ALLERGIES & ASTHMAMARCH 2008 YOUR GUIDE TO ALLERGIES AND ASTHMA

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CONTENTS

Is it an Allergy or a Cold? 4

Have Allergies? 4

The Inside Scoop on IndoorAllergens 5

Playing it safe outdoors 5

Vacuuming Can Be Good For YourHealth 5

Why Are So Many People Allergic? 7

Taking a Bite out of Food Allergies 7

Understanding the Atopic March 7

Controlling Asthma with Web-Based Technology 9

Getting Exercise-Induced Asthmaunder Control 9

Know the Basics About BloodTesting for Allergies 9

Welcome Relief for Red, Itchy Eyes 11

Taking a Shot at AllergenImmunotherapy 11

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3ALLERGIES & ASTHMA

Editorial

Allergists/immunologists and other healthcare professionals have made considerableprogress in understanding asthma and otherallergic diseases over the last two decades.Yet, the number of Americans sufferingfrom these diseases has not declined, and insome instances, such as food allergy, hasdramatically increased.Why nearly 20% of adults and 40% of

children suffer from allergic diseases is notknown. Theories for this high prevalencerate include better living conditions and hy-giene and more widespread use of antibi-otics, environmental factors such as dieselexhaust particles or exposure to airbornepollens, life style and diet changes and ge-netic predisposition. It is likely that all ofthese and other factors contribute to the de-velopment of allergies.Because asthma and allergic disease are

so common, the members of the AmericanAcademy of Allergy, Asthma & Immunol-ogy (AAAAI) devote their professional livestowards gaining better understanding ofhow these diseases develop and how best torecognize and appropriately treat them.This is why we at the AAAAI are excited toparticipate in this independent supplementdiscussing some of the more common aller-gic diseases such as asthma, allergic rhini-tis (or hay fever), insect allergies, food al-lergies and the progression from one toanother. This latter concept, termed the“atopic march” highlights that infants andyoung children often have a progressionfrom food allergy and/or atopic dermatitisor eczema to allergic respiratory diseasessuch as hay fever, and ultimately, asthma.Indeed, the likelihood of developing asthmais much higher in children who have otherallergic disorders and allergies are signifi-cant triggers for asthma in 80% or more ofchildren and 50-60% of adults.One question often asked is: how does

one “develop” an allergy? First, you have tohave the genetic predisposition to make akey antibody, IgE, to a trigger, such as catdander. This process is called sensitization.This IgE antibody then attaches to immunecells known as mast cells and basophils, andserves to capture cat dander when inhaled.This triggers a number of biochemicalevents ultimately resulting in mast cells andbasophils releasing chemicals that cause thesymptoms of allergies and promote inflam-mation. One of the released chemicals ishistamine, and this is why “anti” –hista-mines are often used to treat allergies. How-ever, a number of other chemicals are alsoreleased and the inflammation that results

from an allergic reaction can lead to long-term problems. This is why antihistaminesmay not be totally effective for relieving thesymptoms of allergies. Also, many of the‘over- the -counter” antihistamines causesedation and impair abilities to learn, work,drive and function.Did you know that hay fever or allergic

rhinitis can lead to 2 million lost days ofschool and 10 million lost days of workevery year? Children don’t learn as well inthe classroom and adults don’t function aswell at their jobs during the peak allergyseason. This is compounded by inadequateor inappropriate treatment. That is why it isso important to see an allergist/immunolo-gist to determine if your symptoms are theresult of allergies. If so, the allergist/immu-nologist can best manage your allergies andgive advice on avoidance and the use of ap-propriate medications, and when indicated,prescribe allergy immunotherapy.This is an exciting time for us in the

AAAAI as we study ways to prevent and re-verse asthma and other allergic diseases. Wewould like to be able to manipulate the im-mune system to prevent the child with foodallergy from developing asthma, or betteryet, to stop the development of food allergybefore a child has an acute life threateningreaction to peanuts. Our ultimate goal is toeducate the public and health care providersabout asthma and allergic diseases, advo-cate for our patients to receive appropriatecare, and advance science so you and yourchildren are protected against the conse-quences of allergies.

The AAAAI represents allergists, asthma spe-cialists, clinical immunologists, allied healthprofessionals and others with a special interestin the research and treatment of allergic dis-ease. Established in 1943, the AAAAI has morethan 6,500 members in the United States,Canada and 60 other countries. The organiza-tion serves as an advocate to the public by pro-viding a wealth of educational informationthrough its Web site at www.aaaai.org

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ALLERGIES & ASTHMAMARCH 2008 YOUR GUIDE TO ALLERGIES AND ASTHMA

Thomas B. Casale, MD, FAAAAIPresident 2007-2008American Academy of Allergy, Asthma & Immunology

About thMediaplaThe Wasthis new

An Advertising Supplement to TheWashington Post

An Advertising Supplement to TheWashington Post4ALLERGIES & ASTHMA

Most of us, at one point oranother, have sufferedsymptoms of the “com-

mon cold”. One might suffer frompain and swelling of the sinuses,nasal discharge, a stuffy nose,coughing spells, sneezing, and aheadache. Taking extra vitamin Cand over-the-counter pain relieversmay have been part of your recov-ery regime as well as staying homefor a day or two so as not to con-taminate co-workers.These courses of action are typical

when trying to treat a cold. If youhave an allergy, however, these ef-forts may be constant and possiblyfutile.

