Please Note the Following Changes to our allergy injection hours for July only We will not be giving injections on Wednesday, July 24, 2024, or Thursday, July 25, 2024
Few experiences are more frightening than not being able to breath. We give little thought to the dozen or so breaths we take each minute of our lives …until there is not enough. And then, If our supply of air is threatened for even a moment, we cannot think about anything else.
Shortness of breath is one of the most common complaints of patients coming into our office for an evaluation and can have many causes. Our job is first to find out the cause. Once we know this, we can focus on the proper treatment.
Most people with breathing discomfort will fall into one of two groups: those with a lung problem and those with a heart problem.
Lung: “The Bellows”
All living things move and grow and both require energy. Food is taken in, digestion converts complex food materials to chemical fuel (usually glucose) . The fuel is burned in the presence of oxygen to produce high-energy chemicals that can be used by run the machinery of life. The by-product of this process is water and CO2. Respiration is the process of getting oxygen into our bodies, transporting It to working tissue and then picking up and carrying away CO2. Oxygen is absorbed by the hemoglobuin in our red blood cells as they move through the tiny capillaries in our lung. The empty red blood cell pick up the waste C02 and carry it back to the lungs to be released with each exhalation into the atmosphere.
The lung has two parts: the airways and the alveoli. The airway begins as a single big pipe (the trachea) and then, like the branches of tree, becoming progressively smaller until at the end, less than 1 mm in size, they bud into a collection of balloon-like airsacks called the alveoli. The alveoli are constructed of elastic fibers that stretch to fill up with air when we inspire and contract to expel the air when we breath out.
The smaller airways (bronchioles) are dynamic and can dilate or constrict to increase or decrease the flow of air.
The alveoli are surrounded by tiny capilaires filled with red blood cells that soak up the oxygen and drop off the CO2.
Lung Diagram
Inspiration occurs by expanding the ribcage and flattening the diaphragm creating a vacuum and a rush of inflowing air. When the muscles of the ribcage are relaxed, the elastic alveoli sqeeze the air out.
Inhalation
The Heart and Blood Vessels: The Pump
The right side of the heart recieves oxygen poor and CO2 rich blood from tissues and pumps it through the lung where the C02 is dropped off and oxygen picked up. The oxygen rich blood fills the left side of the heart where it is pumped throughout the body.
Breathing Sensors
When the tisses in our body are working hard, such as when we exercise, we produce more CO2 and the blood becomes more accidic. Specialiszed sensors, located in the big arteries of the neck and chest as well as the brain monitor changes in the amount of oxygen, C02 and acid in the blood. When these sensors sound the alarm, the muscles of the chest and the diaphram are stimulated causeing us to take deeper and more rapid breaths. The heart is stimulated to beat faster and stronger. The firing of these alarm sensors also stimulates our conscious centers, making us feel uncomfortable short of breath”until the oxygen, C02 and acid levels return to normal.
Now that we have the basic physiology down, In my next post, I will review the things that can go wrong to make us feel short of breath.
https://www.allergywise.com/wp-content/uploads/2020/07/shortness-of-breath-1.png10001500brianmillhollonhttp://www.allergywise.com/wp-content/uploads/2016/04/ahwatukee-allergy-specialist.pngbrianmillhollon2020-07-28 17:05:572020-07-28 17:06:00Why Am I Short of Breath?
Since the beginning of the COVID-19 pandemic, our patients have asked if having asthma places them in the “high risk” group, those that are more likely to become infected with the virus and if they get sick, to have a severe illness leading to hospitalization, respiratory failure and even death.
There is no evidence of increased risk of infection with COVID-19 in asthmatics and asthmatics are not more likely to die from COVID-19.
Early on in the pandemic, some experts did warn about the theoretical risk that those with asthma could catch the virus more easily and have a more severe illness if infected. Now however, as more data from around the world has become available, it is clear that there is no evidence of increased risk of infection with COVID-19 in asthmatics and that asthmatics are not more likely to die from COVID-19.
