Newsletters

The Hilltop Allergy Letter

Volume 22 Number 2

MARCH 2023 – MAY 2023

Introduction

We welcome all new and established

patients to our newsletter. This is

formulated four times a year to inform patients and the medical community with

regard to new developments in asthma, allergies, and clinical immunology. Please feel free to take this home with you

and share it with family and friends.

Asthma Inhalers

The most common and important treatment for asthma is

that of inhalers. Inhalers allow medications

to be taken in the airway and this allows for directed and safe therapy for

asthma. Inhalers prevent many side effects that are seen with pills or liquids

that are swallowed.

Inhalers come in a variety of forms. The most common

form is that of a dry powder inhaler. This inhaler requires the patient to have

a good steady breath in so that the dry powder can get into the airways. Side

effects of this kind of inhaler can include a bad taste or a sensation of

powder being on the tongue.

Other inhalers include aerosolized inhalers. These are

the traditional inhalers where the patient presses down and the medication is

sprayed into the mouth by the device. Side effects of this medication can

include cough.

Another type of inhaler is that of an aerosolized mist

inhaler. This type of inhaler involves a very light mist that is released from

the inhaler.

The last type of inhaler is that of a nebulizer. In a

nebulizer, medication is typically mixed with water and a mist comes out of the

nebulizer machine. Much of the medicine in a nebulizer is released into the air

before the patient can inhale it. Also, the medication can stick to the

nebulizer tubing.

All inhaled steroid inhalers can rarely cause thrush,

which is a fungal infection of the upper airway. Also, each of the inhalers listed above has a

slightly different technique for its use. If the patient breathes in too fast,

the medication will stick to the back of the throat and not get into the lungs.

If the medication is not inhaled with strong enough breath in, the medication

will land on the tongue and not get into the airway. Proper use of these types

of inhalers can have a significant impact on how well these medications work

and how likely a patient is to have side effects from these medications.

Our office has the appropriate devices to measure a

patient’s airflow speed when the patient breathes in. If you or your family

member has any questions regarding the proper use of an inhaler, please do not

hesitate to contact us and we will go over it with you. We make every effort to

review proper inhaler use periodically with our patients. It is easy to

overlook this and patients can sometimes develop the wrong technique over time

with regard to proper use of their inhalers. Also, some patients are prescribed

more than one type of inhaler so the technique must be different with each of

the inhalers. We are happy to review this with any of our patients at any time

that they feel the need.

Vaccine

Informed Consent

Vaccines are products that act as “pretend” or “dummy”

infections. Their purpose is to prevent

illness from a bacteria or virus by stimulating the immune system to gather the

appropriate products to fight infection in the future. Like the nervous system, the immune system

analyzes and remembers exposures the body has to viruses and bacteria as well

as vaccines. It then develops ways to

fight these infections should the body be exposed in the future.

Vaccines carry risks.

They also are variable in their effectiveness. Therefore, before receiving any vaccine, a

patient should be made aware of the benefits of vaccination as well as the

risks. No one should be forced to

receive vaccinations. No one should be

coerced into receiving vaccinations.

Patients should make their own decisions regarding receiving

vaccinations. Ideally, no more than one

vaccination should be received at any one time.

This is because if a patient were to have a reaction to the vaccine, it

is very difficult to discern which shot caused a reaction.

If you have any questions regarding vaccines, please

do not hesitate to contact us. Clinical

immunologists are trained to review and offer advanced insights into vaccines

and their appropriate use or avoidance.

The Hilltop Allergy Letter

Volume 20 Number 3

June – August 2021

Introduction

We welcome all new and established patients to our newsletter. This is formulated four times a year to inform patients and the medical community with regard to new developments in asthma, allergies, and clinical immunology. Please feel free to take this home with you and share it with family and friends.

Summertime allergens

The major summertime allergens include mold spores, grass, and weed pollens. With the exception of pine pollen which can pollinate through June, the main sources of airborne allergies include rye grass, Kentucky blue grass, and ragweed, among others.

Mold spores are the most common and numerous airborne allergens floating in the air in the spring, summer and fall. They have been noted to be particularly associated with asthma flare-ups in some allergic individuals.