"Millions of Americans think theyare suffering from a cold whenthey're actually experiencing aller-gies," says Anju Peters, MD, Chair ofthe American Academy of Allergy,Asthma & Immunology’s (AAAAI)Rhinosinusitis Committee. “Cold andallergy symptoms can be very simi-lar. The main difference is thelength of time symptoms last. Acold normally disappears after aweek or so, but allergies can lastmuch longer.”Dr. Paul Greenberger is a Profes-

sor of Medicine in the Allergy-Im-munology Division at NorthwesternUniversity’s Feinberg School ofMedicine. According to Dr. Green-berger, “Allergies cannot be passedfrom person to person and are per-

sistent, unlike a cold. They are sea-sonal and can be triggered by spe-cific substances or environmentalfactors,” he adds. “It can be treepollen as early as February andgrass pollen in May.”Dust mites, mold, or pet dander

can also produce antigens and year-round symptoms like itching of theeyes and nose. These are classic al-lergy signs that differ from the sys-temic response of a cold; an infec-tion caused by a virus with a limitedtime span of 2 to 14 days. Generalaches, pains, or fever can sometimesaccompany a cold, which is neverthe case with allergies.Although there is no cure for al-

lergies, several treatment options areavailable, including over-the-

counter and prescription medica-tions. Immunotherapy, commonlyknown as allergy shots, is anotheralternative. Unlike a cold, allergicdisease is not a condition that some-

one can just “get over.” However,the help of an allergist/immunolo-gist can reduce how often peopleneed to stay home from work orschool due to symptoms.

TEXT:AUDRA FEUER

Noticing the difference between a persistent cold and allergies can improve yourhealth.

Is it an Allergy or a Cold? Allergies Colds

Symptoms

Runny or stuffednose, sneezing, wa-tery and itchy eyesand wheezing (asso-ciated with asthma).

Can include fever,body aches andpains, along withallergy symptoms.

Warning TimeSymptoms beginalmost immediatelyafter exposure to anallergen.

Symptoms usuallydevelop over severaldays.

Duration

Symptoms last aslong as you areexposed to an aller-gen and beyond. Ifthe allergen ispresent year-round,symptoms may bechronic.

Symptoms shouldclear up withinseveral days to aweek.

According to the AmericanAcademy of Allergy,Asthma & Immunology

(AAAAI), allergic disease affectsmore than 50 million people in theUnited States. Asthma alone causesabout 2 million emergency roomtrips each year and nearly 5,000deaths. In fact, it is the fifth leadingcause of chronic disease in theUnited States, costing consumers,employers and healthcare industriesbillions of dollars each year.“A key step toward controlling al-

lergies is finding the right medicalprofessional to consult, according to

Dr. Michael Schatz, Clinical Profes-sor of Medicine at the University ofCalifornia San Diego and Chief ofthe San Diego Kaiser Permanente

Allergy Department. “ Appropriatediagnosis and management canmake the difference between suffer-ing with allergies and living well

with allergies,” says Dr. Schatz.An allergist/immunologist is a

physician specially trained to man-age and treat allergies and asthma.They are physicians certified in ei-ther internal medicine or pediatricswith at least two additional years ofaccredited training and passage ofthe American Board of Allergy-Im-munology examTo help patients find a qualified

allergist/immunologist, the AAAAIoffers an online physician referraldirectory that can help consumerslocate a physician by location orspecialty at www.aaaai.org.

TEXT:AUDRA FEUER

Have you seen an allergist/immunologist?

Have Allergies?An allergist/immunologist is a physician specially trained to manage and treatallergies and asthma. Becoming an allergist/immunologist requires:

• Three years of training in internal medicine (to become an internist) orpediatrics (to become a pediatrician) following medical school

• Passage of the exam of either the American Board of Pediatrics or the Amer-ican Board of Internal Medicine (ABAI)

• Internists or pediatricians who focus on the subspecialty of allergy/immunol-ogy and become allergist/immunologists complete at least an additional twoyears of study, in an allergy/immunology training program

• ABAI-certified allergist/immunologists have passed the certifying examina-tion of the ABAI, following their fellowship.

What is an Allergist/Immunologist?

«An allergist/immunol-ogist is a physicianspecially trained tomanage and treat

allergies and asthma»

An Advertising Supplement to TheWashington Post 5ALLERGIES & ASTHMA

You can reduce dust by wip-ing down tables, countersand bookshelves regularly.

If you have rugs or carpets, vac-uum at least once a week. Not allvacuums are created equal, though;

some low-end vacuums simplyblow the smallest dust particlesthrough the bag and back into theair. It’s best to invest a vacuumwith a HEPA filter, which can re-move 99.97 percent of the tiniestparticles—the ones that are likely totrigger allergy symptoms. In addi-

tion, using an air conditioner is asmart choice because it both dehu-midifies the air and filters out dust.Be sure to change your filtermonthly.You should also wash your

sheets and linens weekly using hotwater (above 130 degrees) to pre-

vent dust mites. Be sure to drythem in a drying machine, other-wise these damp cloths can grownmold.You should also prevent mold by

keeping the surfaces in the bath-room and kitchen dry, and fixingany leaky pipes or cracks in thewall where water can seep in.House pets can also irritate your

allergies—but not, as is commonlybelieved, because of their fur. Infact, it is a protein found in ani-mals’ saliva, dander (flakes of deadskin), and urine that causes aller-gic reactions in humans. Bathingyour dogs or cats on a regular basiscan help. Turtles, snakes, fish andother animals without fur or feath-ers won’t cause allergic reactions.

TEXT:MATT GNAIZDA

The main factors that contribute to indoor allergens are dust, mold, and house-hold pets.