Are Steroids for Asthma Safe?
Another misconception is that steroid use is dangerous if you become infected with COVID-19. There is no evidence that steroid use, in any form, used for the prevention and treatment of asthma, increases the risk of infection with COVID-19 or will make an infection more severe. Actually, the opposite is true. Asthmatics are more likely to get into trouble if they become infected with COVID-19 when their asthma is poorly controlled because they have not been taking there medications. In fact, inhaled and oral steroids should be used to prevent and treat an asthma attack, even in patients with COVID-19.
The bottom line is that all asthmatic should make keeping their asthma under good control through regular use of their preventive medications a top priority. Doing this will keep you from joining the “high risk” group.
https://www.allergywise.com/wp-content/uploads/2020/06/corona-5213394_1920-2.jpg12771920brianmillhollonhttp://www.allergywise.com/wp-content/uploads/2016/04/ahwatukee-allergy-specialist.pngbrianmillhollon2020-06-08 12:21:282020-06-09 11:27:59Asthma and COVID-19: What Is The Risk?
Plantago ovata is a weed native to the southwestern United States. It’s seeds have been used for food by native populations in Arizona and is a common source of psyillium – a dietary fiber found in products such as Metamucil.
Following a wet winter, Plantago ovata can be found growing wild in the desert and along road sides in the spring. It’s presence contributes signifcantly to South Mountain Park in Phoenix turning green in the spring.
Plantago ovata Ahwatukee, Arizona
Plantago ovata is related to English Plantain (plantago lanciolata) an important allergenic weed found in Europe, Asia and North America.
When I first moved to Arizona from New Orleans where I was finishing training at Tulane, I began to familiarize myself with the local weeds, trees, and grasses that were important causes of allergy problems in the Southwest. Some plants were on every local allergist’s list of important allergenic plants, and although some of the names on the list – like Oak and Ragweed – were very common, the Arizona varieties looked very different from their southern cousins. It took a while, but in time I became familiar with all of the plants on the list. There were a few however, that had me stumped.
Most of the Arizona allergists I knew had English Plantain (Plantago lanceolata) on their list of important allergenic weeds and yet after years of hiking around, I never saw anything that looked like the delicate pictures of this weed in the books.
In fact, English Plantain is prevalent around the eastern coastal states, the Northwest, and California where it an important allergen – but not in the deserts of Arizona. So why is it on the list?
The Elusive Plantain
After an unusually rainy winter this year, the desert bloomed as I have never seen it before. The usually brown hues of South Mountain were transformed into a carpet of green. One morning when out riding my bike, I noticed a vaguely familiar-looking weed growing on the rode side of the new Chandler extension in Ahwatukee. I took a few pictures and collected samples to make a pollen reference. Sure enough, it seemed to be the elusive plantain.
Plantago ovata Ahwatukee, Arizona
This was not English Plantain but a close cousin Plantago ovata. This variety of plantain is only found in the Southwestern United States and has a number of common names including Desert Indian Wheat. It has been used by the Pima Indians for food and medicine for millennia.
The seeds of Plantago ovata are a common source of psyllium which is used in the manufacture of bulk laxatives and has been a cause of occupational allergy and asthma in workers exposed to the plant.
psyllium Metamucil
In Phoenix, the plant appears briefly during the spring, particularly after a wet winter, contributing to the display of desert wildflowers… and to the spring allergy season.
Begining June 1, the temporary modification to the allergy immunotherapy administration schedule will end. While we will continue to follow all guidelines and recommendations from the Centers for Disease Control and the Arizona Health Departement to mitigate the risk of COVID-19 exposure and transmission to our patients and staff, we will cautiously resume our normal allergy immunotherapy schedule.
If you are on a build-up schedule and have been receiving injections every 2-4 weeks during the temporary hold, you can now resume weekly to bi-weekly injections.
If you are receiving maintenance allergy injections every 2-4 weeks, no change in schedule is needed.
We ask that all patients entering the office wear a face mask.
