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English, Health, Illness

What is Eosinophilic Asthma?

There are different types of asthma. The most common type is allergic asthma where symptoms are triggered by exposure to specific allergens like dust, pet dander, pollen and mold. Another type is eosinophilic asthma, sometimes called e-asthma.

Eosinophils are a type of white blood cell that helps fight off parasitic infections and cancers. They also play a role in allergic reactions. They make up a small fraction of our white blood cells, and the number of eosinophils in our blood can vary over time. If the number of eosinophils in your bloodstream or organs is elevated, you may have an eosinophil-associated disease.

Many diseases are caused by an increased number of eosinophils in your body; one of the conditions that allergists treat is eosinophilic asthma.

What is Eosinophilic Asthma (e-asthma)? 

Eosinophilic asthma is a subtype of asthma that is caused by high levels of eosinophils in the airways of the lungs. It usually starts in adulthood, although it can sometimes occur in children as well. E-asthma is a severe type of asthma and people who have high levels of eosinophils can have swelling in their airways, making it difficult to breathe.

Unfortunately, the cause of e-asthma remains unknown. However, those with e-asthma do not usually have underlying allergies that provoke asthma symptoms. Severe or uncontrolled asthma can have a significant impact on your health and quality of life. Fortunately, there are a number of ongoing clinical trials working to develop new treatments and therapies to control e-asthma symptoms.

Symptoms

Eosinophilic asthma has similar symptoms to classic asthma. However, the symptoms are more severe and constant. These include: 

  • Shortness of breath 
  • Wheezing 
  • Coughing 
  • Airflow obstruction 
  • Chronic rhinitis with nasal polyps 
  • Inflamed nasal mucous membrane

Diagnosis 

If you have asthma and the symptoms are severe, your allergist may check levels of eosinophils by analyzing your blood, sputum, saliva, or conducting a bronchial biopsy (tiny forceps passed through a channel of the bronchoscope into your lungs). They will take a complete history of past and current symptoms and discuss any history of allergies.

Treatments

The goal when treating e-asthma is to reduce the eosinophils in the airways and control breathing. People with eosinophilic asthma may respond to standard guideline-based therapy which includes inhaled and/or oral corticosteroids. Others may not and need additional options. There are now new treatments that can reduce eosinophils by targeting specific cells. This type of asthma treatment is known as a biologic.

Biologic therapies that target eosinophils may be prescribed to treat eosinophilic asthma. Biologics that are currently approved for use in the U.S. include the following:

  • Benralizumab: antibody that binds Interleukin-5 (IL-5) receptors. 12 years and older
  • Dupilumab: Interleukin-4 (IL-4) and Interleukin-13 (IL-13) inhibitor and binds to the IL-4 alpha receptor. 6 years and older
  • Mepolizumab: an antibody that recognizes and blocks Interleukin-5 (IL-5). 6 years and older
  • Reslizumab: an antibody that recognizes and blocks Interleukin-5 (IL-5). 18 years and older

If you or someone you know suffers from severe or uncontrolled asthma, our board-certified providers are ready to help you find the right treatment to control your symptoms and improve your health. Call (210) 616-0882 to schedule your appointment today.

May 26, 2023/by Kayla Gomez
https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2021/05/E-asthma-blog-banner.png?time=1685998933 788 940 Kayla Gomez https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2021/11/allergysa-logo-accredited.png Kayla Gomez2023-05-26 07:00:372023-05-26 07:00:55What is Eosinophilic Asthma?
Allergies, English, Health

Palforzia – The First FDA Approved Treatment for Children with Peanut Allergy

In 2020, the FDA approved the first treatment for peanut allergy in children.  AllergySA was the first clinic in San Antonio to introduce Palforzia. We were the second clinic in the nation to have a patient reach the maintenance phase in the program. Learn more about Palforzia:

 

What is Palforzia? 

Palforzia is an oral treatment for children ages 4-17 with peanut allergies. Palforzia can reduce the risk of severe allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanuts. It is a defatted peanut protein powder that is carefully measured in capsules or a sachet, depending on the dosage.

PALFORZIA is not a cure for peanut allergy and is used in conjunction with a peanut avoidance diet. However, when taken according to instructions, it can reduce the likelihood of a severe reaction upon accidental exposure to peanuts.

PALFORZIA cannot be used for the emergency treatment of allergic reactions, and those who take it should continue to carry their injectable epinephrine devices.

 

How does Palforzia work? 

There are three (3) phases of the PALFORZIA process: the initial dose escalation phase, up-dosing phase, and the maintenance phase. PALFORZIA is intended to gradually decrease your child’s sensitivity to small amounts of peanuts that may be hidden in foods.

 

How is Palforzia taken? 

Palforzia is a powder product that is mixed in soft, room-temperature food such as pudding, applesauce, or yogurt. You open the capsule or sachet according to the schedule and put in your chosen food. Always wash your hands after handling PALFORZIA.