Contrary to popular belief,most bright flowers do notstimulate allergies; they are

pollinated by flying insects, so theparticles tend to be too large andwaxy to be blown around by thewind.

During the spring, the most com-mon allergy-causing pollens comefrom trees such as walnut, poplar,hickory, cypress, birch, elm,sycamore, ash, maple, and oak. Inthe late spring and early summer,they come from grasses like timothy,orchard, sweet vernal, and Bermuda.And in the fall, pollen mainly comesfrom ragweed and other weeds thathave late pollination seasons.Molds—microscopic fungi—can

also trigger allergies. Some kinds ofmolds, especially in the Southernand Western United States, are pres-ent all year around. Other kindsreach their peaks in the summer or

early fall. Common outdoor moldsare alternaria, aspergillus, and cla-dosporium.

Pollen and mold countsPollen and mold counts measure theamount of airborne allergens presentin the air. Counts are compiled by avariety of methods. Pollen and mold

spore counts can be determineddaily, and are reported as grains percubic meter of air. Certified aeroal-lergen counters at many universities,medical centers and clinics providethese counts on a volunteer basis.The National Allergy Bureau

(NAB) is the nation's only pollen andmold counting network certified bythe AAAAI. As a free service to thepublic, the NAB compiles pollen andmold counts from certified stationsacross the nation and reports themto the media three times each week.These counts are also available onthe NAB page of the AAAAI's Website, www.aaaai.org.

TEXT:MATT GNAIZDA

Outdoor allergies are triggered mainly by pollen andmold. .Pollen is made of male cells of plants, trees,and grasses. The average pollen particle is hard tosee; in fact it is thinner than a human hair.

Playing it safeoutdoors

Avoiding AllergensCan Help ControlAllergy Symptoms

Follow these simple tips to avoidor reduce your chances of hav-ing allergic reactions.

Allergens cause reactions in as manyas one out of every six Americans.While medication can reduce thesesymptoms, one of the best ways tobetter health is to eliminate contactwith the factors—both indoor andoutdoor—that produce these aller-gens, according to the AmericanAcademy of Allergy, Asthma & Im-munology (AAAAI).

The Inside Scoop onIndoor Allergens

«During the spring, the most commonallergy-causing pollens come from trees»

DO keep windows closed atnight to prevent pollens ormolds from drifting into yourhome. Instead, if needed, useair conditioning, whichcleans, cools, and dries theair.

DO minimize early morning ac-tivity when pollen is usuallyemitted-between 5-10 a.m.

DO keep your car windowsclosed when traveling.

DO try to stay indoors when thepollen count or humidity isreported to be high, and onwindy days when dust andpollen are blown about.

DO take a vacation during theheight of the pollen seasonto a more pollen-free area,such as the beach or sea.

DO take medications prescribedby your allergist/immunolo-gist regularly, in the recom-mended dosage.

DON'T take more medication thanrecommended in an attemptto lessen your symptoms.

DON'T mow lawns or be aroundfreshly cut grass; mowingstirs up pollens and molds.

DON'T rake leaves, as this also stirsup molds.

DON'T hang sheets or clothing outto dry. Pollens and molds maycollect in them.

DON'T grow too many, or overwater,indoor plants if you are allergicto mold. Wet soil encouragesmold growth.

Vacuuming Can Be GoodFor Your Health

Living with allergies is tough. Walk-ing outside where there is dust,pollution, or flowering plants can

ruin your day. But the home or officecan be just as dangerous for allergy-suf-ferers.

In particular, carpets and other up-holstery act as giant dust traps, captur-ing dirt, pollen, and dust. They also har-bor dust mites, tiny living creatures thateat food crumbs and dead skin particles.

A dirty carpet can hold up to 100,000dust mites per square yard, and a singledust mite produces about 20 wastedroppings each day—that’s two milliondroppings building up in your carpetevery single day, and they all contain aprotein which can aggravate your aller-gies.

Regular vacuum cleaners clean upvisible dirt and grime, but if they do nothave a tight seal or high-end filter, theycan blow those particles right back outinto the air. And these tiny particles,such as dust mite droppings, are whatcan really make you sick.

One of the best solutions is to use avacuum with a High-Efficiency Particu-late Air (HEPA) filtration system. TheHEPA filtration system was originallydesigned in the 1940s to help scientistsworking on the atomic bomb preventthe spread of airborne radioactive parti-cles. Today, the HEPA filter is availablein high-end consumer vacuums. It cancapture 99.97 percent of the particles

that make you sick. While HEPA vacu-ums are more expensive than low-endvacuums, the health benefits they offerare worth the upfront cost. One of thebest-value HEPA vacuums on the mar-ket is the Electrolux Oxygen3 Ultra,which Consumer Reports commends forits “superb carpet cleaning” and “superbpet-hair performance.”

A quality vacuum is key to keepingyou healthy inside the home or office.Carpets and upholstery should be vacu-umed at least once a week, preferablyevery couple days.

You should also wash your bed linensevery week. While they are in the wash,you can vacuum the surface of yourmattress to prevent the buildup of dustmites where you sleep.

If you don’t have time to do a thor-ough cleaning, focus on the areas inyour home or office where you spendthe most time. Not all office buildingshire a professional cleaning service, soyou might even consider buying an extravacuum for the office—so you can takeyour allergy health into your own hands.

