Due to the COVID19 pandemic, people are trying to avoid going the Emergency Room unless it is absolutely necessary. New guidelines discuss whether it is absolutely necessary to go to the emergency room after an allergic reaction.

The treatment for severe allergic reactions (anaphylaxis) remains prompt use of injectable epinephrine (EpiPen, Auvi-Q, and generic epinephrine injectors). Typically, we recommend that after using epinephrine for an allergic reaction, you call 911 and go to the ER to get observed. I always try to explain that it is not the injection of the medication that requires the emergency room visit, but the allergic reaction itself. Anaphylaxis is a life-threatening event. One dose of epinephrine, given promptly, usually will resolve the symptoms. However, sometimes as the epinephrine wears off, the allergic reaction can return, and this is the reason for going to the ER.

Knowing that people are hesitant to potentially expose themselves to coronavirus, and that they do not want to over burden the healthcare system, new recommendations for the use of epinephrine in anaphylaxis have been developed for use during the pandemic.

We have received a number of questions about the coronavirus (COVID 19) pandemic from our patients. Below are some of the common questions. Our answers are based on our training and experience as well as what is currently known about the virus. Keep in mind that this is a new infection, so there are a lot of unknowns and as we learn more about the virus and the disease, recommendations may change. Understand that this is not “just like the flu”! It spreads more easily and since it is a new type of infection, humans have no immunity to it. Check out the CDC https://www.cdc.gov/coronavirus/2019-ncov/community/index.html for good information

IS THE OFFICE STILL OPEN?

Yes. However, for the protection of our staff, we are temporarily rotating all members of the staff including the physicians who will be in the office on any given day. This means that we may not have someone to immediately answer the phone when you call. We are no longer seeing people for in-person appointments. We will see all new and follow up appointments virtually through televisits.

WHAT IS A TELEVISIT?

A televisit is a virtual office visit, through a secure video conference. It is done over the internet and through our electronic medical record (EMR) and is HIPAA compliant. The doctor will follow the same routine as if you were face to face in the office, except that the examination will obviously be limited to what the doctor can see or hear. It is also billed the same way that an office visit is billed. However, Governor Baker has mandated that there will be no copay for most insurances. This may not apply to some self-insured plans. You may be responsible for your usual copay or deductible for the visit. Because of this, we will not be collecting copays upfront as we usually do. We will wait to see how the different insurance companies are dealing with these visits and bill you if necessary. For the protection of our office staff and you, we are changing all visits to televisits rather than face to face visits in the office. If you have an upcoming appointment, someone from the office will contact you with more information. You can also get ready for your televisit by logging into the patient portal (if you have never done so).

I DON’T REMEMBER MY PATIENT PORTAL LOGIN INFORMATION!

If you do not remember your password, click on the patient portal tab at the top of our website. You can follow the directions to download the Healow app to your phone, or if your computer has a webcam and microphone, you can have the portal send a code to your mobile phone to complete the login on the computer. If you have trouble logging in, or your email is not in the system, please call the office to get your patient portal activated.

WHAT PRECAUTIONS ARE YOU TAKING IN THE OFFICE?

We pride ourselves on the cleanliness of our office, but we are increasing the daily cleaning. We will not permit any staff members to work who may be ill or who have known exposures to COVID19. To protect our staff and other patients, do not come to the office if you are ill or have been exposed to anyone who may have the infection. We are screening all patients who come to the office for signs suggesting an infection. All our staff members, including the physicians will be wearing a mask and either a face shield or protective glasses when interacting with each other or patients. We will wear additional personal protective equipment (PPE) when needed. We have also increased the amount of fresh outside air that circulates through our HVAC system to provide even cleaner air in the office.

AM I AT RISK OF GETTING THE INFECTION?

Everyone is at risk of getting the infection, but your risk increases dramatically if you do not practice social distancing. That means NO GROUP GATHERINGS such as play dates for the kids, neighborhood social gatherings or group pick-up sports games for you or your kids. It also means that you should not be visiting elderly relatives.

I HAVE ASTHMA, COPD OR CHRONIC BRONCHITIS. AM I AT GREATER RISK FOR GETTING THE INFECTION?

Probably not, but you may have a greater risk of having more severe symptoms, especially if your asthma, COPD or chronic bronchitis is not well controlled. So, the most important thing for you to do is to keep taking all your current medications, and to follow our advice for what you should do if your asthma symptoms increase. If you are uncertain what to do, or if your symptoms increase, call the office, or send a message to your physician through the patient portal. However, DO NOT USE THE PATIENT PORTAL IF YOU HAVE AN URGENT QUESTION.

