ALLERGIES Summer Allergy Update

with permathrin and carefully applying DEET-containing insect repellent [at least 20%] have been shown to be effective in preventing tick bites. Closely examining your skin — and the skin of your loved ones, including your canine pals — when returning from an outdoor excursion is always a good habit to get into when living in regions that are home to ticks.

ping it tightly in tape, or flushing it down the toilet. Remember that ticks can’t jump or fly. They climb on tall grasses and shrubs and wait for someone to brush against them. Once they hitch a ride, ticks like to hide in and around the hairline, behind the ears, under the arms, inside the belly button, around the waist, between the legs, and behind the knees. Immediately removing an attached tick as soon as it is found is hugely important because after 36 hours, transmission of tickborne diseases becomes more likely. The CDC suggests not waiting for the tick to detach by using “folklore remedies such as ‘painting’ the tick with nail polish or petroleum jelly, or using heat.” Instead: surface as possible. 2. Pull upward with steady, even pressure. Don’t twist or jerk the tick; this can cause the mouth-parts to break off and remain in the skin. If this happens, remove the mouth-parts with twee

zers. If you are unable to remove the mouth easily with clean tweezers, leave it alone and let the skin heal. 3. After removing the tick, thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. 4. Never crush a tick with your fingers. Dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrap1. Use fine-tipped tweezers to grasp the tick as close to the skin’s

Read the CDC’s outstanding reference manual on “Tickborne Diseases of the United States” here.

Read more about Lyme disease and tickborne illnesses on The PediaBlog here.

Allergies

Summer Allergy Update

Sergei Belenky, MD, PhD : Allergy, Asthma, Immunology. : AHN Pediatric Institute

As the COVID-19 pandemic has been dominating social and medical discourse for quite some time now both globally and locally, we in the healthcare community and the public in general have been particularly strained with ‘run of the mill’ human disease, both chronic and acute. I’d like to give a brief perspective of what to expect this summer and fall from seemingly unending allergy season looming large in our region and geographies across the country.

I am writing this on July 24th which, in our area, puts the community in the midst of a pretty significant outdoor MOLD season - ALTERNARIA. Alternaria thrives in the hot and humid conditions generously provided by the summer time. It is an important cause of allergic rhinitis and asthma and keeps allergists busy through the summer, some years more than others. The GRASS pollen season as such should be considered over at this point, but more sensitive sufferers of allergy may still be feeling its effect.

The outdoor allergen everyone is primarily concerned about in North America, however, is RAGWEED. Its generic name is Ambrosia, which in translation from Latin means ‘food of the Gods’. There are 17 species of ragweed, common ragweed being a chief allergen producer. It starts blooming between 10th and 15th of August and continues its spewing rampage through mid-September. With climate change, even after defusing the political charge of the term, ragweed season can linger until frost and sets the tone for the fall allergy season. Ragweed is a fairly tall weed (up to 18 feet high) with hairy stem, long leaves, and yellow flowers. But don’t mix it up with ‘yellow rods’, which are totally harmless from an allergy standpoint. Ragweed is an unimposing free space taker and roadside grower. But its impact is substantial and lasting. One ragweed plant is estimated to be able to produce up to 1 billion pollen grains per season.

Symptoms of ragweed seasonal allergic rhinitis are similar to any other seasonal allergy of the nose and the eyes. It usually presents as congestion, runny nose, sinus pressure, sneezing, and once well established in the inflammatory cascade, post-nasal drip. During the peak of the season, usually early September, we see a lot of ocular allergic complaints requiring the use of anti-allergic eye drops. Itchy mouth, itchy ears, ‘itchy everything’ are not uncommon. We should be prepared to see a surge in sudden onset of hives attributed to a heavy pollen season.

How to be ready.

The most effective recommendation is to initiate an intranasal steroid spray during the 1st week of August at the very latest. Patients who follow this annual advice are usually protected against the misery that ragweed season inflicts on the ones who don’t take up this action plan. For ragweed allergic patients of all ages, combination therapy of intranasal steroids/antihistamines, oral antihistamines, and ocular antihistamines is commonly applied and, to varying degrees, effective. Some therapy is continued for at least 6 weeks from the onset of the season. Intra-nasal steroid sprays are available over the counter with such well-known brands as FLONASE, NASACORT, RHINOCORT, SENSIMIST. And there are prescription options of both steroid and antihistamine nasal sprays, as well as generic versions of almost all of the brands. PATADAY is an over-the-counter anti-allergic eye drop which is both safe and effective. Bear in mind that almost ALL eye drops and nasal steroid sprays are FDA approved to 2 or 3 years of age. Please, do not use VISINE. It will make your eyes look good, but Visine does not address underlying allergic inflammation. Oral antihistamines are widely represented on any pharmacy shelf in the allergy section. Well-known brands are ZYRTEC, CLARITIN, ALLEGRA, XYZAL. All of them are available in doses and formulations appropriate for adults and children of different ages. Generic equivalents are also available. All of these medicines are over the counter, however, can also be prescribed, and quite possibly will be less expensive that way. As a first line choice for severe allergic reaction like hives, BENADRYL is absolutely safe, but avoid using it on a regular, ongoing basis because of a heavier load of side effects. For allergic symptoms of the nose and eyes second generation anti-histamines as outlined above are the choice.

How to prevent

Allergy immunotherapy is the ultimate answer. Confirmation should be obtained by either skin test or blood test, preferably outside the season, allowing for the time to start immunotherapy in advance. Immunotherapy is very effective and well tolerated. Its efficacy is superior in children and adolescents. It entails 2 main forms: allergen injections (notorious ‘allergy shots’) and oral administration (‘allergy drops’). Specifically for RAGWEED allergy, a third alternative exists for ages 18 years and older - SLIT (sublingual immunotherapy). It is FDA approved, effective and also well tolerated. The brand name is RAGWITEK, and it should be started in the middle of May, three months before the ragweed season and continued through November. Only the 1st dose has to be given in the allergist’s office, and once it is found to be well tolerated, it should be continued DAILY at home. This is an allergy product and NOT a medication - a big winner with young people and their parents who don’t like medications. As any other immunotherapy, if deemed effective SLIT is done for three years - 6 to 8 months each year.

Seasonal asthma

Let’s not forget that asthma is an allergic disease that can be triggered by pollen, including RAGWEED. It also temporally overlaps with the