TEXT: MATT GNAIZDA

Finding the RightVacuumIf you suffer from allergies, when you shopfor vacuum, make sure it has...• A HEPA filtration system, which captures

the smallest particles• A microseal, which prevents dusty air

from escaping.• A light or other indicator to tells you

when to change bags• A comfortable handle and button so you

won’t get tired while using it.

Dos and don’ts

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An Advertising Supplement to TheWashington Post 7ALLERGIES & ASTHMA

Dr. Hugh Sampson, of the Mt.Sinai School of Medicineand President-elect of the

American Academy of Allergy,Asthma & Immunology, says thereis more than one theory about whatis causing this sharp increase in al-lergies among children.“It’s clearly a lifestyle issue,” says

Dr. Sampson, a fact that he says sci-

entists agree with. Research showsthat children in developed nationshave more allergies than children inunderdeveloped countries.Other theories suggest the “hy-

giene hypothesis,” which states thathigh levels of sanitation in our soci-ety can result in a child’s lack ofearly exposure to bacteria, microor-ganisms, and parasites—which actu-ally help strengthen a child’s im-mune system and other biologicalprocesses.Another theory points to how

American food is used andprocessed. For example, Dr. Samp-son points out that the way peanut

butter is homogenized brings outthe protein that causes peanut aller-gies.Scientists are working on identi-

fying why of the most common al-lergen causing foods—peanuts—canaffect so many people.Dr. Scott Sicherer, an Assistant

Professor of Pediatrics at the JaffeFood Allergy Institute of the MountSinai School of Medicine, is part ofthat research.“Finding genes for peanut allergy

or for food allergy in general wouldpotentially allow for better identifi-cation of persons at risk—allowingus to tailor treatments,” says Dr.Sicherer. He says it would also allowfor better diagnosis.

But the key in food allergy generesearch is the clues researchershope it will provide in illuminatingsome of the building blocks of aller-gies.“Most importantly, identifying

genes that determine food allergywould possibly help to unravel thebasic mechanisms that cause the al-lergies,” says Dr. Sicherer.He adds that these basics might

lead to better medical treatments,but cautions that the road ahead ingene research could be a long one.“Unfortunately, finding such genesis difficult, but work is underway,”says Dr. Sicherer.The cause of food allergies likely

lies in multiple factors, which means

no one has yet gotten to the root ofAmerica’s growing food allergyproblem. But by taking simple pre-cautions and being aware of possi-ble physical reactions to food, mostAmericans can avoid serious com-plications.

TEXT: MATT GNAIZDA

Today it is estimated that up to 8% of American children less than 4 years of age experience some kind offood allergy. In two recent studies, the frequency of peanut allergy was found to have doubled in the past5 – 10 years. By comparison, food allergies are believed to affect about 3.5% American adults, with shellfishfish being responsible for the most reactions.

Why Are SoMany People Allergic?

Food allergies are the body’s re-sponse to specific food pro-teins. A person can be allergic

to essentially any food, but the mostcommon ones are peanuts, tree nuts,shellfish, dairy, and eggs.

A severe allergic reaction, calledanaphylaxis, can occur within anhour — or even mere minutes — ofeating a food. It can also result in askin condition, difficulty breathing,

unconsciousness, and even death.More than ever before, people in

the United States are showing thistype of allergy. That is why it is soimportant to know the signs of foodallergies and what to do if theyoccur.Adults or children who experience

coughing, choking, difficulty talk-ing, drooling, swelling, or changes inlevels of awareness need medical at-tention immediately. Those who de-velop hives, skin rashes, itchiness,teary eyes, or nasal congestionshould also see a doctor.An allergist/immunologist can

help you better understand your al-lergy. He or she may prescribe aself-injectable shot of epinephrine(adrenaline) to keep on hand, whichwill help fight off a reaction until

medical treatment is available in theevent of a future allergy emergency.For those patients who want to

look into possible food allergies andtheir treatments through personalonline research, physicians warnagainst blindly trusting informationon the Internet.According to Dr. Wesley Burks is

Chief of the Pediatrics/Allergy andImmunology Division at Duke Uni-versity, “One of the best resources in

the United States for information onfood allergies is the website for TheFood Allergy and Anaphylaxis Net-work,” says Dr. Burks.Unlike other allergies, there is cur-

rently no long-term medical treat-ment for food allergies. However,some children do overcome foodallergies on their own as they growolder.

Americans suffering from food allergies can seektreatments and preventions that can lead to a betterquality of life.

Taking a Bite outof Food Allergies

TEXT: MATT GNAIZDA

When to seek helpIf you experience coughing, choking,difficulty talking, drooling, swelling, orchanges in levels of awareness aftereating something, seek immediate med-ical attention. If you develop hives, skinrashes, itchiness, teary eyes, or nasalcongestion, make an appointment tosee a doctor—you could have food aller-gies.

«A severe allergicreaction, can occurwithin an hour ofeating a food.»

Understanding the Atopic March

One type of allergic reaction in ayoung child may be a sign thathe or she will develop more

types of allergic reactions later in life.This relationship is not yet fully un-

derstood, but it is important to recog-nize. It is called the “atopic march”—achild begins with one kind of allergyand marches towards more as he or shegets older. Atopic refers to an allergicreaction that affects parts of the bodynot in direct contact with the allergen,such as a skin condition triggered byeating something. Atopic diseases areones where allergy often plays a rolesuch as asthma, hay fever, food allergiesand an itchy skin rash called atopic der-matitis.

Frequently, atopic dermatitis is oneof the first atopic diseases a child willexperience, proceeding to respiratorydisorders as they grow up. Atopic der-matitis is a form eczema, a conditionwhere the skin becomes dry, itchy, orcrusty, or blisters, bleeds, turns red, etcetera.

