January Newsletter

Atopic Dermatitis Study

The Baker Research Center has a new study beginning this month for the treatment of adults with moderate to severe atopic dermatitis, otherwise known as atopic eczema. Atopic dermatitis is a chronic inflammatory skin condition partially related to defects in the cells in the skin's outside layer [1]. Signs and symptoms of atopic dermatitis include itchy, dry skin, which has a red, scaly and bumpy appearance [2]. It typically affects the inside of the elbows and the posterior aspect of the knees in adults, although atopic dermatitis may present on any area of the body [3].

The upcoming study involves a medication that is administered in the Baker Research Center every two weeks to treat patients who have had atopic dermatitis for over three years, which hasn't responded adequately to topical steroid medications. Throughout the study, patients will have their skin assessed by a physician at the Baker Research Center. The study lasts approximately one year, with initial visits every two weeks, then every month for the remainder of the study. The medication and treatment is free of charge throughout the study.

If you or someone you know is interested in more information about the atopic dermatitis study, please call Brittany in our Research Center at 503 534-2622.

1. Spergel JM, Paller AS. Atopic dermatitis and the atopic march. J Allergy Clin Immunol 2003; 112:S118.

2. Rudikoff D, Lebwohl M. Atopic dermatitis. Lancet 1998; 351:1715.

3. Williams HC. Clinical practice. Atopic dermatitis. N Engl J Med 2005; 352:2314.

Sublinqual Immunotherapy (SLIT)

Sublinqual immunotherapy has been implemented and used at the Baker Allergy and Asthma Center for the past several years in the form of liquid drops to treat allergic rhinitis. SLIT is an alternative option to subcutaneous immunotherapy (SCIT) for patients with 1-2 significant allergies. Instead of receiving an injection to treat allergic rhinitis, a few drops of the antigen medication are administered under the tongue (sublingually) once daily. The treatment course is for 3-5 years like SCIT, but can be administered at home instead of in the clinic.

SLIT has been used to treat allergies to dogs, cats, pollens and dust mites. For treatment of pollen allergies, SLIT should be administered 1-2 months prior to the beginning of pollen season for best results and continued throughout the pollen season, then repeated during the next pollen season for a total of 3-5 years. We have many patients who use SLIT for tree and grass pollen allergies during the pollen season. We are starting patients on SLIT for tree and grass pollen currently to prepare for the upcoming spring and summer seasons.

For treatment of perennial allergens, such as dust mites and pets, SLIT may be started at any time and needs to be administered year round. The type of antigens included in the SLIT bottles are customized to treat each individual patient's allergies.

If you are interested in learning more about SLIT for the treatment of allergic rhinitis, please contact us at 503-636-9011 for an appointment.

December Newletter

Sublinqual Immunotherapy (SLIT)

Sublinqual immunotherapy has been implemented and used at the Baker Allergy and Asthma Center for the past several years in the form of liquid drops to treat allergic rhinitis. SLIT is an alternative option to subcutaneous immunotherapy (SCIT) for patients with 1-2 significant allergies. Instead of receiving an injection to treat allergic rhinitis, a few drops of the antigen medication are administered under the tongue (sublingually) once daily. The treatment course is for 3-5 years like SCIT, but can be administered at home instead of in the clinic.

SLIT has been used to treat allergies to dogs, cats, pollens and dust mites. For treatment of pollen allergies, SLIT should be administered 1-2 months prior to the beginning of pollen season for best results and continued throughout the pollen season, then repeated during the next pollen season for a total of 3-5 years. We have many patients who use SLIT for tree and grass pollen allergies during the pollen season. We are starting patients on SLIT for tree and grass pollen currently to prepare for the upcoming spring and summer seasons.

For treatment of perennial allergens, such as dust mites and pets, SLIT may be started at any time and needs to be administered year round. The type of antigens included in the SLIT bottles are customized to treat each individual patient's allergies.

If you are interested in learning more about SLIT for the treatment of allergic rhinitis, please contact us at 503-636-9011 for an appointment.

