Doctors
Say Three of the Best From Here.
Dr.
Melamed and Beaucher present paper at the AAAAI 2006 meeting
Gold allergy reported to be fairly common
Allergy
Shots shown to be effective and have lasting benefit.
Final
Growth Does Not Appear to be Affected by Long Term Inhaled Corticosteroid
Therapy.
Nitric
Oxide breath level useful in asthma therapy
Acetaminophen
use linked to increased asthma rate.
Allergy
Shots may prevent the development of asthma.
Copyright © 2006 Allergy & Asthma Specialists
Excerpted from an article by Marjorie Sherman
DOCTORS SAY THREE OF BEST ARE FROM HERE
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"The Guide to Top Doctors" lists 604 "top doctors" based on recommendations by their peers. Both Dr. Wilfred Beaucher and Dr. Julian Melamed were nominated for this honor. There are many lists of Who’s Who directories that rate and categorize doctors. Some of these require a monetary payment by physicians. " I get so many of these things" said Dr. Melamed, whose accent has remnants of his native South Africa. Yet Dr. Melamed warmed to the idea when he heard the list of fellow allergists recommended, all doctors whom he refers patients to regularly. He was even more impressed to learn that that the "top doctors" book was compiled by the same people who publish the well regarded annual HEDIS ratings on how consumers rate their health plans. "That’s a very credible group" he said. The book is hailed by those who want consumers to have a good resource guide for choosing their doctors. The doctors surveyed chose two physicians in each of 30 specialties they considered most desirable to care for a loved one. What factors, in Dr. Melamed’s book lift up a doctor from being average to "top"? Academic training is important. Being clinical "astute" is critical as well. But there is one more thing. "It’s a combination of training and listening to the patient and ‘being in the moment with the patient and hearing not only what is said and what is not said". Dr. Beaucher recalls his lessons in bedside manner from Albany Medical Center where he was on the same student council as Dr. Timothy Johnson. " A lot of information we got was hand holding. Talk to patients, listen to them." The Guide to Top Doctors is available from the Center for the Study of Service, 733 15th St, NW, Washington D.C. 20005 and by calling 800-213-7283 Cost $19.95 |
In November 2002 the prelimary data from the START study was presented. This study followed over 7000 patients from 6 to 66 with mild asthma who were treated with the inhaled steroid Pulmicort or placebo. The treated patients had a 44% reduced chance of having a severe asthma attack. The treated patients had more symptom free days, less prednisone use and had improved lung functions.
This study emphasizes that even in asthmatics with mild asthma, appropriate treatment with inhaled steroids not only prevents asthma attacks including asthma deaths, but is consistent with other studies showing that they prevent airway remodeling.
Dr. Melamed and Beaucher presented a study in March 2006 at the AAAAI meeting in Miami entiled Local Anesthetic Allergy Characterized by Type IV Reactions in Patients Who Received Dental Anesthesia. This study describes three patients who presented with swelling of the face several hours after receiving dental anesthesia. Investigation showed that these three patients had delayed hypersensitivity reactions.. All three patients had been sensitized by using local anesthetics applied to the skin and had a history of poison ivy like lesions to these medications. All 3 patients were tested with alternative anesthetics and received these without side effect.
Allergists typically only evaluate patients with local anesthetic dental reactions for immediate reactions. The patients need to be tested for both immediate and delayed hypersensitivity reactions.
According to experts at the Mayo Clinic, allergic contact dermatitis is a
skin inflammation characterized by swollen, reddened and itchy skin that's
caused by direct contact with an allergen.
The Mayo team analyzed results from contact dermatitis testing conducted on 3,854 patients, each tested with an average of 69 allergens. Of the patients in the study, 69 percent had at least one positive reaction and 50 percent had two or more positive reactions.
The top ten contact dermatitis allergens were:
* Nickel, frequently used in jewelry and clasps or buttons on clothing;
* Gold, common to jewelry;
* Balsam of Peru, a tree resin-derived fragrance used in perfumes and skin
lotions;
* Thimerosal, a mercury compound used in vaccines and local antiseptics;
* Neomycin sulfate, a topical antibiotic common in first-aid creams and ointments.
It's also found in cosmetics, deodorants, soap and pet food;
* Fragrance mix, a group of the eight most common fragrance allergens found
in foods, cosmetic products, insecticides, antiseptics, soaps, perfumes and
dental products;
* Formaldehyde, a preservative used in numerous items including paints, medications,
fabric finishes, paper products, household cleaners and cosmetics;
* Cobalt chloride, a metal found in medical products, hair dye, antiperspirant,
and metal-plated objects such as snaps, buttons and tools. Also found in cobalt
blue pigment;
* Bacitracin, a topical antibiotic;
* Quaternium 15, a preservative found in cosmetic products such as self-tanners,
shampoo, nail polish and sunscreen, and in industrial products such as polishes,
paints and waxes.
The New England Journal of Medicine: August 12 1999
Long term Clinical Efficacy of Allergy Shots. This study showed that patients receiving 3 to 4 years of immunotherapy for their allergies had significant improvement of their allergies. Patients who discontinued immunotherapy for as long as 3 years had a long lasting benefit both as measured by patient symptoms as well as by more sophisticated laboratory tests.
The New England Journal of Medicine: October 12 2000
Effect of Long Term Treatment with Inhaled Pulmicort on Adult Height in Children with Asthma. Inhaled steroids can affect growth velocity ( the rate of growth), however the question that has been posed is- does this matter? If kids catch up then this may not be important. This study looks at kids who were on Pulmicort and is the first study to show no effect of this compound on final height. Children were on Pulmicort for a mean of 9 years and 2 puffs of Pulmicort daily.
Many parents are concerned about the effects of "steroids" on growth. This study should reassure them that for the most part these are very safe medications.
On the same date the results of the CAMP (Childrens Asthma Management Program) were published. This study looked at kids with mild asthma who were placed on either Pulmicort, Tilade or a dummy (placebo) inhaler. This study showed that asthma control was better in group on Pulmicort. A slight and temporary decrease in growth rate was noted in the group on Pulmicort.
Nitric Oxide breath measurement - A useful tool in asthma treatment
The treatment of asthma routinely relies on measurement of airway obstruction
by breathing tests and patient symptom scores. Ideally however treatment should
be tailored according to the degree of inflammation in the lung.
Nitric oxide is a compound that is released from cells in the inflammed lung of asthmatics. This can be measured in the expired breath of adults and children. While this measurement is not routinely available yet in clinical practice there are several studies showing that basing therapy on nitric oxide measurements produces better control of asthma.
RThe utility of an "inflammometer" of asthma will add tremendously to the routine care of asthmatics. There is also a push to produce home models similar to blood sugar meters used the treatment of diabetes.
Niric Oxide in the Treatment of Asthma JACI 2006
Acetaminophen (Tylenol) linked to increased asthma
rate.
Shaheen in London compared the use of acetaminophen in asthmatics and
non asthmatics and noted a progressive increase in asthma frequency correlating
with increasing acetaminophen use. This drug may deplete antioxidant stores
and thus allow damage to the airway to occur.
Shaheen et al Thorax 2000
Immunotherapy may prevent asthma.
A recent study examined the progression of allergic rhinitis (hayfever)
to asthma in patients who were allergic to dust mites. Patients were assigned
either to receive mite shots or placebo and were followed for 2 years. Asthma
developed in 9% of placebo treated patients but in NONE of the patients receiving
active immunotherapy.
Grembiale RD et al AJRCCM December 2000