Dr. Scott Sicherer is an Associate Pro-fessor of Pediatrics at the Jaffe Food Al-lergy Institute of the Mount Sinai Schoolof Medicine in New York City. Dr.Sicherer specializes in food allergies, andsays that atopic dermatitis could be ared flag.

“Atopic dermatitis is often a first signthat a person, an infant usually, may beprone to allergies,” says Dr. Sicherer.

Many young patients with atopic der-matitis also suffer from food allergies.

Identifying the food allergies becomeskey in treatment and developing lifestylehabits that will help the patient avoidcontact with potential allergens.

“We know that for infants and youngchildren with atopic dermatitis, aboutone in three will have food allergy thatcontributes to or occurs along with therash,” says Dr. Sicherer. “Also, allergiesto environmental triggers such as animaldander can contribute to the rash,” headds.

Dr. Sicherer recommends that youfirst visit a pediatrician and get their ad-vice. If necessary, you would then see anallergist or immunologist.

TEXT:MATT GNAIZDA

If your child has allergies now, they might grow along with him.

An Advertising Supplement to TheWashington Post 9ALLERGIES & ASTHMA

If you experience coughing,wheezing, or chest tightnesswhen you exercise, or feel ex-

tremely tired or short of breath whenyou exert yourself, you could be suf-fering from exercise-induced asthma(EIA).People with EIA may find it diffi-

cult to participate in strenuous phys-ical activity, but that doesn’t meanthey have to become sedentary. Withproper diagnosis and treatment,someone suffering from EIA couldbe only a step away from being asactive as they want.Approximately 7% of the popula-

tion—about 20 million Americans—suffer from asthma, according to theAmerican Lung Association. Asthmais a chronic inflammation of thebreathing passages of the lungs.With strenuous physical exercise,most of these individuals experienceasthma symptoms. Many non-asth-matic patients are also at risk. About40% of patients with allergic rhinitis(hay fever), and many people whohave a family history of allergiesalso experience asthma associatedwith exercise.EIA patients have airways that are

overly sensitive to sudden changesin temperature and humidity, andother factors such as high pollencounts and air pollutants can alsoincrease the severity of wheezingwith exercise.People engaging in strenuous ac-

tivity, such as running, tend tobreathe through their mouths. Thecold, dry air that goes to the lowerairways without passing through thewarming, humidifying effect of thenose can cause an asthmatic reac-tion in people with EIA.People with EIA may experience

breathing difficulty within 5-20minutes after exercise. Symptomscan include chest tightness, wheez-ing, coughing and chest pain. Othersymptoms include prolonged short-ness of breath, often beginning 5-10minutes after brief exercise.

The good news is that with appro-priate treatment, almost everyonewith EIA can still exercise.“Asthma with exercise is readily

managed with proper warm up andwarm down and appropriate med-ications including beta agonist bron-chodilators with proper medicationsincluding proper warm up and warmdown, beta agonist bronchodilatorsand/or inhaled steroid or leukotrienemodifiers depending on severity andchronicity of asthma,” says Dr.Christopher Randolph.Dr. Randolph is an Associate Clin-

ical Professor at the Yale Division ofAllergy in a private practice associ-ation with the Center for Allergy,Asthma and Immunology in Water-bury and Southbury, CT. For thosewho are still not convinced, Olympicathletes competing with asthmashould offer encouraging examplesof treatment success stories.According to the American Acad-

emy of Allergy, Asthma & Immunol-ogy (AAAAI), about one in six ath-letes representing the United Statesin the 1996 Olympic Games had ahistory of asthma. Nearly 30% ofthose who had asthma or tookasthma medications won team or in-dividual medals in their Olympiccompetition.

TEXT: LORI HAR-EL

Getting Exercise-InducedAsthmaunder Control

Know the Basics About Blood Testing for Allergies

When it comes to testing for al-lergies, the modern medicalworld is full of options for

patients, including blood testing.Dr. Andy Liu, an Associate Professor of

Pediatric Allergy and Immunology at Na-tional Jewish Medical and Research Cen-ter, says blood testing can work.

“One example of how the allergy test-ing in the blood can be particularly help-

ful is with food allergies,” says Dr. Liu.The method measures the levels of im-munoglobulin E, or IgE, which is clearlyconnected to antibodies and allergicsymptoms.

ImmunoCAP, from Phadia, delivers re-liable results that help physicians iden-tify and manage patients with allergy orasthma—all from a simple blood sample.

“The ImmunoCap gives additional in-formation, more than the skin testingalone can provide,” says Dr. Liu. “The

higher your IgE level to a food likepeanuts, the more likely you are to be al-lergic to them, and the more likely thatyour peanut allergy will persist.”

Dr. Liu adds that it’s important to con-sult your physician before trusting a test.

“Not all systems [for blood testing] areclinically proven,” he says. “That is veryimportant because if you use a systemthat is not clinically proven, it can giveyou false answers which is clearly dan-gerous. It could be deadly.”

