Psoriasis Study

Psoriasis is an autoimmune disease that typically affects the outside of the elbows, knees or scalp, however it may appear on any location. One of the most common forms of psoriasis is called plaque psoriasis. It causes raised, red patches covered with a silvery white layer of dead skin cells. Some people report that psoriasis itches, burns and stings[1].

It is reported that at least 10 percent of the general population inherits one or more of the genes that create a predisposition to psoriasis. However, only 2 percent to 3 percent of this population develops the disease. Researchers believe that for a person to develop psoriasis, the individual must have a combination of the genes that cause psoriasis and be exposed to specific external factors known as "triggers". These triggers can include; stress, injury or trauma to the skin and some types of medications. Psoriasis can also flare following a strep throat infection, earache, bronchitis, tonsillitis or a respiratory infection. Basically, anything that can affect the immune system can affect psoriasis[1].

The severity of psoriasis is not only measured by how much area of the body is affected, but also by how psoriasis affects a person's quality of life. There are a variety of ways to treat psoriasis, including; topical medications, systemic medications, biologic drugs, phototherapy treatment and alternatives therapies1.

The Baker Research Center is currently offering a study to research a topical medication that has been found to be beneficial in the treatment of psoriasis in adults 18 years or older. If you or someone you know has had psoriasis for over 6 months and would like more information regarding this study please notify Emily Widen, Erin Flamiatos, FNP or Angie Johnson at 503 534-2622.

1. National Psoriasis Foundation (n.d.). Retrieved November 26, 2013 from https://www.psoriasis.org/about-psoriasis

Allergic to the holidays? 

Although the pollen season is over, holiday gatherings and increased time spent indoors during the winter can leave people with allergies and asthma wondering if they are “allergic” to the holidays. From decorations to an increase in the stress during the holiday season, there are many components related to this time of celebration that can trigger allergies and asthma.

Christmas trees

If you develop symptoms of allergies or asthma around Christmas trees it’s unlikely that you are allergic to the tree itself, but possibly the terpene in the oil/sap of the tree or the mold spores present on the tree, which can symptoms. Also, the fragrance of the tree may lead to non allergic rhinitis or asthma symptoms. To decrease chances of reacting to your tree you can use a leaf blower in a well-ventilated area to help remove some of the pollen. Also, washing live trees, especially the trunk, with a garden hose, then leaving it in a bucket of water in the garage to dry can decrease allergen exposure. It is helpful to wear gloves when handling the tree to avoid contact with the sap. In addition, artificial trees can harbor dust and mold if stored improperly. These trees can also be washed outside to help eliminate some of the dust or mold. When storing an artificial tree, place it in an air-tight bag or container to decrease allergen accumulation[1].

Decorations
Scented candles and potpourri, along with wood-burning fireplaces can lead to rhinitis and asthma symptoms. Ornaments and other decorations stored in attics and basements for months often gather dust and mold and can cause reactions when they are brought out of storage. Symptoms may be decreased by cleaning each item before decorating and when packing things away, storing them in airtight containers[1].

Stress and gatherings
While stress doesn't cause allergies or asthma, it can temporary alter the effectiveness of your immune system. In addition, it may lead to asthma symptoms in some people, as chemicals released by the body during stressful times can cause the muscles around your airways to tighten. Also, when people gather, viral illnesses are more likely to be passed around and if you have asthma, it is important to discuss getting a flu shot with your doctor[1].

1. American College of Allergy, Asthma & Immunology (n.d.) Retrieved on December 9, 2013 from http://www.acaai.org/allergist/news/New/Pages/avoiding-holiday-asthma-allergy-triggers.aspx

Peanut Desensitization

Peanut allergy is one of the most common forms of food allergy and its prevalence appears to be increasing. Peanut and tree nut allergy account for the vast majority of life-threatening allergic reactions to foods and treatment options are limited to early recognition of symptoms and prompt epinephrine administratio[1].

Oral immunotherapy (OIT) is the administration of increasing amounts of an allergen to individuals with food allergies in order to decrease the allergic response to the substance on future exposures[1]. Immunotherapy involves continually exposing patients to an allergen until their immune system is able to tolerate it. Since even small traces of an allergen can trigger anaphylaxis, oral immunotherapy is only to be administered under the supervision of trained medical professionals and should never be attempted otherwis[2].

At the Baker Allergy, Asthma and Dermatology Research Center, we currently offer food desensitization for IgE-mediated food allergies. This is one option for patients with food allergies and it is important that both children with food allergies and their parents are all involved in this process. Continual avoidance is always the first line treatment for food allergies.

