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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.

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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.

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Why You Should Get Your Flu Shot

New variants of the COVID-19 coronavirus, influenza, and other viruses will be circulating and spreading over the coming months. Flu and other viral infections can trigger asthma attacks and a worsening of asthma symptoms. Influenza also can lead to pneumonia and other acute respiratory diseases. Reports indicate that Australia is nearing the end of its worst flu season in five years. Flu season in Australia is often an indication of what’s to come in the U.S.

The best way to stay healthy this coming season is to be current on all vaccinations, including influenza and COVID-19.

Flu shots are available to AllergySA patients at all 3 locations. Although the influenza vaccine is recommended for most children and adults, it is especially important that our patients with asthma, chronic sinusitis, and immunodeficiency receive their yearly flu shot. Patients between the ages of 6 months and 65 years should visit their AllergySA office to receive the 2022/2023 influenza vaccine. (It is recommended that patients over the age of 65 receive the high-dose influenza vaccine, which AllergySA does not administer. Please visit your primary care physician or local pharmacy.)

No appointment is necessary; however, you should be a current patient. Flu shots can be given to most immunotherapy patients 20 minutes after receiving your allergy injection. Protection from the vaccine begins about two weeks after the injection and is thought to last for the influenza season.

Protect Your Community

Getting the flu vaccine, and being vaccinated against COVID, will protect not only you and your family, but also the community. Our healthcare systems, especially during the coming months, may become overwhelmed treating patients with flu, COVID-19, and other viruses. By getting vaccinated, we can hope to decrease the utilization of our healthcare system, preserving resources for those that need them most.

Stay Healthy!

If you have not been seen recently, now is a great time to schedule an appointment with your AllergySA provider. The better your baseline health going into this season, the better you will be able to fight any infections that come your way.

* Please note that some insurance plans may not cover the influenza vaccine if received in our office. You may prefer to visit your primary care practice for this year’s flu vaccine. Please check the coverage of your specific insurance plan. If your insurance does not cover it, and you receive the vaccine from AllergySA, you will be required to pay the out-of-pocket expense.

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Are You Allergic to Penicillin, Really?

Unverified penicillin allergy is recognized as a significant public health problem. Up to 10 percent of the population report being allergic to penicillin, according to the Centers for Disease Control and Prevention (CDC).  However, most of those may actually be able to safely use penicillin, either because they never were truly allergic or because they have lost sensitivity over time.

For those who think they are allergic to penicillin, it is important to either confirm the allergy or correctly identify if you can safely take this drug. 9 out of 10 patients reporting penicillin allergy are not truly allergic when assessed by skin testing. Unnecessarily avoiding penicillin leads to higher drug costs for patients and healthcare systems, limited and possibly inferior medical treatments, and possible antibiotic resistance.

 

What you need to know:

-True penicillin allergy is serious, even life-threatening. Someone with a confirmed penicillin allergy should avoid the entire medication group which includes 15 chemically related drugs.  Ask your physician if you should be prescribed injectable epinephrine, the only treatment that will stop anaphylaxis, a severe, potentially fatal, allergic reaction. 

 

–A reaction to penicillin as a child does not automatically mean you will react as an adult.  Penicillin allergy is not necessarily a life-long condition.  It is best to get tested to confirm.

 

–Symptoms of penicillin allergy may include hives, swelling of the mouth or throat, dizziness, or difficulty breathing.  Hives are often confused with skin rashes that are non-allergy related. Since it may be difficult to tell the difference, and you can’t always get to a doctor right away, take a photograph of the rash to help with the diagnosis.

–Alternative antibiotics to penicillin may be less effective in treating your infection, may cause unwanted side effects, or maybe more expensive. Don’t limit your treatment options if it isn’t necessary.

 

–Penicillin allergy testing is safe and reliable. The patient undergoes a series of skin prick tests, with gradually increased amounts of penicillin. A raised bump, or wheal, at the site of the prick, indicates an allergy. If the tests are negative, the next step is an oral challenge to confirm the patient can safely take this drug. These tests should always be conducted by a board-certified allergist trained to recognize and treat potential allergic reactions.

 

Penicillin allergy testing is available at all AllergySA locations. To schedule an appointment, call 210-616-0882.

 

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The Fall Asthma Epidemic — What Is It?

Fall is one of the most dangerous times for people with asthma, especially children. Asthmatics often enjoy a reprieve from symptoms during the summer months, but ER visits for asthma increase during September and early October. Reports indicate that approximately 25% of all children’s asthma hospitalizations occur in the month of September. Some refer to this as the “September Asthma Epidemic.”

What contributes to the September Asthma Peak?

