The Allergist AnewsletterfromtheOklahomaAllergy&AsthmaClinicSummer2016

The Allergist

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Greg Metz, M.D.

Scott B. Dennis joins Oklahoma Allergy & Asthma Clinic as COO

Scott B. Dennis, MHA

Raising Awareness about AsthmaMore than 22 million people living in the United States have asthma, a chronic lifelong disease that affects the lungs. Asthma can cause wheez-ing, breathlessness, chest tightness and coughing.“Asthma can’t be cured but it is pos-sible to reduce and prevent asthma attacks,” said Greg Metz, M.D., a board-certified allergist with the Oklahoma Allergy & Asthma Clinic.

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When you have asthma, the airways become inflamed and the muscles around the airways can tighten when you are exposed to a trigger for your asthma. This makes it dif-ficult for air to move in and out of the lungs, causing symptoms such as coughing, wheezing, shortness of breath and/or chest tightnessAsthma attacks can cause adults to miss work and children to miss school. These dangerous and some-times life-threatening episodes can reduce the quality of life for people with asthma.

Scott B. Dennis, MHA, has joined the Oklahoma Allergy & Asthma Clinic as chief operating officer. Dennis has extensive health care experience and was previously the director of opera-tions for the Oklahoma Pain Man-agement and Research. Prior to that, he worked for the Sisters of Mercy Health System in Oklahoma City from 2009-2015 holding several corporate level management positions.Dennis holds a bachelor of business administration from the University of Oklahoma and a master of health administration from the University of Oklahoma Health Sciences Center. “I am very excited to be part of the OAAC organization. Understanding the place our clinic holds within this community and how we have pro-vided care to generations of families, I consider it an honor to help serve our patients. OAAC’s tradition of ex-cellence is one we strive to achieve daily,” said Dennis.He is very familiar with the Oklaho-ma Health Center campus as a stu-dent and also professionally working with several campus entities in his 18 years of experience. A part of his orientation as a new administrator, Dennis was able to experience being a clinic patient.

“I had the opportunity to go through our clinic as a patient during my first week and it was a great experience to see our patient commitment first hand,” said Dennis.He was born in Oklahoma City and grew up in Newcastle. He currently resides in Oklahoma City and he en-joys spending time with his family. His hobbies include golf, fishing, trav-eling and volunteering specifically with The Miracle League in Edmond.

Warren V. Filley, M.D., a board-certi-fied allergist with the Oklahoma Al-lergy & Asthma Clinic, received the Distinguished Doctor designation from the Expert Network.

Congrats to Dr. Filley

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“The good news is that we can raise awareness about asthma and how it can be controlled,” said Metz. “People with asthma can prevent attacks if they learn how to avoid asthma trig-gers. Those triggers can include tobac-co smoke, allergens, outdoor air pollu-tion and infections.”Metz says asthma episodes can also be prevented by using your inhal-ers correctly and as prescribed. For many asthma sufferers, timing of these symptoms is closely related to physical activity.

And, some otherwise healthy people can develop asthma symptoms only when exercising - called exercise-induced bronchoconstriction (EIB),

or exercise-induced asthma (EIA). Stay-ing active is an im-portant way to stay healthy, so asthma shouldn’t keep you on the sidelines. Your physician can develop a manage-ment plan to keep your symptoms un-der control before, during and after physical activity.People with a family history of allergies or asthma are more

prone to developing asthma. Many people with asthma also have aller-gies. This is called allergic asthma. Occupational asthma is caused by

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Camping Safe with Allergies and Asthma

inhaling fumes, gases, dust or oth-er potentially harmful substances while on the job.Childhood asthma impacts millions of children and their families. The majority of children who develop asthma do so before the age of five.“Once asthma is properly diagnosed and a treatment plan is in place,” said Metz, “you will be able to man-age your condition and your quality of life will improve.”An allergist is the best qualified phy-sician in diagnosing and treating asthma. With the help of your al-lergist, you can take control of your condition and participate in normal activities.To make an initial appointment for an allergy or asthma problem or to request more information, please call (405) 235-0040 or visit the web-site.

Here are some tips for kids who are going to camp this summer. Food: Have your parents speak to the camp about your allergies. Pro-vide a list to the camp in advance so they can serve allergy safe foods. If you have food allergies and you aren’t bringing your own food, be sure to bring healthy non allergic snacks and a list of foods you are al-lergic to. Stinging Insects: If you are allergic to bees or wasps or other stinging insects, the sting can cause a life-threatening condi-tion called anaphylaxis. Keep your Epi-pen with you at all times and an adult should be trained to give you an injection if you need it.

Campfire time: Sitting around the campfire is always a fun part of camping. However, if you have asth-ma, smoke can trigger an asthma attack. Sit back from the campfire. Let someone else toast the marsh-mallow for you. Move away from

the smoke if the wind blows it your direction.Tent camp-ing: Set your tent up on a grassy area, un-less you have a severe grass allergy. Dry, dusty areas can make it hard to breathe.First Aid Kit: Pack all of your medications in

your first aid kit before leaving for camp. Be sure to pack your Epi-Pen for a food or sting reaction, an in-haler for asthma, antihistamines for

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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.Scott B. Dennis, MHAWarren V. Filley, M.D.Richard T. Hatch, M.D.Bret R. Haymore, M.D.Gregory M. Metz, M.D.Florina Neagu, M.D.Patricia I. Overhulser, M.D.Shahan A. Stutes, M.D.Karen Gregory, DNPStefanie Rollins, APRN-CNP

