Saturday July 4, 2020



September 05

Shellfish, Shellfish Everywhere, But Not a One to Eat

A steaming bowl of bouillabaisse and a thick chunk of French bread might be just the thing to ward off the winter blues. Or maybe it's a cup of hot, creamy chowder and a pile of meaty scallops that drives the snow away. But not for you.

Even as you dip a small piece of roll into your friend's savory lobster stew, you're stopped by the famous words of Lucretius: "One man's food may be another man's poison."

Poisons often kill, and food allergies can, but rarely do. Hives or an itchy skin reaction, a scratchy throat, hoarseness, teary eyes, shortness of breath or swelling of mucous membranes in the mouth and throat are common symptoms of a food allergy. In rare cases, a sudden drop in blood pressure can signal anaphylaxis  or shock  which requires immediate medical attention.

One can even get a reaction to shellfish if you haven't consumed any. Simply touching the liquid in which the shellfish was cooked, or in some cases, inhaling the steam or cooking odors, can trigger symptoms.

A shellfish allergy can occur within minutes or up to several hours later, and is actually an immune system reaction. The symptoms occur when the mast cells release histamine in response to their interaction with foreign protein molecules. It's not known why some people react to particular proteins and others do not.

Some of these proteins are common to all shellfish; others are found only in one type. Researchers are beginning to analyze the chemistry of these proteins, but most of the allergens are not yet well-defined.

"So if you are allergic to one type of shellfish, such as crabs, assume you are allergic to shrimp, lobsters, crawfish and other shellfish, too." 

"The only way to safely handle the problem is to abstain."

For those who yearn for a Maine lobster claw dipped in butter, but have had an allergic reaction in the past, taking an antihistamine before indulging will not work. "There is no prophylactic treatment that's effective," he says. It is advisable that those who have had extreme reactions in the past to carry an epinephrine injector system in case they inadvertently eat something that contains shellfish protein, such as fish stock, which may be used as a base in soups.

If you're dying to eat oysters, and have only had a reaction to shrimp in the past, you may want to contact an allergist for a diagnostic evaluation which can include skin tests or a blood test known as a RAST (radioallergosorbent test). Skin tests are more sensitive, especially in patients with a history of a systemic reaction. But in 74 percent of cases, the diagnosis is based on history alone, and patients are advised to keep away from all shellfish  cooked and raw  if they have reacted to even one kind.

For those whose reactions have been severe, it's particularly important to remember to read packaged food labels for seafood flavorings or unexpected sources of the allergen. You should also remember that any dish prepared in a seafood restaurant may be cross-contaminated with shellfish during handling or cooking.

September 03

Immunological Treatment of Aplastic Anemia

In severe acquired aplastic anemia, hematopoietic failure is the result of immune-mediated destruction of bone marrow stem and progenitor cells. Immunosuppressive therapy with antithymocyte globulin (ATG) plus cyclosporine is an effective alternative to stem-cell transplantation and improves blood counts and survival. Although horse ATG is the standard therapy, rabbit ATG is more potent in depleting peripheral-blood lymphocytes and is preferred in other clinical circumstances. However, when evaluated in a randomized study, rabbit ATG was inferior to horse ATG as a first treatment for severe aplastic anemia, as indicated by hematologic response and survival.

N Engl J Med. 2011 Aug 4;365(5):430-8.

September 02

Los Angeles Times- Ready for Ragweed Season?

Tips to help fight pollen allergy.

January W. Payne

Premium Health News Service

October 14, 2009


It's ragweed season, and for people with this pollen allergy, that means miserable symptoms such as sneezing, a runny or stuffy nose, trouble sleeping, asthma attacks, and itchy skin, eyes, nose, or throat. The season usually kicks into high gear in mid-August, according to Martha White, research director at the Institute for Asthma and Allergy, a private practice in Maryland with offices in Wheaton and Chevy Chase.


"People are starting to have symptoms already," White says.


Most regions in the United States experience ragweed growth between now and the first frost. Each ragweed plant makes about a billion pollen grains per season, and with the help of the wind, those grains can travel up to 400 miles, according to the American Academy of Allergy, Asthma and Immunology (AAAAI).


Also, some people with ragweed allergy experience itching and swelling around the mouth as a result of eating some common fresh fruits and vegetables. The condition is called oral allergy syndrome and is commonly prompted by eating bananas, cucumbers, melons, and zucchini.


Though the season is just getting started, some experts believe that climate changes associated with global warming may be lengthening the annual ragweed allergy season. That's bad news for the 10 to 20 percent of Americans allergic to these weeds, which studies suggest will flourish for longer each year, thanks to rising temperatures and carbon dioxide levels.


One study found that between 1990 and 2007, the duration of ragweed season in the New York metropolitan area increased from 90 to 105 days.


"The longer you're exposed to it, the more miserable you will be," says study coauthorLeonard Bielory, whose research on the topic was presented this year at the AAAAI's annual meeting in March in Washington, D.C. "It's more misery, and it ... will lead to lost work days and lost school days."


No matter how long ragweed season lasts this year, experts suggest getting a jump-start on symptoms before you start to feel lousy. This should come as no surprise to people accustomed to dealing with seasonal allergy symptoms, but we offer eight refreshers for making this ragweed season as painless as possible:


1. Start taking prescribed or over-the-counter medications now, even if symptoms haven't kicked in yet. If your doctor has prescribed a nasal steroid in the past, make sure you have a supply at home, and start taking it immediately, says White, a fellow with the AAAAI. Popular nasal steroids include Flonase or Nasonex.


