Oregon
Allergy and Asthma Center of Austin
Texas
Allergy and Asthma Consultants
Texas
Southwest Allergy and Asthma Center
Texas
Central Texas Allergy and Asthma Center
Texas
Associated Allergists and Asthma Specialists
Chicago, IL
Association of Allergists & Immunologists from India
M. Razi Rafeeq, MD
Oregon, OH
Asthma Sinus Allergy Program at Greater Baltimore Medical Center
Baltimore, Maryland
Related:
Hospital Social Network List may be a useful resource in your residency, fellowship or job search. Ed Bennett.
Published: 08/20/007
Updated: 01/06/2009
Association between allergies and cancer: do allergies offer protection from cancer?
According a comprehensive literature review, individuals with any type of allergy have a decreased risk for cancer (compared with the general population), including:- glioma
- colorectal cancer
- cancer of the larynx
- non-Hodgkin lymphoma
- cancer of the esophagus
- oral cancer
- pancreatic cancer
- stomach cancer
- uterine body cancer
However, an increased risk for the following cancers was observed among those with allergies:
- bladder cancer
- lymphoma
- myeloma
- prostate cancer
Further research is needed to verify these results and to determine why such associations may exist.
References:
The association between allergies and cancer: what is currently known? Merrill RM, Isakson RT, Beck RE. Ann Allergy Asthma Immunol. 2007 Aug;99(2):102-16; quiz 117-9, 150.
Relationship between Allergy and Cancer: enhanced immunosurveillance might prevent cancer http://goo.gl/uq9mC
Related reading:
Allergo-Oncology. Prof. Erika Jensen-Jarolim, MD, head of the Department of Pathophysiology at the Center of Physiology, Pathophysiology and Immunology, Medical University of Vienna.
Are cancer and allergy mutually exclusive?: Myths and difficulties. JACI News Beyond Our Pages, 2010.
Patients with atopic dermatitis were at 1.5 times greater risk of getting cancer in a large UK study of 4.5 million people. The cancers included lymphoma, melanoma, and non-melanoma skin cancer. http://bit.ly/bGjdpO
Can allergies prevent tumors? Can antihistamines increase risk? CNN - Probably not. Most pts with allergies take anthistamines.
Can allergies prevent tumors? Can antihistamines increase risk? CNN - Probably not. Most pts with allergies take anthistamines.
Assessment of Type of Allergy and Antihistamine Use in the Development of Glioma http://goo.gl/105HQ
The nascent field of AllergoOncology http://goo.gl/tUZ32
The nascent field of AllergoOncology http://goo.gl/tUZ32
Allergy Videos from ICYou.com
The URL name "ICYou.com" is a word play on ICU (intensive care unit) or "I see you." The tag line is "Intensive Content for Your Health."
This new video sharing web sites has a small but notable selection of allergy videos.
An RSS feed is also available.
This new video sharing web sites has a small but notable selection of allergy videos.
An RSS feed is also available.
Ocular Allergy Cases by Indiana University
Indiana University School of Optometry features several cases of allergic conjunctivitis of varying severity.
STAT3 Mutations are a Newly Recognized Genetic Cause of Hyper-IgE Syndrome
Hyper-IgE syndrome (Job's syndrome), first described in 1961, is a rare immunodeficiency disorder characterized by:
- extremely elevated IgE levels
- pneumonias which lead to pneumatoceles
- recurrent cold staphylococcal abscesses
- dermatitis
- retained primary dentition
- and bone abnormalities
Many patients with autosomal dominant hyper-IgE syndrome (HIES) fail to lose their baby teeth and have two sets of teeth simultaneously. HIES was first described by Davis et al. in 1966 in two girls with chronic dermatitis, recurrent staphylococcal abscesses and pneumonias. They named the disease after the biblical character Job, whose body was covered with boils by Satan.
HIES inheritance is autosomal dominant but sporadic cases also occur.
A recent study published in the NEJM suggest that mutations in STAT3 underlie hyper-IgE immunodeficiency syndrome. STAT3 is an abbreviation for Signal Transducer and Activator of Transcription 3 gene (STAT3).
In conclusion, STAT3 mutations are a newly recognized genetic cause of hyper-IgE syndrome.
The discovery of the genetic cause will hopefully lead to better understanding of organ-specific infections and effective therapy in the future.
Cytokine Signaling. This video is from: Janeway's Immunobiology, 7th Edition Murphy, Travers, & Walport. Source: Garland Science.