All patients coming in for an allergy injection will be asked about recent travel, potential exposure to the COVID-19 virus, and recent respiratory symptoms and will have their temperature checked.
Seating in the wating area will be modified to maximize safe distancing.
Because of limited seating, we ask that you do not bring family members into the waiting area and that only one adult accompany a child.
Please do not come to the office if you have a fever or suspect that you have been exposed; call our office first.
If you have any questions, please call 480-705-8844 or email: marla@allegywise.com.
https://www.allergywise.com/wp-content/uploads/2020/03/covid-update-1-1.png10001500brianmillhollonhttp://www.allergywise.com/wp-content/uploads/2016/04/ahwatukee-allergy-specialist.pngbrianmillhollon2020-03-26 17:00:382020-05-26 16:02:17Update: Allergen Immunotherapy During the COVID-19 Outbreak
You can now schedule a new patient consultation or follow-up visit with Dr. Millhollon without having to come into the office and at a time that is convenient, including nights and weekends.
For more information, call our office at 705-8844 or send us a note at mail@allergywise.com.
https://www.allergywise.com/wp-content/uploads/2020/03/Untitled-design-1-2.png10001500brianmillhollonhttp://www.allergywise.com/wp-content/uploads/2016/04/ahwatukee-allergy-specialist.pngbrianmillhollon2020-03-22 11:29:242020-03-22 11:29:27TeleMedicine Appointments Are Now Available
As the global and local effect of coronavirus (COVID-19) continues to evolve, our practice is firmly committed to the health and safety of our patients. We are closely monitoring the changing situation and complying with recommendations from the CDC and The Arizona Health Department. In addition, we are implementing the following change to our usual operating procedures:
Before Coming to the Office
If you have had a fever (temperature above 100) within the past week, do not come to the office. Call our office for further instructions.
Screening
All patients and family members coming to our office will be asked about symptoms, travel, contacts, and have their temperature checked before entering the office.
Social Distancing
We will limit the number of patients in our waiting room at any given time to 10.
We ask that no more than 2 family members accompany a patient into the office.
To minimize the time in the waiting room, all patients with an appointment to see the doctor will be taken immediately to an exam room after checking in.
TeleMedicine
To reduce the need for travel and visits to the office, we are now offering secure, video-based appointments with Dr. Millhollon
Weekend and evening appointments are available
Please call our office for more information.
Allergy Immunotherapy and Biologic Injections
After the initial screening, patients will go to the injection room as usual
After your injection, you may wait in the courtyard or waiting room with the goal of maintaining at least 6 feet from any other patient with no more than 10 patients in the waiting room.
After your wait time, you may come to the outside window to have your arm checked and indicate that all is well before leaving.
Stay Healthy
At this time, the risk of serious illness from coronavirus infection in Arizona is small. However, the risk is greater for some groups including the elderly and those with chronic health problems including asthma and immunodeficiency.
Like all viral respiratory infections, Covid -19 can trigger an asthma attack. Keeping your asthma under good control should, therefore, be a high priority – as always but particularly at this time. This includes taking your preventative medications daily as prescribed, reviewing your asthma action plan, and making sure all medications are available and up-to-date. Patients who take oral steroids such as prednisone daily are also at increased risk. These high-risk groups need to be particularly vigilant about virus avoidance measures such as regular hand washing and avoiding unnecessary exposure to large groups of people.
If you have any questions, please do not hesitate to contact us.
Wine is made from grapes and like grape, true allergic reactions are, thankfully, rare. If a grape allergy is suspected, it can be easily ruled out or confirmed with an allergy skin test.
Many people do however complain of problems when they drink wine and yet are not allergic to grape. If these reactions to wine are not an allergy to grape then what is causing the problem?
In most cases, ill effects reported after drinking wine are the result of a sensitivity to preservatives in the wine or to alcohol.