TEXT: GENEVIEVE LONG

Asthma is a serious disease. Itis the reason that in 2006,there were an estimated 12.8

million lost school days in childrenand 10.1 million lost work days inadults. It is the cause for two millionannual emergency room visits, andit costs Americans almost $20 billionin healthcare costs every year. It cur-rently affects 23 million Americans,and about 7 million children areamong those.Backed by these startling statistics,

The National Heart, Lung, and BloodInstitute (NHLBI) of the National In-stitutes of Health (NIH) released a re-port over 300 pages long at the endof 2007 on asthma. The report in-cludes Guidelines for the Diagnosisand Management of Asthma. Sincethe last NHLBI/NIH report onasthma, in 2002, great advance-ments have been made in researchand improved scientific understand-ing of the disease. The emphasis inthe current guidelines is on control.According to Dr. Gary Rachelef-

sky, Professor of Allergy and Im-munology at the Geffen School ofMedicine at UCLA, the idea is tominimize medicine and improve thequality of life for patients.“The problem with asthma in

America is that people don’t take itas a serious disease,” says Dr.Rachelefsky. To counteract the im-pacts of asthma, specialists are get-

ting behind a nationwide campaignto educate patients and cliniciansabout asthma as a disease and itstreatments.Part of the effort is a web-based

tool called “ASTHMA IQ”. The toolhelps allergist/immunologists andother asthma specialists learn about,and apply in everyday practice, thekey components of new medicalasthma guidelines. This should resultin improved quality of care deliveredto patients with asthma. ASTHMA IQis designed to impart knowledgeabout a disease often misdiagnosedand viewed simply as a series ofsymptoms. Allergist/immunologistsand other asthma specialists who useAsthma IQ will be able to betterapply the guidelines to their practiceand design specific plans to improvethe care of their asthma patients.Dr. Thomas Casale is President of

the American Academy of Allergy,Asthma & Immunology (AAAAI)and Professor of Medicine and Med-ical Microbiology and Immunologyand Chief of Allergy/Immunology atCreighton University in Omaha. Dr.Casale says that ASTHMA IQ can bea useful tool for physicians in diag-nosis and treatment.“ASTHMA IQ contains decision-

support features that provide spe-cific feedback based on patient'sage, asthma impairment, andasthma risk,” says Dr. Casale.“Asthma IQ can help physiciansidentify the most appropriate sever-

ity or control level and initiate oradjust therapies.”Dr. Rachelefsky, of the Geffen

School of Medicine at UCLA, seesmany physicians using technologyas an in-road to aiding in diagnosisand treatment. ImplementingASTHMA IQ will save health caredollars by assuring that patient careis appropriately managed. Knowl-edge of drug and treatment optionsis an important part of Asthma IQ.Inhaled steroids are a major compo-nent to controlling asthma. Usedregularly, they help a person keeptheir airways from swelling. Thelevel of steroids in an inhaler ismuch lower than oral tablets, use ofwhich should be kept to a minimum.Tablets are usually taken when a pa-tient loses control over their asthma.“Asthma is a dynamic disease, not

a fixed one,” says Dr. Rachelefsky.Symptoms and severity are subjectto the environment. For example, ifa patient is exposed to tobaccosmoke, their asthma could be trig-gered to change. When control islost is when patients will experienceexacerbations, and asthma becomesdangerous. Dr. William Busse is Pro-fessor and Chair of Medicine at theUniversity of Wisconsin-Madison,and Chair of the Expert Panel Report3 (EPR-3), the NHLBI/NIH report onasthma, upon which ASTHMA IQ isbased. He says asthma specialists are“stepping up” asthma medications togain better control but also “steppingback” when control is achieved.” Theidea is to aggressively suppress thedisease using a step-wise approachto management.ASTHMA IQ will officially roll-out

in two weeks at the American Acad-emy of Allergy, Asthma and Im-munology’s Annual Meeting inPhiladelphia.

TEXT: COURT PEARMAN

Controlling AsthmawithWeb-BasedTechnologyDevelopments in the medical world are promisingsteps toward treating asthma.

If exercising is a risky gateway to asthma for youor someone you know, there are ways to get thesymptoms under control.

• Asthma is a chronic lung disease inwhich airflow in and out of thelungs may be blocked by musclesqueezing, swelling and excessmucus.

• Asthma can be set off by environ-mental triggers, causing the air-ways to become narrowed and in-flamed, resulting in wheezingand/or coughing symptoms.

• Asthma triggers include: allergens,irritants like tobacco smoke orstrong odors, changes in weather,viral or sinus infections, exercise,medications, food, emotional anxi-ety and reflux disease.

• Even mild asthma can be life-threatening, but with physiciancare, it can be managed.

Fast Facts About Asthma

DESCRIPTIONPATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% is a sterile ophthalmic solution containing olopatadine for topical administration to the eyes. Olopatadine hydrochloride is a white, crystalline, water-soluble powder with a molecular weight of 373.88 and a molecular formula of C21H23NO3 • HCl. The chemical structure is presented below:

Chemical Name: 11-[(Z)-3-(Dimethylamino) propylidene]-6-11-dihydrodibenz[b,e] oxepin-2-acetic acid, hydrochloride.Each mL of PATADAY™ solution contains: Active: 2.22 mg olopatadine hydrochloride equivalent to 2 mg olopatadine. Inactives: povidone; dibasic sodium phosphate; sodium chloride; edetate disodium; benzalkonium chloride 0.01% (preservative) hydrochloric acid / sodium hydroxide (adjust pH); and purified water.It has a pH of approximately 7 and an osmolality of approximately 300 mOsm/kg.

CLINICAL PHARMACOLOGYOlopatadine is a relatively selective histamine H1 antagonist and an inhibitor of the release of histamine from the mast cells. Decreased chemotaxis and inhibition of eosinophil activation has also been demonstrated. Olopatadine is devoid of effects on alpha-adrenergic, dopaminergic, and muscarinic type 1 and 2 receptors.