References:
STAT3 Mutations in the Hyper-IgE Syndrome. NEJM, 10.1056/NEJMoa073687, 09/2007.
Hyperimmunoglobulinemia E (Job) Syndrome. eMedicine.
Hyper IgE Syndrome: An Update on Clinical Aspects and the Role of Signal Transducer and Activator of Transcription 3.
Michelle L. Paulson; Alexandra F. Freeman; Steven M. Holland. Current Opinion in Allergy and Clinical Immunology, Medscape, 2008.
Job Syndrome. eMedicine.
Cutaneous Manifestations of Hyper IgE Syndrome (full text PDF) and http://goo.gl/uJWMT
Hyper-IgE syndrome, from Wikipedia, the free encyclopedia.
- extremely elevated IgE levels
- pneumonias which lead to pneumatoceles
- recurrent cold staphylococcal abscesses
- dermatitis
- retained primary dentition
- and bone abnormalities
Many patients with autosomal dominant hyper-IgE syndrome (HIES) fail to lose their baby teeth and have two sets of teeth simultaneously. HIES was first described by Davis et al. in 1966 in two girls with chronic dermatitis, recurrent staphylococcal abscesses and pneumonias. They named the disease after the biblical character Job, whose body was covered with boils by Satan.
HIES inheritance is autosomal dominant but sporadic cases also occur.
A recent study published in the NEJM suggest that mutations in STAT3 underlie hyper-IgE immunodeficiency syndrome. STAT3 is an abbreviation for Signal Transducer and Activator of Transcription 3 gene (STAT3).
In conclusion, STAT3 mutations are a newly recognized genetic cause of hyper-IgE syndrome.
The discovery of the genetic cause will hopefully lead to better understanding of organ-specific infections and effective therapy in the future.
Cytokine Signaling. This video is from: Janeway's Immunobiology, 7th Edition Murphy, Travers, & Walport. Source: Garland Science.
References:
STAT3 Mutations in the Hyper-IgE Syndrome. NEJM, 10.1056/NEJMoa073687, 09/2007.
Hyperimmunoglobulinemia E (Job) Syndrome. eMedicine.
Hyper IgE Syndrome: An Update on Clinical Aspects and the Role of Signal Transducer and Activator of Transcription 3.
Michelle L. Paulson; Alexandra F. Freeman; Steven M. Holland. Current Opinion in Allergy and Clinical Immunology, Medscape, 2008.
Job Syndrome. eMedicine.
Cutaneous Manifestations of Hyper IgE Syndrome (full text PDF) and http://goo.gl/uJWMT
Hyper-IgE syndrome, from Wikipedia, the free encyclopedia.
Exhaled nitric oxide (FeNO) in asthma and sinusitis
FeNOFractional exhaled nitric oxide (FeNO) is a noninvasive marker of eosinophilic airway inflammation. FeNO measurement is easily done and results are immediately available.
FeNO measurement is gradually becoming part of the routine evaluation of patients with asthma for both diagnosis and guide in asthma control. FeNO level is normal in well-controlled asthma.
Active and passive smoking decreased FeNO levels in adults.
nNO
In patients with sinusitis, nasal nitric oxide (nNO) is decreased, and it rises up after a course of antibiotics.
nNO is also low in primary ciliary dyskinesia and can probably be used as a screening test.
Hand-held FeNO device
The current chemiluminescence FeNO analyzers (e.g. NIOX) are costly and lack transportability. Newer hand-held devices are available (NIOX MINO), and according to a recent study, they are just as reliable as their bulkier counterparts. The price of one NIOX MINO unit is around $ 4,200.
References
Exhaled nitric oxide in children with asthma and sinusitis. S. Carraro, G. Gottardi, G. Bonetto, E. Baraldi (2007). Pediatric Allergy and Immunology 18 (s18), 28–30.
doi:10.1111/j.1399-3038.2007.00629.x
Reliability of a new hand-held device for the measurement of exhaled nitric oxide. B. Khalili, P. B. Boggs, S. L. Bahna (2007). Allergy 62 (10), 1171–1174.
doi:10.1111/j.1398-9995.2007.01475.x
How to use Niox Flex. NioxFlex.com.
nNO
In patients with sinusitis, nasal nitric oxide (nNO) is decreased, and it rises up after a course of antibiotics.
nNO is also low in primary ciliary dyskinesia and can probably be used as a screening test.