 

How effective is Palforzia? 

Recent studies have shown that children with long-term daily dosing treatments have had the greatest strides in reaching maintenance in desensitization to their peanut allergy. After two years of taking Palforzia, more than 80% of children demonstrated desensitization to 2000 mg of peanut protein (which is equivalent to 6 peanut kernels).

 

What are the side effects?

Most side effects are mild and resolve within 40 minutes of taking Palforzia. The most commonly reported side effects are stomach pain/cramping and itching of the mouth or throat. These symptoms are usually mild and typically do not require intervention. More severe reactions include the risk of anaphylaxis and developing Eosinophilic Esophagitis (EoE). Speak with your ASA allergist about these risks.

Side effects may include:

  • Stomach pain 
  • Vomiting 
  • Feeling sick 
  • Itching or burning in the mouth 
  • Throat irritation 
  • Cough
  • Runny rose 
  • Sneezing 
  • Itchy skin
  • Hives 

 

How do I start my child on Palforzia?

All children must first be enrolled in the Palforzia Risk Evaluation and Mitigation Strategy program (REMS). This is a safety program that manages the risk of anaphylaxis associated with Palforzia and is required by the FDA to ensure the benefits outweigh the risks.

If Palforzia is prescribed by your allergist for your child, they will send the prescription to a specialty pharmacy. If insurance eligible, the pharmacy will reach out to you to confirm the shipment details.

Patients with no insurance or with commercial insurance who have been denied coverage can be put in the Palforzia Pathway Patient Assistance Program and are eligible to receive Palforzia at no cost.

 

If you want to learn more about Palforzia and whether it is appropriate for your child, schedule an appointment with one of our food allergy experts at 210 616-0882.

May 16, 2023/by Kayla Gomez
https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2021/04/What-You-Need-to-Know-About-Plaforzia-3.png?time=1685998933 3456 6912 Kayla Gomez https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2021/11/allergysa-logo-accredited.png Kayla Gomez2023-05-16 11:20:162023-05-16 12:09:40Palforzia – The First FDA Approved Treatment for Children with Peanut Allergy
Allergies, Health, Illness

What Is Eosinophilic Esophagitis?

When it comes to conditions that an allergist/immunologist treats, we most often think of nasal allergies, asthma, food allergies, as well as skin rashes, and immune disorders. But there is a chronic inflammatory condition of the esophagus you may not have heard of – and cases are on the rise.  

Eosinophilic Esophagitis (EE or EoE) is a lifelong allergic/immune condition that causes inflammation in the esophagus. The esophagus is the tube that connects your throat and stomach, delivering food and liquid to your body. In EoE, large numbers of white blood cells, called eosinophils, are found in the lining of the esophagus resulting in inflammation. This chronic inflammation leads to symptoms. EoE can be triggered by a food allergy, acid reflux, or an airborne (seasonal) allergy.

What are the Symptoms of Eosinophilic Esophagitis?

The main symptom of EoE is difficulty swallowing. Other symptoms of EoE can vary with    age: 

  •  Infants and toddlers may refuse to eat and, therefore, not grow properly.
  • School-age children may show decreased appetite, recurring abdominal pain, trouble swallowing, and vomiting.
  • Teens and adults can have the same symptoms but will most often complain of difficulty and pain in swallowing, especially with dense, dry foods.

People with EoE may feel the need to drink a lot of fluids to help swallow and often feel full and unable to finish a meal. The pain and difficulty in swallowing occur due to inflammation in the esophagus. In severe cases, the esophagus narrows to the point where food gets stuck. This is called a ‘food impaction’ and can result in a medical emergency.

Some patients may experience reflux, when acid from the stomach backs up into the esophagus, causing a burning sensation or chest pain. It is important to note that eosinophils can be present in the esophageal tissue in diseases other than EoE. One example is acid reflux. These diseases must be ruled out before making an accurate diagnosis of EoE.

Who is at Risk for Eosinophilic Esophagitis?

Most people with EoE are atopic, meaning they have symptoms of one or more allergic disorders. These allergic conditions include allergic rhinitis, asthma, atopic dermatitis (eczema), and food allergy. 

About half of the people with EoE also have seasonal allergies or asthma and notice their EoE symptoms get worse during the times of the year they experience seasonal allergy symptoms. Others may have food allergies or eczema, and some have a combination of allergic conditions that increase the risk of EoE.  About one in four people who have food allergy-induced EoE notice a seasonal variation in their symptoms.

In some cases, there is a genetic component, so having a family member with EoE can also be a risk factor. You can develop EoE at any age, though for reasons not yet understood, it impacts three times as many men as women. If left untreated, symptoms cause further damage to your esophagus and, potentially, your overall health.

How is Eosinophilic Esophagitis Diagnosed and Treated?