Systemic bioavailability data upon topical ocular administration of PATADAY™ solution are not available. Following topical ocular administration of olopatadine 0.15% ophthalmic solution in man, olopatadine was shown to have a low systemic exposure. Two studies in normal volunteers (totaling 24 subjects) dosed bilaterally with olopatadine 0.15% ophthalmic solution once every 12 hours for 2 weeks demonstrated plasma concentrations to be generally below the quantitation limit of the assay (< 0.5 ng/mL). Samples in which olopatadine was quantifiable were typically found within 2 hours of dosing and ranged from 0.5 to 1.3 ng/mL. The elimination half-life in plasma following oral dosing was 8 to 12 hours, and elimination was predominantly through renal excretion. Approximately 60–70% of the dose was recovered in the urine as parent drug. Two metabolites, the mono-desmethyl and the N-oxide, were detected at low concentrations in the urine.

CLINICAL STUDIESResults from clinical studies of up to 12 weeks duration demonstrate that PATADAY™ solution when dosed once a day is effective in the treatment of ocular itching associated with allergic conjunctivitis.

INDICATIONS AND USAGEPATADAY™ solution is indicated for the treatment of ocular itching associated with allergic conjunctivitis.

CONTRAINDICATIONSHypersensitivity to any components of this product.

WARNINGSFor topical ocular use only. Not for injection or oral use.

PRECAUTIONSInformation for PatientsAs with any eye drop, to prevent contaminating the dropper tip and solution, care should be taken not to touch the eyelids or surrounding areas with the dropper tipof the bottle. Keep bottle tightly closed when not in use. Patients should be advised not to wear a contact lens if their eye is red.

PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% should not be used to treat contact lens related irritation. The preservative in PATADAY™ solution, benzalkonium chloride, may be absorbed by soft contact lenses. Patients who wear soft contact lenses and whose eyes are not red, should be instructed to wait at least ten minutes after instilling PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% before they insert their contact lenses.

Carcinogenesis, Mutagenesis, Impairment of FertilityOlopatadine administered orally was not carcinogenic in mice and rats in doses up to 500 mg/kg/day and 200 mg/kg/day, respectively. Based on a 40 µL drop size and a 50 kg person, these doses were approximately 150,000 and 50,000 times higher than the maximum recommended ocular human dose (MROHD). No mutagenic potential was observed when olopatadine was tested in an in vitro bacterial reverse mutation (Ames) test, an in vitro mammalian chromosome aberration assay or an in vivo mouse micronucleus test. Olopatadine administered to male and female rats at oral doses of approximately 100,000 times MROHD level resulted in a slight decrease in the fertility index and reduced implantation rate; no effects on reproductive function were observed at doses of approximately 15,000 times the MROHD level.

Pregnancy:Teratogenic effects: Pregnancy Category COlopatadine was found not to be teratogenic in rats and rabbits. However, rats treated at 600 mg/kg/day, or 150,000 times the MROHD and rabbits treated at 400 mg/kg/day, or approximately 100,000 times the MROHD, during organogenesis showed a decrease in live fetuses. In addition, rats treated with 600 mg/kg/day of olopatadine during organogenesis showed a decrease in fetal weight. Further, rats treated with 600 mg/kg/day of olopatadine during late gestation through the lactation period showed a decrease in neonatal survival and body weight.

There are, however, no adequate and well-controlled studies in pregnant women. Because animal studies are not always predictive of human responses, this drug should be used in pregnant women only if the potential benefit to the mother justifies the potential risk to the embryo or fetus.

Nursing Mothers:Olopatadine has been identified in the milk of nursing rats following oral administration. It is not known whether topical ocular administration could result in sufficient systemic absorption to produce detectable quantities in the human breast milk. Nevertheless, caution should be exercised when PATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% is administered to a nursing mother.

Pediatric Use:Safety and effectiveness in pediatric patients below the age of 3 years have not been established.

Geriatric Use:No overall differences in safety and effectiveness have been observed between elderly and younger patients.

ADVERSE REACTIONSSymptoms similar to cold syndrome and pharyngitis were reported at an incidence of approximately 10%.The following adverse experiences have been reported in 5% or less of patients:Ocular: blurred vision, burning or stinging, conjunctivitis, dry eye, foreign body sensation, hyperemia, hypersensitivity, keratitis, lid edema, pain and ocular pruritus.Non-ocular: asthenia, back pain, flu syndrome, headache, increased cough, infection, nausea, rhinitis, sinusitis and taste perversion.Some of these events were similar to the underlying disease being studied.

DOSAGE AND ADMINISTRATION The recommended dose is one drop in each affected eye once a day.

HOW SUPPLIEDPATADAY™ (olopatadine hydrochloride ophthalmic solution) 0.2% is supplied in a white, oval, low density polyethylene DROP-TAINER® dispenser with a natural low density polyethylene dispensing plug and a white polypropylene cap. Tamper evidence is provided with a shrink band around the closure and neck area of the package.

NDC 0065-0272-25 2.5 mL fill in 4 mL oval bottle

Storage:

Store at 2°C to 25°C (36°F to 77°F)

U.S. Patents Nos. 4,871,865; 4,923,892; 5,116,863; 5,641,805; 6,995,186

Rx Only

PAT08504JA

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ALCON LABORATORIES, INC.Fort Worth, Texas 76134 USA

©2005-2006 Alcon, Inc.

