The Allergist AnewsletterfromtheOklahomaAllergy&AsthmaClinicWinter2015-16

The Allergist

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Drug Approved by FDA for Asthma TreatmentLaryngopharyngeal

reflux (LPR) also known as silent reflux is similar to another condition – gastroesophagel re-flux disease (GERD) which is the result of the contents of the stomach back-ing up and burning in your lower chest. However, LPR symp-toms are often dif-ferent than those that are typical of GERD.

LPR can cause respiratory symptoms cause by acid from the stomach regurgi-tating into the throat, mouth, nasal pas-sages and even the lungs. This results in a chronic cough, hoarseness, sinusitis and tough decay. It is called silent reflux because the lack of heartburn and it can be challenging to diagnose and to treat.

At the end of the esophagus is a ring of muscle called a sphincter and these keep the contents of the stomach where they belong. Those who have LPR, their sphincters don’t work prop-erly causing stomach acid to back up to the throat, voice box or even to the back of the nasal airway. These areas are not protected against gastric acid exposure and become inflamed. Silent reflux is common in infants because sphincters are undeveloped; they have a shorter esophagus and lie down most

Silent or Laryngopharyngeal Reflux

of the time. Adults with this condition, the cause is unknown.

Symptoms

Infants and children:• Hoarseness

• Barking or chronic cough

• Reactive airway disease (asthma)

• Noisy breathing or pauses in breathing (apnea)

• Trouble feeding, spitting up or inhaling food

• Trouble gaining weight

Adults:• Heartburn or a bitter taste or

burning sensation in the back of the throat

• Excessive throat clearing

• Persistent cough

• Hoarseness

• A lump in the throat that won’t go away even with repeated swallowing

Spiriva Respimat was recently approved by the FDA for long-term, once-daily asthma treatment for those who are 12 years of age and older. Spiriva Respi-mat has already been approved to de-liver COPD maintenance medicine in a slow-moving mist without the use of propellants. Inhaling the mist deeply two times, once a day, helps relax the airways and keep them open for 24 hours. Spiriva Respimat also reduces the chance of COPD flare-ups (or COPD exacerbations). Spiriva Respimat does not treat sudden breathing problems and cannot be used in place of a rescue inhaler.

The FDA approval came from data of 12 trials that included approximately 5,000 adults and adolescents with mild, mod-erate and severe symptomatic asthma who at least used an inhaled cortister-oid. According to William Busse, MD, a professor of medicine at University of Wisconsin School of Medicine and Public Health who said that some pa-tients with uncontrolled asthma, de-spite treatment continue to experience symptoms, which can include coughing, wheezing, waking at night or shortness of breath, Spiriva Respimat has been shown to provide additional broncho-dilation to help patients breathe better and reduce asthma attacks.

For more information about this treat-ment, visit with your OAAC allergist.

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Cedar and Elm Strike AgainTree pollen is a common cause of allergy symptoms. While most trees are typically thought to cause problems in the spring, cedar and elm tree pollen can start releasing their pollens in the fall. These allergens can cause symptoms from fall through spring. Cedar pollen comes from the family Cupressaceae. It is an evergreen shrub native to northeastern Mexico and the south-central U.S. Elm pollen comes from the family, Ulmaceae. It is a deciduous and semi-deciduous tree that covers large parts of North America including the eastern plains through the central plains.Symptoms to cedar and elm allergy can include the fol-lowing:• Sneezing often accompanied by a runny or clogged

nose. • Coughing and postnasal drip• Itching eyes, nose, and throat • Allergic shiners (dark circles under the eyes caused by

increased blood flow near the sinuses) • The “allergic salute” (nasal crease mark)• Watering eyes• Conjunctivitis (an inflammation of eyelids- red-

rimmed, swollen and crusted)• Post nasal drip• Mental dullness and fatigueTalk to your OAAC allergist about proper diagnosis and management of cedar and elm allergy.