Frequently asked questions about peanut desensitization at Baker Allergy, Asthma and Dermatology Center:

1. How many patients have participated in peanut desensitization?
152

2. How many patients are now on a maintenance dose of peanuts daily?
118

3. What is a maintenance dose of peanuts?
The maintenance dose varies based on age, weight and tolerance to taste.

4. What is the average time range for appointments?
The first visit is 2-3 hours and subsequent appointments are about 1 hour. Visits must be at least one week apart but can be spread as far apart as needed as long as the home dose in maintained. Some patients come once a month.

5. What is the average amount of appointments to reach maintenance?
The average amount is about 6 visits The range of total appointments is typically 3-10 visits.

6. What other foods are we offering desensitization to?
Several foods including: milk, egg, various tree nuts, coconut, chickpeas, sesame seeds. Any food would be considered, but not all may be possible.

7. What is the minimum age to begin desensitization?
Ideally the youngest age is 5, but we have treated younger children depending on the individual child.

8. What are the most common side effects of desensitization?
The most common adverse reactions are mild oral itching and stomach discomfort.

9. What happens if a reaction occurs during a desensitization appointment?
A protocol is followed for treatment of a reaction. First, the severity is assessed and then the patient is treated as needed. It may be that we watch and wait for mild symptoms to subside, or we may treat with one or more of the following: benadryl, H2 blocker (Zantac), adrenaline, nebulizer treatment and/or oral prednisone. We have always been able to treat the symptoms/reaction in our clinic.

10. How many years does a patient need to continue on a maintenance dose?
It is through the constant exposure of the food one is allergic to that keeps the body in a tolerant state and unless, through the ongoing studies it is discovered that after a period the body builds immunity, this could be a lifetime commitment.

If you are interested in learning more about peanut desensitization, please call Baker Allergy, Asthma and Dermatology Center at (503) 636-9011 to make an appointment for more information.

1. American Academy of Allergy, Asthma & Immunology (n.d.) Retrieved on December 9, 2013 from http://www.aaaai.org/global/latest-research-summaries/Current-JACI-Research/Peanut-allergy-%E2%80%93-a-new-treatment-option-on-the-hor.aspx

2. Brock, E. (2013, January) Recent findings in food allergy research. Retrieved on December 9, 2013 from http://foodallergies.stanford.edu/about_us/pdf/foodallergyresearchA.pdf

The Holiday Season

With the holiday season fast approaching, we would like to remind patients with food allergies and parents of children with food allergies to be aware of the possibilities of cross-contamination of allergens into food dishes. Many of the holiday traditions put emphasis on various food dishes and it is important to be informed of the ingredients in these prior to consuming them if you or your child has a food allergy. Holiday meals are often times shared with many friends and relatives and if your child has a food allergy, we encourage you to always let your child know that he or she should ask a responsible adult if a food is okay to eat prior to consuming it. Many food allergy reactions occur after a child has been diagnosed with an allergy, but they are given a food to eat by a friend or relative who may not know they have an allergy. With food allergies, it may only take a small amount of food consumed to cause an allergic reaction. Please always carry an Epipen or Auvi-Q pen to have nearby in case of an allergic reaction.

Nasal Polyp Study

Nasal polyposis is a clinical condition characterized by the presence of multiple polyps (growths of inflamed tissue) in the nose. The main complication associated with polyp formation is chronic sinus infection, with symptoms lasting more than 12 weeks. Symptoms include long-term nasal obstruction and congestion, decrease or loss of sense of smell, nasal discharge, post nasal drip and facial pain. These symptoms can impact greatly upon a patient’s quality of life. Chronic sinus infections have a greater burden of symptoms and a higher relapse rate after treatment. Treatment options range from local or systemic corticosteroids to sinus surgery. The cause of polyps is not entirely known. They are most commonly thought to be caused by allergies, although a large number are associated with non-allergic asthma or no respiratory or allergic triggers can be found1,2,3,4.

The Baker Allergy, Asthma and Dermatology Research Center is beginning a study to research a medication to treat nasal polyps. This new medication has been used in asthma and has shown promise in reducing nasal polyps. There is an unmet need in this area as patients require more effective medication available to treat nasal polyps and prevent complications of sinus infections. If you or someone you know would like more information regarding this study, please contact Marianne Paul, research coordinator at 503-505-5906 or email her at mariannepaul@aadrc.com.


1. Thomas M, Yawn B, Price D, Lund V, Mullol J, Fokkens W. EPOS Primary Care Guidelines: European position paper on the primary care diagnosis and management of rhinosinusitis and nasal polyps 2007 - a summary. Primary Care Respiratory Journal 2008; 17(2):79-89.