ADVANCED THERAPY FOR ASTHMA AND OTHER IMMUNOLOGIC DISORDERS.

A variety of new therapies have been developed over the past few years to treat severe asthma, severe atopic dermatitis, and severe hives. These medications are classified as biologics. Biologics are proteins that are manufactured to block specific inflammatory proteins made by the immune system. Unlike regular medications (pharmaceuticals), biologics are monoclonal antibodies, i.e., specific proteins that mimic anti-inflammatory proteins that the body produces. Biologics block a variety of inflammatory proteins in the human body. This results in a significant decrease in inflammation.

Inflammation is the major driving force in causing the negative effects of asthma, atopic dermatitis (eczema) and hives. Inflammation can be described as excess heat.

When an engine does not have enough oil, but is still able to run, the excess heat produced could be described similar to the inflammation that the body produces when the immune system is inappropriately stimulated.

Biologics have been used to treat cancer for many years. However, in the past few years, biologics have become widespread in the treatment of a variety of disorders such as severe migraines.

Concerns about the development of cancers has always been thought about in the development of biologics. Fortunately, some of the biologics used for allergic diseases have been around for a long time and we are not seeing a rise in cancers or other diseases with the use of these therapies.

The major biologics are as follows:

Xolair – Xolair is used to treat asthma. It was the first biologic that received FDA approval to treat severe asthma. More recently, Xolair has been approved to treat chronic hives. It is an excellent treatment for severe hives. Most recently, Xolair has been FDA approved to treat nasal polyps.
Side effects of Xolair can include serious allergic reactions. Xolair may be administered at home after a trial of receiving it in a doctor’s office.
Nucala – This biologic is used to treat asthma and a rare disease called hypereosinophilic syndrome. Nucala is given on a monthly basis.
Nucala is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home.
Fasenra – Similar to Nucala, this medication is used to treat severe asthma as well as hypereosinophilic syndromes. Fasenra can be given every two months after three months of monthly therapy.
Fasenra is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home.
Dupixent – Dupixent was first approved to treat severe eczema. It was one of the few new therapies in the past ten years to treat severe eczema. It is an excellent drug to treat severe eczema.
Dupixent is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home.
It has also been FDA approved to treat asthma and to treat nasal polyps. Side effects of Dupixent can include irritation of the eyelids. This is rare, but we have seen it in our office.
Cinqair – Cinqair is similar to Nucala and Fasenra, but is given as an IV infusion on a monthly basis. It is effective in treating severe asthma.

Around the Mitchell House

One of the grandchildren of Charles and Mary Gleason Mitchell visited with her husband this spring. She was last in this house when she was five years old. Fortunately, she was able to remember much of this house and reminisced about her visits to Cadillac from Oregon where the son of Charles Mitchell, William Mitchell, raised his family. We were happy to host them and give them a tour of Cadillac.

The Hilltop Allergy Letter

Volume 19 Number 4

September - December 2020

Introduction

The Rise and Fall of

COVID-19

The Coronavirus (SARS-CoV-2) was first seen in the United States at the end of January 2020. In Michigan, we had very short peak of COVID-19 cases. A COVID-19 case should be defined as a person who is infected with the Coronavirus and has symptoms. A positive Coronavirus test is not the same as someone who has COVID-19.

Since April, the death rate of Coronavirus has decreased by more than 80%. Furthermore, the CDC has revealed that the true numbers of Coronavirus deaths in Michigan may be significantly fewer than those that are currently being listed. This is due to the fact that all pneumonia deaths have been counted as Coronavirus deaths and people who have died of other causes were listed as dying of Coronavirus even though the virus may not have been the cause of their death.

Research and statistics have confirmed that the Coronavirus is almost never deadly to those under the age of 40. Over the age of 40, most patients will fully recover from Coronavirus. Those with significant underlying health conditions are at an increased risk for death or severe illness from COVID-19 illness.

Treatment with Hydroxychloroquine and Zithromax has been shown to be extremely effective in curing the disease in the vast majority of patients who have been treated with these medications.

No one can predict whether or not there will be a rise in COVID-19 illness. Certainly the number of positive tests is not at all indicative as to where we are with this virus as positive tests are often meaningless in someone who has no illness. Furthermore, false positive results can occur with Coronavirus and this must be taken into account when looking at the statistics regarding this illness.