• Postnasal drip or excess throat mucus

• Trouble swallowing

• Trouble breathing

• Sore throat

Stomach acid that pools in the throat and larynx (voice box) can cause long-term irritation and damage. If not treat-ed, it can be very serious.

Infants and children who have LPR can have narrowing of the area below the vocal cords, ulcers, recurrent ear infec-tions and lasting build up of middle ear fluid.

In adults, silent reflux can scar the throat and voice box. It can also increase risk for cancer in the area, affect the lungs and may irritate conditions such as asthma, emphysema or bronchitis.

Physicians can diagnose LPR through a combination of medical history, physi-

cal exam and tests.

Suggested Treatments May Include -

For children and infants:

• Smaller and more frequent feedings

• Keep an infant in the vertical position for at least 30 minutes after feeding

• Medications such as H2 blockers or proton pump inhibitors

• Surgery for any abnormalities that can’t be treated in other ways

For adults, treatments may include these lifestyle modifications:

• Losing weight

• Stopping smoking

• Avoiding alcohol

• Restricting chocolate, mints, fats, citrus fruits, carbonated beverages,

spicy or tomato-based products, red wine and caffeine.

• Don’t eat at least three hours before going to bed.

• Elevate under the head of the bed 4 to 6 inches

• Don’t wear tight fitting clothes around the waist

• Chewing gum can increase saliva and neutralize acid

• Medications such as H2 blockers or proton pump inhibitors

Talk to your physician concerning what type of medical treatment would be best for you. Some respond well to self care and medical management. Others may need more aggressive and lengthy treatment. Surgery may be another op-tion for those still struggling with this medical condition.

Source: Web MD

Silent reflux... (continued from page 1)

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“The Allergist” is published quarterly by the Oklahoma Allergy & Asthma Clinic. Contents are not intended to provide personal medical advice, which should be obtained directly from a physician.

“The Allergist” welcomes your letters, comments or suggestions for future issues.Send to:The Allergist750 NE 13th Street Oklahoma City, OK 73104-5051Phone: 405-235-0040www.oklahomaallergy.com

Oklahoma Allergy & Asthma ClinicEditorial Advisory BoardDean A. Atkinson, M.D.Laura K. Chong, M.D.Warren V. Filley, M.D.Richard T. Hatch, M.D.Gregory M. Metz, M.D.Florina Neagu, M.D.Patricia I. Overhulser, M.D.Shahan A. Stutes, M.D.Gordon Heiselbeltz, COO, MHAKaren Gregory, DNPStefanie Rollins, APRN-CNP

2 1/2 cups all purpose flour 3/4 cup superfine sugar 1/4 tsp salt 2 sticks margarine, softened 2 Tbsp regular or milk-free cream cheese, softened 2 tsp vanilla

Directions

Put sugar, flour, and salt in the food processor and combine. Add in marga-rine, a little at a time. Then add in the cream cheese and vanilla and mix un-til dough begins to form large clumps. Knead dough in the bowl by hand a few times until it forms a cohesive mass. Shape into two disks and put these in the refrigerator until they are cold - about an hour or so. Adjust oven rack to the middle position and heat oven to 375 °F. Roll out one disk of dough in between two sheets of parchment. (You don’t need to flour the surface, because parchment is nonstick!) Roll out to 1/8 inch thickness and cut with cookie cutters.

Bake cook-ies for about 10 min-utes, until light golden brown. Let cookies cool a few min-utes on bak-ing sheets b e f o r e transferring to a wire rack.

Notes

The cream cheese adds a nice tang to these cookies. Be sure the dough is COLD when you roll it out. If you don’t feel like rolling out cookies and icing them, it works nicely to just make these into little balls and roll in sugar (or colored sugar!). As the cook-ie flattens in the oven, it makes a nice snickerdoodle-type cookie.