2. Fokkens W, Lund VJ, Mullol J. European position paper on rhinosinusitis and nasal polyps 2007. Rhinology 45; 2007; 20: 1-13

3. Bryson JM, Tasca RA, Rowe-Jones JM. Local and systemic eosinophilia in patients undergoing endoscopic sinus surgery for chronic rhinosinusitis with and without polyposis. Clin Otolaryngol 2003; 28:55-58.

4. Slavin RG. Nasal polyps and sinusitits. JAMA, 10 Dec 1997; 278: 1849-1854.

Itch Study

An itch or pruritus is the sensation of an itch and can be either localized or generalized. It is triggered by an irritation to a specific type of nerve that leads to an itch sensation and the desire to scratch the skin. Itching can result from skin conditions, such as eczema, medication reactions or systemic illness1. It is defined as chronic when the symptoms of itching have been present for six weeks or longer, according to the International Society for the Study of Pruritus. The incidence of a chronic itch has been found to increase with age2.

People who have itching often times seek medical care from their dermatologist, as it can contribute to a decrease in quality of life, including difficulty functioning and sleeping3. The Baker Allergy, Asthma and Dermatology Research Center is currently involved in a study researching an investigational treatment for chronic itching. If you or someone you know has chronic itching, are 18 years or older and would like additional information about the research study, please contact either Emily Widen, research coordinator or Erin Flamiatos, FNP in our research center at (503) 534-2622.


1. Reich A, Stander S, Szepietowski JC. Drug-induced pruritus: a review. Acta dermatovenereologica. 2009;89(3):236-244.

2. Grundmann S, Stander S. Chronic pruritus: clinic and treatment. Annals of dermatology. Feb 2011;23(1):1-11.

3. Thaipisuttikul Y. Pruritic skin diseases in the elderly. The Journal of dermatology. Mar 1998;25(3):153-157.

Baker Allergy, Asthma and Dermatology Newsletter
James Baker MD Holly Morrison FNP Elizabeth Smith, FNP
3975 SW Mercantile Dr. Ste 158 Lake Oswego, OR 97035
503 636-9011, Cell: 503 784-7452, jameswbaker@aadrc.com

September 2013

 

Asthma Action Plans

With the month of September well underway, the staff at Baker Allergy, Asthma and Dermatology Center have been preparing our patients for the upcoming school year with regard to asthma and allergy education. As fall is upon us, so is the cold and flu season. If you or your child has a diagnosis of asthma that is triggered by upper respiratory infections it is important to have the tools to detect increase in asthma symptoms (coughing, wheezing, shortness of breath and chest retractions), along with the medications to treat those symptoms. An asthma action plan can be very helpful with treating patients who have asthma symptoms with upper respiratory infections by temporarily increasing or adding an extra asthma medication for a few weeks to prevent complications. Additional asthma triggers that are often seen with the fall and winter seasons are dust and mold allergies, and exercising in cold air. If you feel an asthma action plan would be beneficial for you or your child, please contact us at (503) 636-9011. You can find more information about environmental controls for allergies to dust and mold on our website, http://bakeraad.com/ or AAAAI.org.


 

Auvi-Q, A New Epinephrine Device

As children with food allergies are entering or returning to school this year, it is important to make sure they have an Epipen or Auvi-Q device to bring with them. There are now two epinephrine devices available for administration to treat anaphylaxis. The newest device, Auvi-Q offers the same medication as Epipen, but is smaller and shaped similar to a cell phone for convenient carrying. In addition, it offers step-by-step audio instructions on how to use the device should anaphylaxis occur. Our patients have found it to be user friendly and convenient. It comes in both child and adult strength. When picking up either the Epipen or Auvi-Q devices from your pharmacy, please make sure they do not expire until the end of the school year, to ensure you will not have to refill the prescription due to expiration of the device during the school year. Along with either the Epipen or Auvi-Q devices, patients with food allergies should also have a written anaphylaxis action plan available to provide guidance for treatment of food allergy reactions. We are happy to discuss the Auvi-Q with you and review your food allergy action plan as needed. For more information on Auvi-Q, please refer to http://www.auvi-q.com/. For more information on Epipen, please refer to http://www.epipen.com/.

 
 










Cat Allergy Study

Allergy to cat dander is one of the most common forms of allergic rhinitis. In the United States alone, over 26 million people suffer from cat allergies1. Those with a cat allergy who live with cats may experience many unpleasant symptoms, such as itching, sneezing, nasal congestion, and watery eyes. One of the most effective forms of treatment for cat allergies is specific immunotherapy. Specific immunotherapy for cat allergies provides a long term benefit by boosting the immune system against cat specific proteins.