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 induce 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 temporarily 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 December 9, 2013 from http://www.acaai.org/allergist/news/New/Pages/avoiding-holiday-asthma-allergy-triggers.aspx

October Newsletter II

Chronic Hives (urticaria)

Chronic hives (urticaria) is defined by the presence of hives on most days for a duration of longer than six weeks [1]. Some patients may have angioedema or swelling of body tissue associated with urticaria as well

Chronic urticaria is initially treated with H1 antihistamines, such as Zyrtec or Allegra, sometimes at higher than usual doses. In addition, many patients may need a combination with H2 antihistamines and Singulair as well [2]. It is not uncommon to need short courses of systemic glucocorticoids to control severe exacerbations, however, long-term oral glucocorticoids should be avoided if possible, as they may have severe side effects and there is not any evidence that they alter the natural history of chronic urticaria [2,3].

In treating patients with chronic urticaria, our goal of therapy is to achieve symptom control which is tolerable for the patient and an improvement in his or her quality of life. Choices of treatment options are made carefully as minimizing therapy-related side effects is a priority in treating a patient with chronic urticaria.

Omalizumab is a monoclonal antibody against immunoglobulin E (IgE), and was approved for chronic urticaria that doesn't respond to H1 antihistamines by the US Food and Drug Administration earlier this year [1]. Omalizumab is safe and effective for most patients and has been used to treat many different types of urticaria, including autoimmune, solar, cholinergic, dermatographism and angioedema without urticaria. Dr. Baker has been using Xolair since 2008 for the treatment of both chronic urticaria, urticaria with associated angioedema and histaminergic angioedema without urticaria. If you or someone you know is interested in receiving treatment or more information about chronic urticaria, please notify us at (503)636-9011.

1. http://www.gene.com/media/press-releases/14563/2014-03-21/fda-approves-xolair-omalizumab-for-peopl (Accessed on October 21, 2014).

2. Kaplan AP. Clinical practice. Chronic urticaria and angioedema. N Engl J Med 2002; 346:175.

Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol 2014; 133:1270.

3. Kim S, Baek S, Shin B, et al. Influence of initial treatment modality on long-term control of chronic idiopathic urticaria. PLoS One 2013; 8:e69345. US Food and Drug Administration (FDA) new and generic drug approvals.

Halloween and Food Allergies

With the celebration of Halloween coming up, so does the associated concern of accidental exposure to food allergies for our patients. Many types of candy given out during trick or treating contain the most common food allergens, such as milk, egg, soy, peanuts, tree nuts and wheat. It is important to take time to read labels prior to allowing children with food allergies ingesting halloween treats. This year, The Food Allergy, Research & Education (FARE) network is encouraging families to paint a pumpkin teal and place it on their doorsteps to notify trick or treaters that they offer non-food treats, such as:

•Glow sticks, bracelets, or necklaces
•Pencils, pens, crayons or markers
•Bubbles
•Halloween erasers or pencil toppers
•Whistles, kazoos, or noisemakers
•Finger puppets or novelty toys
•Mini Slinkies
•Bouncy balls
•Coins
•Spider rings
•Vampire fangs
•Mini notepads
•Playing cards
•Bookmarks
•Stickers
•Stencils

According to FARE, the Teal Pumpkin Project is aimed at promoting inclusion and respect for all children with food allergies. In addition, it may help to increase safety for those with food allergies who would like to participate in trick or treating [1].

You can print your own Teal Pumpkin Project sign and place it on you door to raise awareness using the following link:

http://blogdotfoodallergydotorg.files.wordpress.com/2014/10/teal-pumpkin-sign.pdf

1. http://www.foodallergy.org/teal-pumpkin-project (Accessed on October 21, 2014).

October Newletter I

Asthma Action Plans

With the fall season 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 these signs and 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 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, exercise and cold air exposure. 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://www.bakeraad.com/ or http://www.AAAAI.org.

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 therapies[1].

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 Angie Johnson at 503-534-2622.

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

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 allergies[1]. 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.