EoE is a complex disorder that often requires a gastroenterologist and an allergist/immunologist to work together to confirm the diagnosis and develop the proper EoE treatment and management plan.

Currently, an upper endoscopy and biopsies of the esophagus conducted by a gastroenterologist are necessary to confirm a diagnosis of EoE. This involves passing a flexible tube containing a light source and a camera lens down your throat to allow your doctor to see the tissue more clearly. Tiny samples of tissue can also be collected to detect levels of eosinophils by examining them under a microscope.

An allergist will determine what role allergies are playing in your condition. They may utilize allergy testing and a thorough history of symptoms during the diagnostic process. Allergy skin prick tests can identify sensitivity to environmental allergens like pollen, mold, pet dander, and dust mites.

Adverse responses to food are the main cause of EoE in many patients. If food(s) are suspected, eliminating the most common triggers may be recommended to see if symptoms improve. Common food triggers include dairy, eggs, peanuts, other tree nuts, wheat, fish and shellfish, and soy products. If allergy testing identifies other food allergies, eliminating those foods may also be recommended. With EoE, it can be more difficult to establish the role caused by foods since reactions are slower, and a single food may be harder to pinpoint.

Medication Therapies for EoE

The treatment prescribed will depend on what’s triggering your EoE and the severity of your symptoms. In May 2022, the FDA approved the use of Dupixent (dupilumab) in adults and children 12 years and older for treating eosinophilic esophagitis. This is the first medicine to be approved for EoE treatment. This injectable biologic medication reduces inflammation associated with the disease improving the ability to swallow.

Other medications have been used to reduce eosinophils in the esophagus, including proton pump inhibitors (PPIs) which reduce acid production in the stomach and swallowed inhaled steroids, which control inflammation. Careful monitoring by physicians knowledgeable in treating EoE is important.

After diagnosis, managing EoE will require close collaboration and communication between your allergist and gastroenterologist. For those newly diagnosed, additional resources are available from the American Partnership for Eosinophilic Disorders.

Treatment for Eosinophilic Esophagitis in San Antonio

At AllergySA, our San Antonio allergists are experts in treating a wide range of conditions, including EoE. The first step in living with eosinophilic esophagitis is an accurate diagnosis. We have three convenient allergy clinics in San Antonio that treat both children and adults. To schedule an appointment, call (210) 616-0882.

May 12, 2023/by Kayla Gomez
https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2023/05/Young-woman-suffering-from-sore-throat.jpg?time=1685998933 326 833 Kayla Gomez https://4xz24f.p3cdn1.secureserver.net/wp-content/uploads/2021/11/allergysa-logo-accredited.png Kayla Gomez2023-05-12 14:24:482023-05-12 14:26:59What Is Eosinophilic Esophagitis?

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LOCATION INFORMATION

Medical Center

2414 Babcock Rd #109
San Antonio, TX 78229

Medical Center AllergySA - 2414 Babcock Rd #109, San Antonio, TX 78229
Clinic Hours

Monday: 8:00am – 5:00pm
Tuesday: 8:00am – 5:00pm
Wednesday: 8:00am – 7:00pm
Thursday: 8:00am – 5:00pm
Friday: 8:00am – 12:00pm
Saturday: 8:00am – 12:00pm

Allergy Shot Hours

Monday: 8:00am – 4:40pm
Tuesday: 8:00am – 4:40pm
Wednesday: 8:00am – 6:15pm
Thursday: 8:00am – 4:40pm
Friday: 8:00am – 11:40am
Saturday: 8:00am – 11:40am

Stone Oak

19016 Stone Oak Pkwy #250
San Antonio, TX 78258

Stone Oak AllergySA - 19016 Stone Oak Pkwy #250, San Antonio, TX 78258
Clinic Hours

Monday: 8:00am-5:00pm
Tuesday: 8:00am-5:00pm
Wednesday: 8:00am-5:00pm
Thursday: 8:00am-5:00pm

Allergy Shot Hours

Monday: 8:00am – 4:40pm
Tuesday: 8:00am – 4:40pm
Wednesday: 8:00am – 4:40pm
Thursday: 8:00am – 4:40pm

Southside

7500 Barlite Blvd #106
San Antonio, TX 78224

South Side - AllergySA.com - 7500 Barlite Blvd #106, San Antonio, TX 78224
Clinic Hours

Monday: 8:00am – 5:00pm
Tuesday: 8:00am – 5:00pm
Wednesday: 8:00am – 5:00pm
Thursday: 8:00am – 5:00pm
Friday: 8:00am – 12:00pm

Allergy Shot Hours

Monday: 8:00am – 4:40pm
Tuesday: 8:00am – 4:40pm
Wednesday: 8:00am – 4:40pm
Thursday: 8:00am – 4:40pm
Friday: 8:00am – 11:40am

CONTACT INFORMATION

OFFICE: (210) 616-0882  | FAX: (210) 692-7833

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