One of the largest downsides of immunotherapy is the potential risk of allergic reaction or anaphylaxis. The Baker Research Center is participating in a study that looks to overcome this risk by using an alternate formula for immunotherapy. This new study drug improves upon traditional immunotherapy by using molecules significantly smaller than those found in regular immunotherapy. Essentially, they are little fragments of the normal allergen. These fragments, called peptides, are too small to contain multiple allergy antibody binding sites. Thus, only a single allergy antibody can bind them. This prevents cross-bridging, which may lead to anaphylaxis. Since they can still be bound by an allergy antibody but not cross-bridged, the peptides boost the immune system without large risk of an adverse reaction.

The goal of the cat allergy study is to prove that use of the new investigational immunotherapy drug helps safely reduce symptoms of cat allergy and reduces dependence on allergy medication. The study lasts for approximately one year. During this time, study subjects will receive 8 doses of study drug, placebo, or both. Study subjects will record their symptoms and medication use for a few weeks during the year, and the results will be compared between placebo and non-placebo groups. In order to qualify for the study, patients must be 12-65 years of age, experience symptoms when exposed to cats, live with a cat that is indoors for more than 8 hours each day, and not have any severe asthma, food allergies, or dust and mold allergies.
If you or someone you know is interested in learning more about this study, please contact our research department at 503 534-2622.

1. World Allergy Organization. The global epidemiology of allergy. White Book on Allergy, 2011.

Allergy Programs, Research & Therapy at Baker Allergy, Asthma & Dermatology

Baker Allergy, Asthma and Dermatology Newsletter
James Baker MD Holly Morrison FNP Elizabeth Smith, FNP
3975 SW Mercantile Dr. Ste 158 Lake Oswego, OR 97035
503 636-9011, Cell: 503 784-7452, jameswbaker@aadrc.com


August 2013


Outgrowing a Milk Allergy

A new study has found that milk allergy is not outgrown as early as research once demonstrated. A recent study of 244 children with milk allergies showed that at age of 66 months, 52.6% percent had outgrown the allergy and were able to consume milk products safely . Additional research has shown promising results of children outgrowing milk allergy faster by introducing baked milk products on a consistent basis. This initial oral challenge involving a baked muffin containing milk must be completed in a clinic setting for safe monitoring. We are now implementing this program at The Baker Allergy, Asthma and Dermatology Center. If you have a child or know someone with a child who has a milk allergy, feel free to contact the clinic for further information regarding this program at 503 636-9011.

1. Wood RA, Sicherer SH, Vickery BP, et al: “The Natural History of Milk Allergy in an Observational Cohort.” The Journal of Allergy and Clinical Immunology. 131 (2013): 805-812.

Pollen Counts

We are currently receiving reports of low tree and weed pollen counts from the American Academy of Allergy, Asthma & Immunology website. The counts are based out of Eugene for the state of Oregon. The grass pollen season began in late April this year, which is very early as it typically begins in mid May. It lasted through July, although the grass pollen counts for the latter part of July were in the low range. You can follow the pollen counts by going to the website at AAAAI.org and clicking on the pollen count link in the upper right hand corner.








Current Study at Baker Research Center

House dust mites are the source of one of the most common allergies in the United States. According to the National Health and Nutrition Examination Surveys III, 27.5% of Americans show sensitivity to dust mites based on skin prick testing1. There are three basic treatment options available for those who suffer from house dust mite allergies. The first is avoidance, which may be difficult for many individuals. Second, some may obtain relief of symptoms through control with medication. Lastly, immunotherapy provides long-term benefit by building the body’s tolerance to dust mite allergens. Immunotherapy is a great option for those who do not obtain relief from or want to avoid large doses of medication. There is a new dust mite study being offered at The Research Center, it aims at studying a sublingual form of dust mite immunotherapy that a subject can safely take in the comfort of their own home. The goal of the study is to test if taking a dust mite immunotherapy tablet by mouth can help relieve symptoms of dust mite allergy. In this study, patients will be taking an immunotherapy tablet once a day by letting it dissolve under their tongue. After screening to determine eligibility takes place, the study lasts for approximately one year. Study subjects will record their symptoms for a few weeks during the peak house dust mite seasons, and the results will be compared between placebo and non-placebo groups. By doing so, we hope to show that the sublingual form of immunotherapy provides significant relief to those suffering from dust mite allergies. If you are interested or know someone who may be is interested in this study, please call our research center at 503 534-2622.

1. Arbes SJ, Gergen PJ, Elliot L, Zeldin DC. "Prevalences of Positive Skin Test Responses to 10 Common Allergens in the US Population: Results from the Third National Health and Nutrition Examination Survey." The Journal of Allergy and Clinical Immunology 116.2 (2005): 377-83.