With almost ten months of experience with the diagnosis, treatment and management of Coronavirus patients, the United States has shown that this virus is no more dangerous than influenza. Widespread testing of testing who are not ill does not seem to make sense as this virus has been shown to have very low risk of spread in asymptomatic carriers. If you have any questions regarding the Coronavirus, please do not hesitate to contact me. We have been putting out a newsletter periodically and depending on the state of the country and the virus, we will continue to do so in our office. It is posted on our Facebook page. We also offer this to be emailed. Individuals who would like an email copy are invited to contact our office with their email addresses.

A New Possible Treatment for Cat Allergy:

A new food additive for cats has been approved by the FDA which can decrease the amount of allergenic protein that is released by cats. However, it remains to be seen as to whether or not this food additive will be of benefit in decreasing cat allergy symptoms in patients. This food is packaged by Purina as Pro Plan LiveClear Allergen Reducing Cat Food.

Around the Mitchell House

We have been doing battle with a mysterious leak in one of our chimneys here at the Mitchell House. Continued maintenance of this beautiful building is top priority and one of our major community service activities as stewards of this historic property.

The Hilltop Allergy Letter

Volume 20 Number 1

December 2020 – February 2021

Introduction

Winter Allergens

With winter, patients can often have an increase in their indoor allergy symptoms. This is because we spend more time indoors and we have less air circulation with the outdoors as windows are closed and air is being recirculated in order to heat the indoor air.

Common indoor allergens include molds, animal dander, and dust mite particles. Indoor plants can sometimes be a cause of indoor allergen sensitivity. However, this can be difficult to diagnose as we do not have standardized skin test products for many indoor plants. If you have any questions regarding indoor allergies, please do not hesitate to contact us.

Wintertime Infections

It is well known that people often have increased pneumonia and sinus problems during the late fall and winter, i.e. November through March. Certain bacteria and viruses have more activity in the wintertime. There are many reasons for this. Included in that is that the indoor air is dry in the wintertime leading to irritated skin of the airways which is then fertile breeding ground for bacteria and viruses to settle in. Indoor allergy symptoms can be more significant during the wintertime. This is also a setup for infection. Certain viruses and bacteria do not do well when exposed to ultraviolet light. With people being indoors more, they are not exposed to the natural anti-infectious benefits of sunshine. It is thought that vitamin D can be playing a role in increasing one’s susceptibility to infection. Therefore, vitamin D supplementation in our part of the country is, I believe, vital to keeping one’s airway healthy. If you have any questions regarding this, please do not hesitate to contact us.

Everything That is Illness is not Covid-19

It is well known that COVID-19 infection is in almost all cases not life-threatening. Even in those over the age of 75 years of age, for every 100 people over the age of 75 who get COVID-19 more than 94 of them will survive COVID infection.

A study conducted by the Michigan Department of Health showed that there was a 62% increase in out-of-hospital deaths from the end of March to the end of May 2020. The CDC has shown an over 40% decrease in the diagnosis of six major cancers from January through the end of April 2020 in the United States. There has been a 43% increase in suicides according the Michigan Department of Health.

These statistics are sobering. The undue fear that has taken over many Americans has led to a multitude of problems. A significant issue is that the main death rate of COVID-19 may not be from the infection itself but actually as a consequence of fear. Isolation of individuals can be deadly. Misinformation can also be a significant risk factor for health problems or death during these times. It is strongly recommended that people educate themselves and find trusted and reasonable sources of information regarding COVID-19.

“God will send them strong delusion, that they should believe the lie, that they all may be condemned who did not believe the truth” 2 Thessalonians 2:11-12

Around the Mitchell House

We continue to maintain one of the most historic buildings in Wexford County. The Mitchell house was built by the founder of Cadillac, George Mitchell. This summer, we had tuck pointing completed around this building. This will help to maintain building for many years to come. We are extremely diligent in choosing what we believe to be the best possible craftsman to maintain this excellent building. Many of them are local. We consider ourselves caretakers more than owners of this important structure. A big thanks goes to Gwen Dubravec, founder and director of the Cadillac Preservation Guild, for her efforts in overseeing the restoration and maintenance of this building.