Substitutions

If you don’t have superfine sugar, use regular granulated sugar, but pulse it in the food processor for about 30 seconds. Gluten: Gluten is a protein found in specific grains (wheat, spelt, kamut, barley, rye). Other grains are naturally gluten-free but may have cross-contact with gluten-containing grains. Look for certified gluten-free products if you need to avoid gluten. Find out more about wheat and gluten substitutions. Butter and Margarine: Butter is a dairy product made from cow’s milk. Margarine typically contains milk or soy, but there are milk-free and soy-free versions available. Milk and Soy Substitutions: Alternative dairy-free milk beverages and products will work in most recipes. Find out more about milk substitutions and soy substi-tutions.

Source: www.kidswithfoodallergies.org

Egg Free Holiday Cookies

Employee Spotlight: Jana Leslie

One of the longest employees in service at the OAAC is Jana Leslie, a registered nurse who works part time in the North-west satellite office. Jana retired from full time work in 2010 but has worked for the OAAC for 44 years. For 20 years she managed one of the satellite offices and also worked for Dr. Warren Filley as his nurse.

She grew up in Lawton; her father was stationed there while in the military. During their family’s military service time, they also lived in Germany during several tours.

Jana always wanted to be a nurse so she moved to Oklahoma City to attend and graduate from St. Anthony’s Nursing School with her RN. During the Vietnam

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Latex AllergyWhen you go visit a physician or medical facility, one of the questions you may be asked is if you are allergic to latex. This substance is typically found in rubber gloves, balloons, rubber bands, erasers, toys and condoms. Latex comes from a milky sap produced by rubber trees and is blended with chemicals to give the elastic quality during the manufactur-ing process.

This allergy is more common for those who work in healthcare and also for those who have undergone multiple surgeries. For more than 50 percent of those who have a latex allergy, they also have a history of other allergies.

Latex allergy reactions can range from mild to even as severe as anaphylaxis, a life-threatening allergic reaction. Re-peated exposure can worsen allergic re-actions. Some fruits and vegetables can also cause allergic symptoms for some who are latex-sensitive because latex can cross react with certain foods.

Dr. Laura Chong, a board-certified aller-gist with the OAAC, said, “Hundreds of latex-allergic people each year have life-threatening anaphylaxis. It is extremely important for a proper evaluation of la-tex allergy.”

Symptoms can be very different after contact with latex. For those who have delayed-contact dermatitis, the condi-tion appears 12 to 36 hours after con-tact. Symptoms can include red, scaly and/or itchy skin. This reaction is usu-ally triggered by the added chemicals in the rubber. Symptoms can be irritating but not usually life-threatening.

Those who have immediate allergic re-actions have been exposed to latex and sensitized to the allergen which triggers the immune system to respond. With latex re-exposure, symptoms may in-clude sneezing or runny nose, coughing or wheezing, itchy throat or itchy, wa-tery eyes.

For serious allergic reactions, symptoms occur within minutes and involve mul-

tiple systems in the body – anaphylaxis. Symptoms of anaphylaxis include red rash (maybe itchy welts, hives), swol-len throat or swollen areas of the body, wheezing, passing out, chest tightness, trouble breathing, hoarse voice, trouble swallowing, vomiting, diarrhea, stom-ach cramping and pale or red color to the face and body.

She also advises those who have a latex allergy to wear a MedicAlert bracelet and carry two emergency epinephrine syringes. There is no cure for latex aller-gy, so the best treatment for this condi-tion is avoidance.

War, Jana served her country in the U.S. Army Nurse Corps.

Her journey to the OAAC simply came from a newspaper notice for a job opening at the OAAC for a nurse and 44 years later, she still enjoys working with the patients and her co-workers.

She and her husband, Wayne, live in northwest Oklahoma City. They have two sons and four grandchildren.

In her down time, she loves to quilt and is currently working on an OKC Thun-der-themed quilt. She also loves to gar-den and cook.

Jana Leslie...(continued from page 3)

“If you think you might be allergic to latex, talk to your OAAC aller-gist,” said Dr. Chong. “There is a blood aller-gy test to latex. How-ever, there is no cur-rent FDA approvded commercial latex skin test available.”

Source: American Academy of Allergy, Asthma and Immunol-ogy

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