WHO SHOULD I CALL IF I AM SICK AND MY ASTHMA FLARES UP? YOUR OFFICE? MY PCP? THE HOSPITAL?

First, understand that, unlike many other diseases, if you suspect that you have the COVID 19 infection, treatment is supportive only. There is no cure except time. You will not receive any special medications if you actually have the COVID 19 infection as opposed to a common cold or the flu, so don’t go to the hospital unless you are very ill. If you have a fever, take acetaminophen, (such as Tylenol), or ibuprofen (such as Motrin or Advil) as long as you are not allergic to these medications. Drink plenty of liquids, and remember that if you have a fever, vomiting, or diarrhea you need to increase the amount that you drink. If your asthma flares up, use your rescue medications (Proair, Venotlin, albuterol) and follow your rescue plan. If your asthma or other breathing symptoms do not calm down, call us and we can set up a televisit to see you. If your symptoms are severe go to the hospital.

I HAVE AN IMMUNODEFICIENCY. AM I AT GREATER RISK FOR GETTING THE INFECTION?

You are probably not at greater risk for getting the infection, but like persons with asthma, COPD or chronic bronchitis, you are at greater risk for more severe symptoms. Keep taking your medications, including your immunoglobulin infusions (if this is part of your treatment), use common sense and be vigilant about practicing social distancing. Call the office if you have an urgent question, or you are getting sick.

SHOULD I KEEP GETTING MY ALLERGY SHOTS?

This is not a simple question to answer and it depends on why you get allergy shots. This is what is called a risk versus benefit decision. This means that you need to weigh the risk of being exposed to the virus against the benefits that you get from being on the injections. Whether you decide to continue or temporarily stop your shots, keep taking your daily allergy medications. We are now in the tree pollen season and soon also the grass season (https://www.maallergy.com/conditions-we-treat/allergies/seasonal-allergies).

• If you get allergy shots for only eye or nasal symptoms such as sneezing, runny nose or itchy eyes or nose, this is a personal decision.
• If you get allergy shots because you have asthma, and you are allergic to tree or grass pollen, and in the past you have had problems with your asthma in the spring or summer, then it is probably a good idea to continue your shots.
• If you decide to pause your allergy shots for now, call us when the pandemic is over and we will get you back in to restart them.

HOW OFTEN SHOULD I GET MY SHOTS IF I DECIDE TO CONTINUE INJECTIONS?

Based on recommendations from the two national allergy societies, we are recommending the following changes in shot schedules:

• If you are still on weekly injections, begin getting your shots every 2 weeks. We will not increase the dose, but will resume the normal build up schedule once the pandemic is over.
• If you currently get your shots every 2 or 3 weeks, we will be switching you to a 4 week schedule until the pandemic is over.
• If you get your shots every 4 to 6 weeks, we will be switching you to a 6 week schedule until the pandemic is over.

WHAT ABOUT VENOM (BEE STING) SHOTS?

If you are getting venom shots for a bee sting allergy, you should continue your current schedule. Of course, the decision to continue is up to you, but we would strongly recommend that you discuss a decision to stop or change your current schedule with the doctor before doing so.

I GET A BIOLOGIC INJECTION (XOLAIR, NUCALA, FASENRA, DUPIXENT). SHOULD I STILL GET MY SHOTS?

Yes. At this time there is no indication that these medications will increase your risk of getting the infection or of having a more severe infection. Because these medications are for asthma, we strongly recommend that you continue to take them to keep your asthma under control.

As always, we are committed to your health and safety. If you have questions or concerns please do not hesitate to contact the office.

In honor of National Asthma and Allergy Awareness month, we will share a series on food allergy focusing on everything from myths to personal stories of dealing with food allergy. Today we have a story written by Michele Benyue about her experience with a food allergy emergency. 

It was a typical Friday night and my children were asking for ice cream. Because of our oldest son’s food allergies, we always buy the same kind. I never thought to check the ingredients on this unopened container. It looked the same as always. Shortly after eating his scoop, my son told me he had a fat lip. He is 6, so I didn’t think much of it. I asked what he bumped his lip on and he said he didn’t bump it on anything. I took a peek and shrugged it off. A few minutes later he started coughing uncontrollably and telling me that maybe he was getting the flu because his stomach and throat hurt. It was in that moment that a light bulb went off. I asked him to come into the bathroom and I looked at his lips.