Hand-held FeNO device
The current chemiluminescence FeNO analyzers (e.g. NIOX) are costly and lack transportability. Newer hand-held devices are available (NIOX MINO), and according to a recent study, they are just as reliable as their bulkier counterparts. The price of one NIOX MINO unit is around $ 4,200.
References
Exhaled nitric oxide in children with asthma and sinusitis. S. Carraro, G. Gottardi, G. Bonetto, E. Baraldi (2007). Pediatric Allergy and Immunology 18 (s18), 28–30.
doi:10.1111/j.1399-3038.2007.00629.x
Reliability of a new hand-held device for the measurement of exhaled nitric oxide. B. Khalili, P. B. Boggs, S. L. Bahna (2007). Allergy 62 (10), 1171–1174.
doi:10.1111/j.1398-9995.2007.01475.x
How to use Niox Flex. NioxFlex.com.
Exhaled nitric oxide correlated with control in recurrent infantile wheeze treated with inhaled corticosteroids. http://goo.gl/AS7I
Humming increases airflow between the sinus and nasal cavities, which could protect against sinus infections. NYTimes, 2010.
In the UK, FeNO is used in primary practice to guide ICS initiation, dosing and identify poor ICS adherence http://buff.ly/1aHKopT
Image source: NioxMino.
In the UK, FeNO is used in primary practice to guide ICS initiation, dosing and identify poor ICS adherence http://buff.ly/1aHKopT
Image source: NioxMino.
Fruity Vegetables May Protect Against Atopy
A diet rich in fish and vegetables, such as tomatoes and cucumbers, may have a protective effect against childhood wheeze and atopy, according to the results of a study published in Pediatric Allergy and Immunology.The study was done in Menorca, a Spanish Mediterranean island, and included 460 children who underwent skin testing with 6 common aeroallergens, and parents completed a questionnaire with 96 food items.
Large intake of fruity vegetables (more than 40 g/day), defined as tomatoes, eggplants, cucumber, green beans, and zucchini, was associated with decrease in wheezing.
A 2012 review did not show a Significant Influence of Mediterranean Diet on Asthma Symptoms http://buff.ly/YcVEq0
References:
Diet, wheeze, and atopy in school children in Menorca, Spain. Chatzi L, Torrent M, Romieu I, Garcia-Esteban R, Ferrer C, Vioque J, Kogevinas M, Sunyer J. Pediatric Allergy Immunol 2007: 18: 480–485.
Tomatoes, Cucumbers, and Fish Protect Against Childhood Wheeze and Atopy. Medscape, 2007.
Mediterranean diet during childhood may protect against asthma. CasesBlog, 2007.
Anti-IgE treatment with omalizumab for eosinophil-associated gastrointestinal disorders (EGID)
Eosinophil-associated gastrointestinal disorders (EGIDs) are being recognized with increasing frequency but current therapy with swallowed inhaled steroids is often inadequate.
In a recent study, 9 subjects with EGIDs received omalizumab every 2 weeks for 16 weeks.
Omalizumab was associated with a decrease in absolute eosinophil count but did not lead to a statistical significant decrease in tissue eosinophils. Symptom scores were also decreased (P of less than 0.005).
In conclusion, anti-IgE with omalizumab might be a potential therapy for EGIDs.
References:
Anti-IgE treatment of eosinophil-associated gastrointestinal disorders. J Allergy Clin Immunol. 2007 Sep;120(3):594-601.
Eosinophilic Esophagitis videocast from The DAVE Project - Gastroenterology, 2005.
Updated: 11/13/2007
In a recent study, 9 subjects with EGIDs received omalizumab every 2 weeks for 16 weeks.
Omalizumab was associated with a decrease in absolute eosinophil count but did not lead to a statistical significant decrease in tissue eosinophils. Symptom scores were also decreased (P of less than 0.005).
In conclusion, anti-IgE with omalizumab might be a potential therapy for EGIDs.
References:
Anti-IgE treatment of eosinophil-associated gastrointestinal disorders. J Allergy Clin Immunol. 2007 Sep;120(3):594-601.
Eosinophilic Esophagitis videocast from The DAVE Project - Gastroenterology, 2005.
Updated: 11/13/2007
From the Blogs: Tips on Ear Exam and Other Parts of HEENT
Musings of a Distractible Mind offers tips on conducting an examination of the ears.