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An Advertising Supplement to TheWashington Post 11ALLERGIES & ASTHMA

Taking a Shot at Allergen Immunotherapy

Immunotherapy treatment is aseries of shots with increasinglevels of allergens intended to

induce tolerance to these allergens.“It is the process of teaching the

cells in the body to respond properlyto allergens,” according to Dr. LindaCox, Chair of the American Acad-emy of Allergy, Asthma & Im-munology’s Immunotherapy and Al-lergy Diagnostics Committee. Sheadds that through the treatments,“[The body] learns to tolerate thesesubstances [allergens] which is whatshould have happened in earlychildhood.”Allergy shots treat allergic

asthma, allergic rhinitis and con-

junctivitis, as well as stinging insectallergy, but are not useful for foodallergies.The process involves a buildup

phase and a maintenance phase.Buildup usually takes three to sixmonths with one to two shots perweek. The maintenance phase in-volves larger shot gaps of one totwo shots per month and requiresdiligent visits for three to five years.The process can yield impressive

results. Dr. Richard Lockey is a Pro-fessor of Medicine, Pediatrics andPublic Health at the University ofSouth Florida and Director of theCollege of Medicine’s Allergy andImmunology division. According toDr. Lockey, success with insectvenom is near 100 percent, and

plant allergies are drastically re-duced in most and completely over-come by some.When immunotherapy is admin-

istered to children, usually over theage of five, it can prevent the devel-

opment of additional allergies andasthma.One reason younger children

don’t do immunotherapy is the fre-quent clinical visits, and requiredobservation for at least thirty min-

utes after each shot to treat any sideeffects.The use of sublingual tablets, re-

placing shots, would eliminate thefrequent visits to the clinic. Thistreatment could be suitable foryounger children, is currently beingused in Europe, and is expected inAmerica soon.“Sublingual tablets seem to be

safer, I would like to treat childrenbefore age five and possibly preventthe progression of their allergic dis-ease,” says Dr. Cox about the newform of treatment and its possibili-ties.Dr. Cox is also looking forward to

new modified allergen shots; an-other method that will reduce repet-itive doctor visits. The allergens aremodified so a patient’s body can re-ceive more of them without an al-lergic response. “Four to six shots—boom—and you may be done,” saysDr. Cox when describing the shots.This option is still in development.

TEXT: COURT PEARMAN

Dr. Bob Lanier is a ClinicalProfessor of Pediatrics andImmunology at the Univer-

sity of North Texas Health ScienceCenter, and says avoiding these trig-gers can be almost impossible.“It's awfully difficult to avoid air-

borne pollens anytime, but espe-

cially it's hard as the winds of springstir the air,” says Dr. Lanier. “Whatjust ruffles your hair causes havocin your eyes. You can feel the result,as the eyes water to rid themselvesof the irritants, and cause miserywith itching and swelling.”

The good news is that there is away for people with allergy eyes tofind relief. Clinically proven PATA-DAY, with just one drop in each eyeonce a day, can relieve the sufferingof itchy, burning and watering eyes.

Dr. Lanier says PATADAY couldbe the answer some allergy eye suf-ferers are looking for.“Your choice is pretty clear—you

have misery or you use medica-tions,” says Dr. Lanier. “But here'sthe problem. The medications weuse by mouth (antihistamines) withnasal allergy cansometimes make the eyes worse.

PATADAY applied directly to the eyesurfaces soothes and prevents theallergy response for a whole day ata time.”Dr. Lanier adds that the conven-

iences of PATADAY are important toremember when choosing treatmentfor your eyes.“With a once a day medication,

your eyes can relax, and if you wearcontacts, this once a day treatmentis so useful,” says Dr. Lanier.

TEXT: GENEVIEVE LONG

If you suffer from allergy eyes, or allergic conjunctivitis, the first step is to identify what is causing it.The most common causes are allergens, which act as triggers.

Welcome Relief for Red, Itchy Eyes

Allergen immunotherapy, or allergy shots, is a long-term option for attaining stronger control ofallergies, or possibly overcoming them all together.

«Your choice is prettyclear — you

have misery or youuse medications»

says Dr. Lanier.

Tips from the American Academyof Allergy, Asthma & Immunology

• Keep windows closed at all timesduring ragweed season (Aug.-Oct.),and use air conditioning instead,since it cleans, cools and dries theair.

• Minimize outdoor activity whenpollen counts are high, usuallybetween 10 a.m.-4 p.m.

• Keep your car windows closedwhen traveling.

• Take a shower after spending timeoutside, pollen can collect on yourhair and skin.

• Don't hang sheets or clothingoutside to dry. Pollens can collecton them as well.

• Minimize exposure to other knownallergens during ragweed season,since symptoms are the result of acumulative effect of multipleallergens and non-allergic triggers.

• Get up-to-date pollen informationfor your area from the NationalAllergy Bureau (NAB).

Avoid Exposure to heyfever

Once-a-Day PATADAY™

Solution. The firstand only once-a-day prescription eye dropthat gives you relief from itchy allergy eyes. You’ll start feeling reliefin minutes. See howbeautiful life can be when you’re not seeing it through itchy allergy eyes. Themost common side effects include cold, sore throat, blurred vision, burning or stinging. Ask your doctorif PATADAY™ Solution isright for you. You are encouraged to report negative side effects of prescription drugs to the FDA. Visitwww.fda.gov/medwatch,or call 1-800-FDA-1088.

Call 1-877-3-PATADAY or visit pataday.comPlease see adjacent page for additional product information. ©2008 Alcon, Inc. 2/08 PAT08504JA

Once-a-day relief for itchy allergy eyes. That’s genius.

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