Sulfite Sensitivity
Sulfites are routinely added in the winemaking process as a preservative to prevent the growth of bacteria and unwanted yeast. Without sulfites, most wine will turn to vinegar. These sulfiting agents – sulfur dioxide, sodium potassium sulfite, bisulfite, and metabisulfite – can be added at different times and in varying amounts depending on the type of wine being made. In general, white wine has a higher sulfite content than red and sweeter wines have more sulfite than drier wines.
All wine contains naturally occurring sulfites so finding a wine that is completely sulfite-free would be unlikely. However, some winemakers offer organic wines with no added sulfites. In the US, new regulations in place since 2012 require that all wines with sulfite levels greater than 10 mg/L (ppm) be labeled as containing sulfites. Similar guidelines have been adopted by the EU and Britain.
“Sulfite Free” actually means no sulfites were added to the wine
Exposure to sulfites has been associated with a number of symptoms in sensitive individuals including anaphylaxis and hives. Although asthmatic symptoms are uncommon in patients with sulfite sensitivity without a history of asthma, serious and potentially life-threatening asthmatic reactions can occur in patients already under treatment for asthma.
In addition to wine, sulfites are added to a variety of foods including fruits, vegetables, and seafood to preserve freshness and prevent browning. Similar to wine, the FDA requires labeling on any food or beverage with greater than 10 mg/L (ppm) of these preservatives.
Ethanol Sensitivity
In addition to grape juice and preservatives, wine (of course) contains alcohol, specifically ethanol. As discussed in more detail in an earlier post (here), some individuals develop serious symptoms when they consume any form of alcohol. This is caused by a deficiency in a liver enzyme called aldehyde dehydrogenase. Without this enzyme, high levels of the chemical acetaldehyde accumulate in the blood. Acetaldehyde can cause symptoms that resemble an allergic reaction including facial flushing, nasal congestion, respiratory difficulty, nausea, and headaches when they drink any form of alcohol.
Without the enzyme aldehyde dehydrogenase, acetaldehyde levels increase after drinking alcohol causing symptoms
Some reports suggest that wine may contain varying amounts of acetaldehyde in addition to ethanol. This may explain why some people are able to tolerate certain varieties of wine but not others.
What About Yeast?
Yeast is the engine that turns common grape juice into highly valued wine. The industrious yeast eat the sugar in the grapes and as a waste product produces ethanol. Although wild yeast found natively on the surface of harvested grapes has been used in winemaking for centuries, most winemakers today add yeast to ensure consistent results. Saccharomyces cerevisiae is the variety of yeast most frequently used in winemaking. It is also the yeast used in beer making and baking and is commonly called brewer’s yeast.
Saccharomyces cerevisiae yeast
Although brewer’s yeast is an allergen, there are few reports of allergy to the yeast causing problems drinking wine or beer or eating bread. It is, however, a significant cause of occupational allergy for those exposed to high levels of airborne yeast in the workplace such as a baker. As an interesting side note, this yeast also grows on our skin and can be a cause of yeast infections in women.
Why is brewer’s yeast a problem in the air and not in wine? Although wine production starts with living, growing, feasting yeast cells, rising levels of alcohol in the wine will eventually kill a large percentage of the yeast and are removed from the final product when they precipitate out.
Precipitated yeast in a wine bottle
How Do I Know What is Causing My Problems When I Drink Wine?
As mentioned above, allergy to grape can be determined with an allergy skin test. Allergy testing is also available for sensitivity to Saccharomyces cerevisiae yeast, although a positive test result does not necessarily mean that yeast in the wine is causing problems. Diagnosing alcohol and sulfite sensitivity is more challenging and requires a careful history by a physician experienced with these syndromes and a controlled food challenge.
Beer is the third most popular beverage, behind water and tea. In spite of this, true allergic reactions to beer are rare.
Beer contains four primary ingredients: Water, malted barley, yeast, and hops. Barely that has been partially sprouted and then dried is called malt. Malting develops enzymes that break down the starches in the grain to sugars that can be fermented by yeast. Yeast eats the sugars and produces gas (CO2) and ethanol as waste products. Hops is added for flavor and as a preservative.