Do you think you or someone in your family has a food allergy? To find out, your OAAC allergist may ask that you take an oral food challenge or feed-ing test. This is a medical procedure where food is eaten slowly, gradually increasing amounts, under medical supervision. An Oral Food Challenge or OFC is usually done when a care-ful medical history and allergy tests (skin and blood tests) are inconclu-sive. OFC is a more definitive test because it will show whether food ingested produces no symptoms or triggers a reaction.In clinical practice, most OFCs are performed openly, meaning that both the patient and the person ad-ministering the OFC know what food is being eaten; for example, eating peanut butter.In blinded challenges, either the patient (single-blind), or both the patient and the medical personnel (double blind) do not know whether the “real” test food is being eaten or a fake food, known as placebo. For

As an alternative, medications other than antihistamines may be used, such as intranasal steroids, leukot-riene antagonist or inhaled cortico-steroids, in the 1 to 2 week period before the OFC to minimize the dis-comfort caused by stopping oral an-tihistamines. If a person needs their asthma rescue medications around the time of the test, the test should be postponed. However, NEVER avoid using a needed emergency treatment such as epinephrine, anti-histamines or inhaled asthma rescue medications just because you have an OFC scheduled. Treat the prob-lem and postpone the test.

Talk to your aller-gist about your specific food is-sues. Some may have you bring spe-cific items, others may provide the food. Discuss your child’s food prefer-ences. For infants, younger children or picky eaters, you may need to have

several food options ready to mini-mize the possibility of food refusal for a picky eater. For example, soy may be given as edamame, tofu, soy ice cream or soy milk. For children, bring favorite serving dishes and utensils, and distractions such as toys, books, or homework.On the day of the test, you may be in-structed to avoid food or have a very light meal before starting. A physical examination and vital signs are done before starting and periodically dur-ing the test. The OFC starts with a small serving of the food and after a period of time, usually 15-30 min-utes, if no symptoms are present, a slightly larger amount is eaten.

What is an Oral Food Challenge?example, peanut flour may be hid-den in a cookie while a similar look-ing and tasting cookie without the peanut flour is the placebo. The double blind OFC is considered the best test since it reduces possi-ble anxiety related reactions. Blind-ed challenges are rarely performed in clinical practices, and are usually done in research studies.What do I need to do in preparation to have an OFC? You need to be in good health on the day of the test. Chronic allergic conditions such as asthma, atopic dermatitis (eczema) and allergic rhinitis (hay fever) have

to be well controlled so they do not interfere with the interpretation of any symptoms. If you are sick on the day of the test, postpone it. You should also carry your usual medica-tions and emergency medications with you so you have them for the trip to the doctor and back.Antihistamines have to be stopped before the OFC since they might mask mild early symptoms. Ask your OAAC allergist how long you need to be off the type of antihistamine you are using. It may be difficult to stop allergy medications during an allergy season or in patients with significant eczema, therefore OFCs may need to be timed to avoid the seasons that cause problems. (continued on page 4)

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Before each subsequent dose, care-ful evaluation is performed to look for any symptoms. If symptoms oc-cur, and the medical personnel judge that a reaction is happening, the feeding is stopped and medications are given as needed. Otherwise, the feeding continues until, typically, a meal sized portion is eaten.Most food challenges that result in a reaction trigger skin or stom-ach symptoms. The symptoms are usually mild because the testing is done gradually with small amounts of food at the start, and feeding is stopped at the onset of symptoms. Most often, antihistamines are given for these mild symptoms. If there are

more severe symptoms, treat-ments can include epinephrine and other medications. If there were no symptoms during an OFC, usually patients are discharged from the office within 1 to 3 hours of complet-ing the feeding. In case of al-lergic symptoms, the patient is typically watched for at least 2 to 4 hours from the time symp-toms go away or improve, with longer observation periods required for patients with more severe reac-tions.Most food allergies lead to symp-toms soon after the food is ingested. However, some forms of food al-lergy are delayed. For example, in

allergies and cortisone for skin reac-tions. Mold: Air out your tent in advance of the camping trip. Clean any mold with a diluted bleach and water mix-ture under adult supervision. Mold spores can trigger allergy and asth-ma attacks.Poisonous plants: Plants such as poison ivy, oak and sumac can cause

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a serious itchy rash. Learn the phras-es: “Leaves of three? Let them be!” or “One, two, three? Don’t touch me” as these plants have a cluster of three leaves at the end of a long stem. Ointments, lotions and anti-histamines can treat potential aller-gic skin reactions. Wear long pants when hiking through tall weeds and bushy areas. Ragweed: A common allergy trig-ger, ragweed typically grows in ar-eas where wind can spread the pol-len. Ragweed season typically starts ramping up in August and lasts until the first hard frost. Avoid walking through large open meadows if pos-sible.Most importantly, have fun!

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food protein-induced enterocolitis (FPIES), symptoms typically do not begin for at least 2 hours and so the feeding is performed faster and the observation time is longer than for typical allergies. The dosing and observation time for an OFC can be adjusted to address an individual pa-tient’s pattern of reaction.If the OFC did not cause symptoms, the patient is recommended to start regular consumption of the chal-lenge food at home the following day. It is usually advised to make the food a routine part of the diet. Hav-ing symptoms after a “passed” OFC is uncommon. If the OFC resulted in an allergic reaction, then continued avoidance is recommended. The risks of OFC include an allergic reaction including anaphylaxis. To date, no death from a physician su-pervised OFC has been reported in the medical literature. There is no evidence that having an allergic re-action during an OFC makes future reactions worse or prolongs allergy in children. The benefits of OHC include the nu-tritional and social benefits of being able to expand the diet if the food is successfully eaten without symp-toms. However, even if the food triggered a reaction, the benefit is knowing that the food is truly a problem and needs to be avoided to maintain health. Source: AAAAI

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Oral Food Challenges...

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