SEPTEMBER VACATIONS 2017 –
BOTH OFFICES CLOSED LABOR DAY, SEPTEMBER 4
SEPTEMBER VACATIONS 2017 –
BOTH OFFICES CLOSED LABOR DAY, SEPTEMBER 4
Elizabeth (Beth) Strong is a board certified Family Nurse Practitioner. She completed her Bachelor of Science in Nursing at SUNY Buffalo and went on to earn her Masters of Science in Nursing at the University of Rochester. Beth learned world-class allergy care while working closely with and training under top researchers and experts. For the past eleven years, she worked through the Jaffe Food Allergy Institute at Mount Sinai in NYC. She treated patients with food allergies, eczema, seasonal allergies and asthma. She managed several clinical trials studying immunotherapies for food allergy and was highly integral in opening the Food Allergy Treatment and Research Center to treat food allergic patients with an advanced oral desensitization protocol. In her free time, Beth enjoys being outdoors and traveling. Most of all, she loves spending time with her husband and two young children.
The U.S. Food and Drug Administration is alerting consumers to Meridian Medical Technologies’ voluntary recall of 13 lots of Mylan’s EpiPen and EpiPen Jr (epinephrine injection) Auto-Injector products used for emergency treatment of severe allergic reactions. This recall is due to the potential that these devices may contain a defective part that may result in the devices’ failure to activate. The recalled product was manufactured by Meridian Medical Technologies and distributed by Mylan Specialty.
While the number of reported failures is small, EpiPen products that potentially contain a defective part are being recalled because of the potential for life-threatening risk if a severe allergic reaction goes untreated. Consumers should keep and use their current EpiPens if needed until they get a replacement. Consumers should contact Mylan at 800-796-9526 or firstname.lastname@example.org with any questions.
As stated on the product label, consumers should always seek emergency medical help right away after using their EpiPens, particularly if the device did not activate.
At this time, the 13 lots identified – distributed between Dec. 17, 2015, and July 1, 2016 – are the only EpiPen lots impacted by the U.S. recall. Consumers who have EpiPens from lots that are not included in this recall, do not need to replace their EpiPen prior to its expiration date.
|Product/Dosage||NDC Number||Lot Number||Expiration Date|
|EpiPen Jr Auto-Injector, 0.15 mg||49502-501-02||5GN767||April 2017|
|EpiPen Jr Auto-Injector, 0.15 mg||49502-501-02||5GN773||April 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||5GM631||April 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||5GM640||April 2017|
|EpiPen Jr Auto-Injector, 0.15 mg||49502-501-02||6GN215||September 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM082||September 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM072||September 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM081||September 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM088||October 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM199||October 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM091||October 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM198||October 2017|
|EpiPen Auto-Injector, 0.3 mg||49502-500-02||6GM087||October 2017|
The FDA asks health care professionals and consumers to report any adverse reactions or device malfunctions to the FDA’s MedWatch program, by:
The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.
“Sanofi and Regeneron Pharmaceuticals, Inc. announced today that the U.S. Food and Drug Administration (FDA) approved Dupixent® (dupilumab) Injection, the first and only biologic medicine approved for the treatment of adults with moderate-to-severe atopic dermatitis (AD) whose disease is not adequately controlled with topical prescription therapies, or when those therapies are not advisable.”
After much anticipation, dupilumab becomes the first biologic approved for the treatment of atopic dermatitis (a form of eczema). Dupilumab is indicated for adults with moderate to severe eczema that are not well controlled with steroid creams or ointments. The current options for these patients are limited. Most often oral immunosuppressants, like prednisone or cyclosporine, are used. These medications may have several adverse effects. Dupilumab is a biologic that aims to more specifically target the underlying factors driving allergic inflammation. In this case it blocks the signals of two molecules, Il-4 and IL-13.
Approval was based on three studies. The results of these studies showed the medication to be effective for the majority of patients. Additionally, 36-38% of patients achieved clear to almost clear skin.
Dupilumab will come in a pre-filled syringe for self-administration, to be given by subcutaneous injection every other week. A loading dose in your physician’s office may be required.
The wholesale cost was reported $37,000 per year. However, the actual cost to patients is still unknown.
Future directions. Two studies are currently testing safety and effectiveness in children, 6 months to 11 years and 12 to 17 years of age. Other uses under investigation include asthma, nasal polyps and eosinophilic esophagitis.
If you do have atopic dermatitis that is not well controlled, speak to your allergy doctor to see if dupilumab is right for you.