Nutritionally, beer is mostly water and sugar with a little protein. A can of regular beer contains about 26 grams of sugar and 1.5 grams of protein. The rest is water.
For the most part, all allergens (things that cause an allergic reaction) are intact proteins. Most of the protein in beer is in the form of enzymes that are released from barley in the malting process. After the malting process, when the enzymes have done the work of breaking down complex carbohydrates to be used by the yeast, the mixture is boiled. Boiling coagulates and precipitates a lot of the protein which is then removed by filtration from the final product. The protein that remains is likely to be in the form of heat resistant enzymes.
For this reason, the intact protein profile, and hence the allergenicity, of beer is quite different from that of the grains the process started with. This may account for the fact beer, the third most widely consumed beverage on the planet, rarely causes true allergic reactions. As discussed here, allergic-like reactions to alcohol is another story.
Sorting out the cause of a suspected allergic reaction to beer can be a challenge. Allergy skin testing to the most common beer ingredients including barley, malt, hops, and wheat is available and is the place to start. Frequently, a carefully controlled food challenge is required.
Why Am I Short of Breath?July 28, 2020 - 5:05 pm
Asthma and COVID-19: What Is The Risk?June 8, 2020 - 12:21 pm
Plantago ovataMay 26, 2020 - 4:29 pm
Update: Allergen Immunotherapy During the COVID-19 OutbreakMarch 26, 2020 - 5:00 pm
TeleMedicine Appointments Are Now AvailableMarch 22, 2020 - 11:29 am
Coronavirus UpdateMarch 18, 2020 - 5:58 pm
July Summer Vacation Allergy Injection Hours
/in Uncategorized /by brianmillhollonPlease Note the Following Changes to our allergy injection hours for July only We will not be giving injections on Wednesday, July 24, 2024, or Thursday, July 25, 2024
Why Am I Short of Breath?
/in Article Menu /by brianmillhollonFew experiences are more frightening than not being able to breath. We give little thought to the dozen or so breaths we take each minute of our lives …until there is not enough. And then, If our supply of air is threatened for even a moment, we cannot think about anything else.
Shortness of breath is one of the most common complaints of patients coming into our office for an evaluation and can have many causes. Our job is first to find out the cause. Once we know this, we can focus on the proper treatment.
Lung: “The Bellows”
All living things move and grow and both require energy. Food is taken in, digestion converts complex food materials to chemical fuel (usually glucose) . The fuel is burned in the presence of oxygen to produce high-energy chemicals that can be used by run the machinery of life. The by-product of this process is water and CO2. Respiration is the process of getting oxygen into our bodies, transporting It to working tissue and then picking up and carrying away CO2. Oxygen is absorbed by the hemoglobuin in our red blood cells as they move through the tiny capillaries in our lung. The empty red blood cell pick up the waste C02 and carry it back to the lungs to be released with each exhalation into the atmosphere.
The lung has two parts: the airways and the alveoli. The airway begins as a single big pipe (the trachea) and then, like the branches of tree, becoming progressively smaller until at the end, less than 1 mm in size, they bud into a collection of balloon-like airsacks called the alveoli. The alveoli are constructed of elastic fibers that stretch to fill up with air when we inspire and contract to expel the air when we breath out.
The alveoli are surrounded by tiny capilaires filled with red blood cells that soak up the oxygen and drop off the CO2.
Inspiration occurs by expanding the ribcage and flattening the diaphragm creating a vacuum and a rush of inflowing air. When the muscles of the ribcage are relaxed, the elastic alveoli sqeeze the air out.
The Heart and Blood Vessels: The Pump
The right side of the heart recieves oxygen poor and CO2 rich blood from tissues and pumps it through the lung where the C02 is dropped off and oxygen picked up. The oxygen rich blood fills the left side of the heart where it is pumped throughout the body.