In honor of National Asthma and Allergy Awareness month, we will share a series on food allergy focusing on everything from myths to personal stories of dealing with food allergy.

There is a substantial amount of false information available on the internet and it can be very difficult to separate fact from fiction in food allergy.  This post will try to correct some of these myths. (This article is adapted from “Common questions in food allergy avoidance”, written by Maureen Egan, MD & Matthew Greenwalt, MD and published in the Annals of Allergy, Asthma & Immunology, March 2018.)

MYTH: MY CHILD HAS A PEANUT ALLERGY, SO I NEED TO REMOVE ALL PEANUT PRODUCTS FROM MY HOME.

FACT: If a food allergic person touches a surface (such as a table top) that has remnants of the food still on it and then puts the hand into their mouth or touches their eyes, a reaction can occur, but this is considered an ingestion (eating it), not an inhalation (breathing it) reaction.  Some families may choose to be peanut free at home, but that is a personal decision. If a family chooses to keep peanut (or any allergen) in their house, they should wash their hands with soap and water after eating it, and clean the table top with cleaner or commercial wipes. Hand sanitizer does not remove food proteins.

(an occasional series by Dr. Pedersen about her experiences with allergy in her family)

Prior to becoming a mom, I was pretty sure that I would be calm, cool, and collected about my kids’ health. After all, I am a board-certified pediatrician and allergist. So, when my picky son (we will call him Mini P) was 9 months old and FINALLY ate a few bites of eggs and then refused to eat any more, I thought it was no big deal. When he got fussier and fussier over the next few minutes and just wanted to be held, I thought he was tired from a long day at daycare. When my husband looked at him and said, “he looks blotchy, and is he itching his ear?” I brushed him off. When Mini P refused his bottle, I figured he was overstimulated and brought him to his room to calm him down. When, as I was changing him into his pajamas, he began to projectile vomit multiple times, I finally realized what was going on.

For children with food allergies, Halloween is not just a time to dress up and have fun, it is yet another experience where they need to be vigilant about their food allergies. FARE (Food Allergy Research and Education) started the Teal Pumpkin Project to make Halloween and Trick or Treating a safe and inclusive event for all children regardless of food allergies or dietary restrictions. Instead of only buying candy to hand out to Trick or Treaters, people who participate in the Teal Pumpkin project also have non-food treats available that eliminate the risk of an allergic reaction. (This also works for people who are worried about too much sugar and junk food being passed out on Halloween!)

Some people who participate in the Teal pumpkin project will have pumpkins pained teal outside of their houses. Other people will make or print out signs to show that they are participating. But, if you don’t have time to do that stuff, just having a separate bowl of non-food treats that you offer to trick or treaters will work!

Help make Halloween a safe and fun experience for all kids!

Sign up on the FARE website to let kids with food allergies know that your house is a safe place for trick or treating this year, and look for other people participating in your neighborhood! 

Ideas for non-food treats

Summer is just about over.  Everyone in the family has hopefully been healthy, but now it’s back to school.  About 2-3 weeks after the summer school break ends there is always a big increase in children’s asthma symptom, and emergency room visits.  In the northern hemisphere (such as the USA, Canada, and Europe) it’s known as the “September Spike”.  It occurs earlier or later depending on when school reopens, but typically 2-3 weeks after the first day of school. In Australia and New Zealand, it happens after the Christmas break (which is the end of their summer recess).

Knowing where to look for bees and what to look for if you are stung can help avoid some of the fear of bee allergy.

Where are bees found?

Honey bee nests are in tree hollows and old logs and generally they only sting when provoked. They usually leave in the stinger with the attached venom sac (although some yellow jackets also can leave their stinger).

Yellow jackets build nests in the ground, so you’re likely to see them when doing yard work, farming and gardening.

Hornets build large nests in trees and shrubs. 

Wasps build honey combed nests in shrubs and under the eaves of homes and barns.

Yellow jackets, hornets and wasps are scavengers, often found at outdoor events where there is food or garbage and are more aggressive than honey bees. 

What type of reactions can happen when stung?

Although not frequent, severe springtime thunderstorms have been linked to asthma attack epidemics. Last year, more than 8,500 patients overwhelmed hospitals and emergency personnel during a thunderstorm on November 21 (Australia’s springtime) in Melbourne.

So, what happens during a thunderstom that causes asthma to get so bad?