Upon a first or quick glance, a skateboard looks pretty simple and innocuous. In layman’s terms, a skateboard deck is just a piece of wood with some wheels attached to its bottom. However, as with just about anything in life, upon closer inspection, you’ll quickly discover that there’s much more to a skateboard than meets the eye. Skateboards are, in fact, at the same time, complicated and delicate – which allows skateboarders the freedom to move about in any environment with precision, speed, toughness, and, when required, the ability to defy gravity and grind down rails. At the same time, expert riders and enthusiasts are also capable of performing incredible leaps, jumps and other mind-boggling tricks.
That’s pretty impressive for something which, at its core, is just a piece of wood with wheels affixed to its underside. So, what makes a skateboard a electric skateboard? What goes into its construction and development which allows professional and high-level skateboarders the ability to propel, jump, turn, twist and do all those other super-cool things? And while a skateboard would be pretty much useless without someone activating and using it, the design of the actual deck, from its trucks to its grip tape and everything in between, also has something to do with it too.
With that being said, there are certain elements and aspects which are nothing but absolutely critical to a skateboard. Without these components, a skateboard would literally be – as has been mentioned previously – just a piece of wood with wheels stuck to it. However, certain modifications and additions transform that ordinary wheeled piece of wood into a rolling, flying, grinding machine that has caught on in popularity like wildfire. So, when trying to distinguish a world-class skateboard from a simple piece of wood with wheels, try to keep an eye out for some of these vital pieces:
This is the piece of wood that’s more than a piece of wood. Skateboard decks usually are rectangular or oval in shape, and feature raised back-ends (sometimes called kick tails) and sloped front ends. And while yes, sometimes skateboard decks are made of wood, they can also be made from other materials such as plastic, fiberglass and even kevlar.
Applied to the top surface of the skateboard deck like a sticker, grip tape is what keeps a skateboarder’s feet from slipping and sliding all over the place while they’re using the board. Grip tape has a tough, grinding feel to it, much like sandpaper does. While commonly seen in black, grip tape does indeed come in many different colors and styles.
Skateboard trucks are attached directly to the underside of the skateboard deck. Somewhat shaped like a capital letter T, the wheels of the skateboard are connected to either end of the truck. There are two trucks per skateboard, and each truck holds two wheels, thus giving the skateboard four wheels in total. When thinking of a skateboard truck, try to picture the axles of an automobile.
Without wheels, it would be very tricky, and very well near impossible, to actually move about on your skateboard deck. While skateboard wheels are commonly made from polyurethane, the actual size and diameter of the wheels can vary as well. There is no standard guidelines as to how big skateboard wheels can be, however, wheel sizes does depend on how you intend on using your skateboard.
Without wheel bearings, the wheels which are attached to the board wouldn’t turn much, if at all. Bearings for a electric skateboards usually are manufactured in the standard 608 bearing size and are usually made from steel. However, that being said, other compounds, like silicon nitrade, can also be found in skateboard wheel bearings.
Preventing allergy is a priority for both physicians and parents. There have been many studies attempting to lessen the risk of both food and environmental allergies.
Here are a few examples of possible interventions to decrease the risk of allergy;
A study, started in 1990 and recently completed and accepted for publication, looked at fish oil supplementation in pregnancy*. Over 500 pregnant mothers were given supplements containing fish oil, olive oil or no oil. The hypothesis was that maternal supplementation with long chain n-3 polyunsaturated fatty acids (PUFAs) may have immunological effects on the developing fetus and decrease allergies and asthma. The children were evaluated when they reached 18 years of age.
The probability of having had asthma medication prescribed was significantly reduced in the fish oil group compared to the olive oil group (HR=0.54, 95% CI: 0.32-0.90, p=0.02). The probability of having had allergic rhinitis medication prescribed was also reduced in the fish oil group compared to the olive oil group (HR=0.70, 95% CI: 0.47-1.05, p=0.09), but the difference was not statistically significant. Self-reported information collected at age 18-19 years supported these findings.
Maternal supplementation with fish oil may have prophylactic potential for long-term prevention of offspring asthma.
Hansen S, Strøm M, Maslova E, Dahl R, Hoffmann HJ, Rytter D, Bech BH, Henriksen TB, Granström C, Halldorsson TI, Chavarro JE, Linneberg A, Olsen SF, Fish oil supplementation during pregnancy and allergic respiratory disease in the adult offspring, Journal of Allergy and Clinical Immunology (2016), doi: 10.1016/j.jaci.2016.02.042.
Spring pollen season has arrived!
Check back here (or twitter.com/allergyct) for Fairfield County’s only local counts.