Breathing Sensors
When the tisses in our body are working hard, such as when we exercise, we produce more CO2 and the blood becomes more accidic. Specialiszed sensors, located in the big arteries of the neck and chest as well as the brain monitor changes in the amount of oxygen, C02 and acid in the blood. When these sensors sound the alarm, the muscles of the chest and the diaphram are stimulated causeing us to take deeper and more rapid breaths. The heart is stimulated to beat faster and stronger. The firing of these alarm sensors also stimulates our conscious centers, making us feel uncomfortable short of breath”until the oxygen, C02 and acid levels return to normal.
Now that we have the basic physiology down, In my next post, I will review the things that can go wrong to make us feel short of breath.
Asthma and COVID-19: What Is The Risk?
/in Article Menu, Asthma, News /by brianmillhollonAre Asthmatics at High Risk
Since the beginning of the COVID-19 pandemic, our patients have asked if having asthma places them in the “high risk” group, those that are more likely to become infected with the virus and if they get sick, to have a severe illness leading to hospitalization, respiratory failure and even death.
Early on in the pandemic, some experts did warn about the theoretical risk that those with asthma could catch the virus more easily and have a more severe illness if infected. Now however, as more data from around the world has become available, it is clear that there is no evidence of increased risk of infection with COVID-19 in asthmatics and that asthmatics are not more likely to die from COVID-19.
Are Steroids for Asthma Safe?
Another misconception is that steroid use is dangerous if you become infected with COVID-19. There is no evidence that steroid use, in any form, used for the prevention and treatment of asthma, increases the risk of infection with COVID-19 or will make an infection more severe. Actually, the opposite is true. Asthmatics are more likely to get into trouble if they become infected with COVID-19 when their asthma is poorly controlled because they have not been taking there medications. In fact, inhaled and oral steroids should be used to prevent and treat an asthma attack, even in patients with COVID-19.
The bottom line is that all asthmatic should make keeping their asthma under good control through regular use of their preventive medications a top priority. Doing this will keep you from joining the “high risk” group.
Plantago ovata
/in Arizona Allergenic Plant Guide, Weeds /by brianmillhollonPlantago ovata is a weed native to the southwestern United States. It’s seeds have been used for food by native populations in Arizona and is a common source of psyillium – a dietary fiber found in products such as Metamucil.
Following a wet winter, Plantago ovata can be found growing wild in the desert and along road sides in the spring. It’s presence contributes signifcantly to South Mountain Park in Phoenix turning green in the spring.
Plantago ovata is related to English Plantain (plantago lanciolata) an important allergenic weed found in Europe, Asia and North America.
Desert Laxative
/in Article Menu /by brianmillhollonWhen I first moved to Arizona from New Orleans where I was finishing training at Tulane, I began to familiarize myself with the local weeds, trees, and grasses that were important causes of allergy problems in the Southwest. Some plants were on every local allergist’s list of important allergenic plants, and although some of the names on the list – like Oak and Ragweed – were very common, the Arizona varieties looked very different from their southern cousins. It took a while, but in time I became familiar with all of the plants on the list. There were a few however, that had me stumped.
Most of the Arizona allergists I knew had English Plantain (Plantago lanceolata) on their list of important allergenic weeds and yet after years of hiking around, I never saw anything that looked like the delicate pictures of this weed in the books.
In fact, English Plantain is prevalent around the eastern coastal states, the Northwest, and California where it an important allergen – but not in the deserts of Arizona. So why is it on the list?
The Elusive Plantain
After an unusually rainy winter this year, the desert bloomed as I have never seen it before. The usually brown hues of South Mountain were transformed into a carpet of green. One morning when out riding my bike, I noticed a vaguely familiar-looking weed growing on the rode side of the new Chandler extension in Ahwatukee. I took a few pictures and collected samples to make a pollen reference. Sure enough, it seemed to be the elusive plantain.
This was not English Plantain but a close cousin Plantago ovata. This variety of plantain is only found in the Southwestern United States and has a number of common names including Desert Indian Wheat. It has been used by the Pima Indians for food and medicine for millennia.