The series covers a complete HEENT exam plus more:
Most of these areas are examined during a routine visit to an allergist. A quote from the blog:
"As a medical student, I was taught by allergists and ENT’s that you can tell a lot by looking into the nose. In truth, it generally looks about the same to me. Usually it is red and there is a lot of mucous in it (what did you expect?). Occasionally in pediatrics you are rewarded by finding objects that have been stored away for future use that have caused chronic nasal problems. Peas are probably the most common item for me to find in the nose, although I think breakfast cereals are common as well (Cheerios, not Shredded Wheat)."
References:
Physical exam posts from Musings of a Distractible Mind.
Video: Examination of the Larynx and Pharynx. NEJM, 01/2008.
Diagnosis of Ear Pain. AFP, 03/2008.
Image source: Wikipedia, a GNU Free Documentation License.
Updated: 07/26/2008
When is a "Drug Allergy" Not a Drug Allergy?
From White Coat Rants:"Penicillin “allergies” are notorious. When I ask the patient what their allergic reaction is, they tell me “My mom just always told me I was allergic. I must have had a reaction when I was a little kid.” That’s it. So what do you do?
I have to blame some physicians for not explaining to the patients that nausea, flushing, diarrhea, and bad tastes in the mouth are NOT allergies. They are adverse reactions."
References:
Is This Patient Allergic to Penicillin? An Evidence-Based Analysis of the Likelihood of Penicillin Allergy. JAMA. 2001;285:2498-2505.
A Picture of a Mutated Mast Cell. The Happy Hospitalist, 02/2008.
Unique Medical Allergies. White Coat, 2011.
Image source: Allergies list, White Coat Rants.
Related:
My Newest Medical Problem. White Coat's Call Room. Emergency Physicians Monthly, 2009.
Image source: Allergies list, White Coat Rants.
Related:
My Newest Medical Problem. White Coat's Call Room. Emergency Physicians Monthly, 2009.
"Are you allergic to any medications?" sometimes yields unexpected answers... http://goo.gl/u185
Clinical Case: Adverse Reaction to Intravenous Contrast
A 46-year old female was undergoing a CT scan of the abdomen with IV contrast for investigation of abdominal pain when she started to complain of difficulty breathing.What is the most likely diagnosis?
Read more in Allergic Reaction to Intravenous Contrast on AllergyCases.org.
Image source: Wikipedia, GNU Free Documentation License.
Clinical Case: Anaphylaxis Due to Bee Sting
A 45-year-old male was taken to the ED with generalized body hives and decrease in blood pressure to 80s systolic per EMS.He was working on his house when he was attacked by bees.
What is the most likely diagnosis?
Read more in Anaphylactic Shock Due to Bee Sting on AllergyCases.org.
Image source: Wikipedia 1, 2, GNU Free Documentation License.
Asthma and Allergy Patient Forum with Answers by National Jewish Center
MedHelp.org has developed a patient forum about asthma and allergy with answers provided by doctors from National Jewish Medical & Research Center.
How to Use EpiPen (Epinephrine) Auto-Injector
1. Videos by EpiPen manufacturer (recommended).
2. Amateur videos on YouTube:
How to use the EpiPen injector. Allergy News Blog.
Luke’s Guide to Saving Luke. Allergy News Blog.
Drugs used for management of anaphylaxis are remembered by the mnemonic EASI:
Epinephrine IM
Antihistamines PO, IM
Steroids PO, IM, IV
Inhaled b2-agonists, if wheezing
This may happen if EpiPen is not used properly: thumb self-injection.
2. Amateur videos on YouTube:
How to use the EpiPen injector. Allergy News Blog.
Luke’s Guide to Saving Luke. Allergy News Blog.
Drugs used for management of anaphylaxis are remembered by the mnemonic EASI:
Epinephrine IM
Antihistamines PO, IM
Steroids PO, IM, IV
Inhaled b2-agonists, if wheezing
This may happen if EpiPen is not used properly: thumb self-injection.
References:
What are the ‘ideal’ features of an adrenaline (epinephrine) auto-injector in the treatment of anaphylaxis? http://goo.gl/lxCh
Figure: Design overview of currently available auto-injectors for emergency self-administration of adrenaline in the treatment of anaphylaxis.
Training of trainers on epinephrine autoinjector use increases correct use from 23.3% to 74.2% http://goo.gl/lMfSR
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