The same goes for oral antihistamines, which include over-the-counter options such as Claritin (loratadine) or Zyrtec (cetirizine) as well as prescription options such as Allegra (fexofenadine) or Xyzal (levocetirizine).


Also, because so many people complain of itchy eyes during ragweed season, it may be a good idea to ask your doctor for a prescription for allergy eye drops, such as Patanol (olopatadine), Optivar (azelastine), or Pataday (olopatadine), or to try an over-the-counter antihistamine eye drop like Zaditor (ketotifen fumarate).


2. Keep windows closed at home and in the car. It may feel good to catch a breeze from outside, but the pollen you're allowing to enter your home or car can make your allergy symptoms worse, says White. That's especially "if you're in a moving car, with the pollen hitting you kind of fast." Instead, use your air conditioner at home and in your car because that will filter, cool, and dry the air, says Bielory, an allergist in private practice in Springfield, New Jersey, and a fellow with the AAAAI.


3. Call your doctor now for an appointment if you're out of prescription medication refills. "It's not a good idea to wait until you're miserable and then compete with everybody else for an appointment," White says.


4. Bathe your pets frequently. Even if you're not allergic to your dog or cat, it's probably a good idea to bathe the animal more frequently during ragweed season because it can track pollen into the house, White says.


5. Shower before bed so that you're not introducing pollen from outside into your bed at night, experts suggest. That includes washing pollen from your face and hair so it doesn't wind up on your pillow, Bielory says.


6. Consider allergy shots, also known as immunotherapy, which can be effective for up to 90 percent of patients who are allergic to ragweed, according to the AAAAI. A 2003 update of a Cochrane Collaboration review found that allergy immunotherapy helps to ease asthma symptoms, reduce the need for medicines, and decrease the risk of severe asthma attacks during future exposure to allergens. Allergy immunotherapy is typically covered by health insurance.


7. Check pollen counts in your area and avoid being outdoors on days when counts are high. AAAAI offers an online tool ( that provides pollen counts in various locations across the country.

September 01

Allergic Conjunctivitis Guide



Allergic conjunctivitis is inflammation of the tissue lining the eyelids (conjuctiva) due to a reaction from allergy-causing substances such as pollen and dander.


Reference: Bielory L,  Freilaender MH. Allergic conjunctivitis. Immunol Allergy Clin North Am. 2008 Feb;28(1):43-58


Causes, Incidence, And Risk Factors

When your eyes are exposed to anything to which you are allergic, histamine is released and the blood vessels in the conjunctiva become swollen (the conjunctiva is the clear membrane that covers the "white" of the eye). Reddening of the eyes develops quickly and is accompanied by itching and tearing.

Allergies tend to run in families, although no obvious mode of inheritance is recognized. The incidence of allergy is difficult to determine, because many different conditions are often lumped under the term allergy. Keep in mind that rubbing the eyes makes the situation worse.



Symptoms may be seasonal and can include:

  1. Red eyes

  2. Dilated vessels in the clear tissue covering white of the eye

  3. Intense itching or burning eyes

  4. Puffy eyelids, especially in the morning

  5. Tearing (watery eyes)

  6. Stringy eye discharge


Signs And Tests

Your doctor may look for the following:

  1. Certain white blood cells, called eosinophils, in scrapings, secretions, or discharge

  2. Small, raised bumps on the inside of the eyelids (papillary conjunctivitis)

  3. Positive skin test for suspected allergens (See: Allergy testing)



The best treatment is avoiding exposure to the cause or allergen. Unfortunately, this is not often practical. Discomfort can be relieved by applying cool compresses to the eyes or taking antihistamines by mouth (many of these are available over-the-counter).

If home-care measures do not help, treatment by the health care provider may be necessary. This may include:

  1. Antihistamine or anti-inflammatory drops that are placed into the eye

  2. Mild eye steroid preparations applied directly on the surface of the eye (for severe reactions)

  3. Eye drops that prevent certain white blood cells called mast cells from releasing histamine; these drops are given in combination with antihistamines for moderate to severe reactions


Expectations (Prognosis)

Treatment usually relieves the symptoms. However, the condition tends to recur if exposure to the offending agent continues.



There are no serious complications; persistent discomfort is common.



Prevention of allergic conjunctivitis is best accomplished by avoiding the allergen, if it is known. In many cases, however, this is impossible since the allergy-causing agents are everywhere nearly all the time.

August 31

Allergy to Albumin and reactions to Invito fertilization

Serum albumin constitutes an intriguing puzzle that can involve the development of allergic sensitizations from a variety of sources and induces different clinical manifestations.  The potential role of sensitization to serum albimunins inducing allergic diseases that can come from various sources (not just human) is associated with complex interactions and cross-reactivity between albumins resulting from its presence in various mammalian tissues and fluids. Serum albumins alone are an uncommon cause of allergic sensitization in airways, but these allergenic proteins likely play a significant role as cross-reacting allergens in individuals sensitized to several types of animal dander. They can be also found in saliva and urine. Serum albumins are a minor allergen in milk but a major allergen in meats. Interestingly, serum albumin is used in variou sculture media and bovine serum albumin is used in the culture medium of spermatozoids used for artificial insemination. As a consequence, some case reports have shown that bovine serum albumin may be a causative agent in severe anaphylaxis after standard intrauterine insemination or in vitro fertilization.

Curr Allergy Asthma Rep. 2011 Aug 2. [Epub ahead of print]

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Location: Springfield, NJ
Today's Date: July 04, 2020
Station Director: Leonard Bielory, M.D
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