The seeds of Plantago ovata are a common source of psyllium which is used in the manufacture of bulk laxatives and has been a cause of occupational allergy and asthma in workers exposed to the plant.
In Phoenix, the plant appears briefly during the spring, particularly after a wet winter, contributing to the display of desert wildflowers… and to the spring allergy season.
Update: Allergen Immunotherapy During the COVID-19 Outbreak
/in News /by brianmillhollonBegining June 1, the temporary modification to the allergy immunotherapy administration schedule will end. While we will continue to follow all guidelines and recommendations from the Centers for Disease Control and the Arizona Health Departement to mitigate the risk of COVID-19 exposure and transmission to our patients and staff, we will cautiously resume our normal allergy immunotherapy schedule.
Please do not come to the office if you have a fever or suspect that you have been exposed; call our office first.
If you have any questions, please call 480-705-8844 or email: marla@allegywise.com.
TeleMedicine Appointments Are Now Available
/in News /by brianmillhollonYou can now schedule a new patient consultation or follow-up visit with Dr. Millhollon without having to come into the office and at a time that is convenient, including nights and weekends.
For more information, call our office at 705-8844 or send us a note at mail@allergywise.com.
Coronavirus Update
/in Article Menu, News /by brianmillhollonAs the global and local effect of coronavirus (COVID-19) continues to evolve, our practice is firmly committed to the health and safety of our patients. We are closely monitoring the changing situation and complying with recommendations from the CDC and The Arizona Health Department. In addition, we are implementing the following change to our usual operating procedures:
Before Coming to the Office
Screening
Social Distancing
TeleMedicine
Allergy Immunotherapy and Biologic Injections
Stay Healthy
At this time, the risk of serious illness from coronavirus infection in Arizona is small. However, the risk is greater for some groups including the elderly and those with chronic health problems including asthma and immunodeficiency.
Like all viral respiratory infections, Covid -19 can trigger an asthma attack. Keeping your asthma under good control should, therefore, be a high priority – as always but particularly at this time. This includes taking your preventative medications daily as prescribed, reviewing your asthma action plan, and making sure all medications are available and up-to-date. Patients who take oral steroids such as prednisone daily are also at increased risk. These high-risk groups need to be particularly vigilant about virus avoidance measures such as regular hand washing and avoiding unnecessary exposure to large groups of people.
If you have any questions, please do not hesitate to contact us.
Wine Allergy
/in Food Allergy /by brianmillhollonWine is made from grapes and like grape, true allergic reactions are, thankfully, rare. If a grape allergy is suspected, it can be easily ruled out or confirmed with an allergy skin test.
Many people do however complain of problems when they drink wine and yet are not allergic to grape. If these reactions to wine are not an allergy to grape then what is causing the problem?
In most cases, ill effects reported after drinking wine are the result of a sensitivity to preservatives in the wine or to alcohol.
Sulfite Sensitivity
Sulfites are routinely added in the winemaking process as a preservative to prevent the growth of bacteria and unwanted yeast. Without sulfites, most wine will turn to vinegar. These sulfiting agents – sulfur dioxide, sodium potassium sulfite, bisulfite, and metabisulfite – can be added at different times and in varying amounts depending on the type of wine being made. In general, white wine has a higher sulfite content than red and sweeter wines have more sulfite than drier wines.
All wine contains naturally occurring sulfites so finding a wine that is completely sulfite-free would be unlikely. However, some winemakers offer organic wines with no added sulfites. In the US, new regulations in place since 2012 require that all wines with sulfite levels greater than 10 mg/L (ppm) be labeled as containing sulfites. Similar guidelines have been adopted by the EU and Britain.
Exposure to sulfites has been associated with a number of symptoms in sensitive individuals including anaphylaxis and hives. Although asthmatic symptoms are uncommon in patients with sulfite sensitivity without a history of asthma, serious and potentially life-threatening asthmatic reactions can occur in patients already under treatment for asthma.