Dog allergies are very common, up to 20% of the population are affected. This has not limited the popularity and enjoyment of having a dog at home. The ASPCA estimates that 37-47% of all households in the United States have a dog. Patients with dog allergies may have upper respiratory symptoms (sneezing, runny nose, itchy eyes), lower respiratory symptoms (cough, wheezing) or even skin symptoms (itching, rash). An allergist can confirm dog allergy as the cause of these symptoms.
What’s next? What are the options? Removing the dog from the home is an option, but not very pleasing for the owners or their dogs. There are medications that can lessen symptoms. However, patients are looking for other ideas. Suggestions have included, frequent washing, frequent vacuuming, putting air filters in the house and buying a “hypoallergenic dog.”
What is a “hypoallergnic dog?” The substance produced by a dog, causing an allergy is an allergen. The word hypoallergenic means less likely to cause allergy. This implies that the dog would produce less allergen. As of today, there have been six identified dog allergens, named Can f 1, 2, 3, 4, 5 and 6. These proteins are found in hair, skin, dander (skin flakes), saliva and urine. Each allergen can be found in each type, or breed of dog. Can f 1 and 5 are considered major allergens, causing allergy in a large percentage of patients. However, patients can be allergic to any single allergen or any combination as well. Interestingly, Can f 5 is found only in male dog urine, suggesting that some patients may be allergic to male dogs only.
These proteins come off the dog and are found throughout the home. For example in carpets, couches and pillows. They can also be found in places without a dog. For example, in a classroom or on an airplane.
A Google search will recommend, if you have allergies buy a hypoallergenic dog. Dogs that do not shed or with wiry hair.
So is there such thing as a hypoallergenic dog? A dog breed that produces less allergen than other breeds? Is there anyone certifying or testing breeds to show that there are real benefits?
Here are a few studies that may answer these questions:
TITLE: Dog factor differences in Can f 1 allergen production. Allergy 2005.
TITLE: Can f1 levels in hair and homes of different dog breeds: Lack of evidence to describe any dog breed as hypoallergenic. JACI 2012.
CONCLUSIONS: Allergen levels in hair and coat samples were higher in breeds considered hypoallergenic. Although there was a lot of variability between dogs of each breed. The amount of allergen in dust samples was similar for hypoallergenic and other breeds. Although certain dog breeds are described and marketed as being “hypoallergenic”, no evidence was found that these breeds are less allergenic.
TITLE: Dog allergen levels in homes with hypoallergenic compared with nonhypoallergenic dogs. American Journal of Rhinology & Allergy 2011.
CONCLUSIONS: Clinicians should advise patients that they cannot rely on breeds deemed to be “hypoallergnic” to in fact disperse less allergen in their environment.
The evidence is pretty clear, at this time there is no “hypoallergenic” dog breed. Some dogs may produce more allergen than other dogs. Some people may be more allergic to one dog than other dogs. There is no consistency for which breed is best. Here are some tips for patients with dog allergy. Unfortunately, they are based more on common sense then scientific evidence.
Here is some more practical, but no better proven advice, for patients with dog allergies :
There is much interest in wheat sensitivity in people without celiac disease, many of these patients have been labeled with nonceliac wheat sensitivity. Little is known about any risks associated with nonceliac wheat sensitivity. A recent study published in the journal of Gastroenterology evaluated autoimmune diseases in patients with nonceliac wheat sensitivity and investigated whether they carry the autoimmune antibody (ANA).
The study looked at patients who were given the diagnosis of nonceliac wheat sensitivity, celiac disease and control subjects. The ANA (autoimmune antibody) was measured in 3 groups. The authors concluded from the study that significantly higher proportions of patients with nonceliac wheat sensitivity or celiac disease have autoimmune disorders with positive ANA’s. This data provides physicians with an awareness that patients with nonceliac wheat sensitivity might have an increased risk of autoimmune diseases.
Nonceliac wheat sensitivity remains a not well defined clinical condition. In fact there are some doubts about whether it is a real diagnosis. This study showed a higher frequency of autoimmune diseases, in particular thyroiditis, psoriasis and type 1 diabetes mellitus were reported.
Allergists see many patients who are concerned regarding gluten allergy, many patients may in fact have nonceliac wheat sensitivity. This is relatively new diagnosis that there is not much information about. These are patients who do not have celiac disease or wheat allergy, but do have problems with eating gluten and/or wheat. Although allergy testing may be negative for these patients, this study shows that patients with nonceliac wheat sensitivity may have some autoimmune issues. There is still a lot to learn about nonceliac wheat sensitivity and as more studies come out we will learn more about it.
Celiac disease has been in the news a lot recently http://allergylosangeles.com/allergy-blog/gluten-free-in-the-news/
As always speak to your doctor about any concerns that you have regarding gluten or wheat.