In addition to wine, sulfites are added to a variety of foods including fruits, vegetables, and seafood to preserve freshness and prevent browning. Similar to wine, the FDA requires labeling on any food or beverage with greater than 10 mg/L (ppm) of these preservatives.
Ethanol Sensitivity
In addition to grape juice and preservatives, wine (of course) contains alcohol, specifically ethanol. As discussed in more detail in an earlier post (here), some individuals develop serious symptoms when they consume any form of alcohol. This is caused by a deficiency in a liver enzyme called aldehyde dehydrogenase. Without this enzyme, high levels of the chemical acetaldehyde accumulate in the blood. Acetaldehyde can cause symptoms that resemble an allergic reaction including facial flushing, nasal congestion, respiratory difficulty, nausea, and headaches when they drink any form of alcohol.
Some reports suggest that wine may contain varying amounts of acetaldehyde in addition to ethanol. This may explain why some people are able to tolerate certain varieties of wine but not others.
What About Yeast?
Yeast is the engine that turns common grape juice into highly valued wine. The industrious yeast eat the sugar in the grapes and as a waste product produces ethanol. Although wild yeast found natively on the surface of harvested grapes has been used in winemaking for centuries, most winemakers today add yeast to ensure consistent results. Saccharomyces cerevisiae is the variety of yeast most frequently used in winemaking. It is also the yeast used in beer making and baking and is commonly called brewer’s yeast.
Although brewer’s yeast is an allergen, there are few reports of allergy to the yeast causing problems drinking wine or beer or eating bread. It is, however, a significant cause of occupational allergy for those exposed to high levels of airborne yeast in the workplace such as a baker. As an interesting side note, this yeast also grows on our skin and can be a cause of yeast infections in women.
Why is brewer’s yeast a problem in the air and not in wine? Although wine production starts with living, growing, feasting yeast cells, rising levels of alcohol in the wine will eventually kill a large percentage of the yeast and are removed from the final product when they precipitate out.
How Do I Know What is Causing My Problems When I Drink Wine?
As mentioned above, allergy to grape can be determined with an allergy skin test. Allergy testing is also available for sensitivity to Saccharomyces cerevisiae yeast, although a positive test result does not necessarily mean that yeast in the wine is causing problems. Diagnosing alcohol and sulfite sensitivity is more challenging and requires a careful history by a physician experienced with these syndromes and a controlled food challenge.
Beer Allergy
/in Allergies, Food Allergy /by brianmillhollonBeer is the third most popular beverage, behind water and tea. In spite of this, true allergic reactions to beer are rare.
Beer contains four primary ingredients: Water, malted barley, yeast, and hops.
Barely that has been partially sprouted and then dried is called malt. Malting develops enzymes that break down the starches in the grain to sugars that can be fermented by yeast. Yeast eats the sugars and produces gas (CO2) and ethanol as waste products. Hops is added for flavor and as a preservative.
Nutritionally, beer is mostly water and sugar with a little protein. A can of regular beer contains about 26 grams of sugar and 1.5 grams of protein. The rest is water.
For the most part, all allergens (things that cause an allergic reaction) are intact proteins. Most of the protein in beer is in the form of enzymes that are released from barley in the malting process. After the malting process, when the enzymes have done the work of breaking down complex carbohydrates to be used by the yeast, the mixture is boiled. Boiling coagulates and precipitates a lot of the protein which is then removed by filtration from the final product. The protein that remains is likely to be in the form of heat resistant enzymes.
For this reason, the intact protein profile, and hence the allergenicity, of beer is quite different from that of the grains the process started with.
This may account for the fact beer, the third most widely consumed beverage on the planet, rarely causes true allergic reactions. As discussed here, allergic-like reactions to alcohol is another story.
Sorting out the cause of a suspected allergic reaction to beer can be a challenge. Allergy skin testing to the most common beer ingredients including barley, malt, hops, and wheat is available and is the place to start. Frequently, a carefully controlled food challenge is required.