  • High fall pollen levels from allergens like ragweed and mold in the air
  • As children return to school, increased exposure to indoor allergens like animal dander or indoor mold, and VOC’s from new carpeting or construction over the summer.  Also, respiratory irritants like air pollutants from idling cars and buses may cause problems
  • Irregular use of medications to control asthma/allergies over the summer months
  • Greater exposure to viruses including cold germs, influenza, and COVID-19, after returning to the classroom
  • Anxiety and stress, along with changing schedules, associated with the new school year

Here are some good reminders, for both children and adults, during this season and throughout the year:

  • Identify and avoid your asthma triggers.
  • Have an appropriate treatment plan for allergies, one of the most common triggers of asthma symptoms.
  • Update and follow your child’s Asthma Action Plan and provide a copy to the school.
  • Take long-acting asthma medications as prescribed, even when you feel well and your asthma is controlled.
  • Refill all medications prior to school start and make sure your child has access to their quick-relief inhaler.
  • Wash hands frequently, eat nutritious meals and get plenty of rest to avoid illness. Serious asthma flares are often associated with respiratory tract infections.
  • Stay up-to-date on immunizations including the annual influenza shot and COVID-19 vaccinations (all family members).
  • See your allergist for regular asthma check-ups to maintain good control. As children grow, medications may need to be adjusted.

The physicians at AllergySA are experts in the diagnosis and management of asthma and allergic diseases.  Schedule an appointment at one of our 3 locations for an accurate diagnosis and a management plan to keep your family healthy and active this season. Call 210-616-0882

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What is an Asthma Action Plan?

School is right around the corner so we want to make sure your kids with asthma will be safe. 

 

If your child suffers from asthma, it is likely that you already have an Asthma Action Plan for them. If you don’t have one yet, don’t worry! We will show you what an Asthma Action Plan is, what it includes and how to manage it.  

 

What is an Asthma Action Plan? 

An asthma action plan is an individualized worksheet that helps you know whether your asthma is controlled and what medications to take. It also can help you know if you should call your doctor or go to the emergency room. 

 

If you use the Asthma Action Plan worksheet properly, it can reduce visits to the doctor. 

 

What does the Asthma Action Plan include? 

The asthma action plan includes helpful tools such as:  

  • A daily log of asthma triggers and symptoms 
  • Identifying severity of asthma, normally by using 3 colors- green, yellow, and red (as go, caution, and danger)
  •  What medication you should be taking and when and how often you should be taking it

An example of an asthma action plan looks like this:

Image: AAFA.org

Can I Manage Asthma Another Way? 

The Asthma Action plan can be a great way to manage your child’s asthma on a daily basis, but it isn’t the only way. 

 

Some other ways that you can manage asthma are avoiding your triggers, keeping your home clean and cool, and having an inhaler with you at all times (to learn how to properly use your inhaler, check out one of our providers, Erica Gomez’s video, ‘How To Use an Inhaler’).

 

AllergySA wants nothing more than to help you and your child’s quality of life. If you need assistance in creating the perfect asthma action plan, one of our board-certified providers can help you. 

 

Call 210-616-0882 to schedule your appointment today

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Is It Mountain Cedar Allergies or COVID-19?

 

Are you feeling a slight sniffle, cough or headache? This winter brings an extra layer of worry for mountain cedar sufferers as they try to decipher the difference between mountain cedar allergies and COVID-19.

The CDC has shared this helpful Venn diagram showing the differences and similarities of seasonal allergies to COVID-19. The biggest difference is that COVID-19 may cause: fever, chills, body aches, loss of taste or smell, nausea or vomiting, and diarrhea while seasonal allergies will not.

If you are experiencing a mixture of these symptoms it could be possible that you have contracted the COVID-19 virus while also being affected by mountain cedar pollen in the air. The only way to know for sure is by getting a COVID-19 test.

Taking extra precaution to wear a mask and social distance this winter is advised. If you believe that you may have COVID-19, be sure to get tested and quarantine to avoid spreading the virus to others. If you are having trouble breathing, or other emergency warning signs, seek emergency medical care immediately.

AllergySA is not a current testing site for COVID-19. For a list of testing locations please visit: https://covid19.sanantonio.gov/What-YOU-Can-Do/Testing#TestingLocation

A COVID-19 Vaccine is days away from approval. For up to date information on the vaccination, visit our COVID-19 Information page at: https://allergysa.com/covid19/#COVID-Vaccination

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Information on Coronavirus (COVID-19)

As we continue to see the impact of Coronavirus (COVID-19), we feel it is important to share with you what AllergySA is doing to help slow the spread while continuing to provide critical care to our patients.

Read more
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San Antonio Ranked The #5 Most Challenging U.S. City To Live In With Pollen Allergies

San Antonio has been ranked the #5 most challenging U.S. city to live in with pollen allergies, according to the Spring Allergy Capitals Report from the Asthma and Allergy Foundation of America (AAFA).

The city jumped from the 22nd spot in 2016 to the 5th spot in 2018 because of the report’s findings on the following factors:

  • Pollen and mold counts
  • Allergy medication usage
  • Availability of board-certified allergists

San Antonio is not the only South Texas city to make the top of the list. McAllen, Texas came in at #1 followed by: #2: Louisville, Kentucky, #3: Jackson, Mississippi, and #4: Memphis, Tennessee. See the full 2018 Spring Allergy Capitals report here.

According to Kenneth Mendez, president and CEO of AAFA, the report, “helps people in these areas be more aware of what may contribute to their allergy symptoms, so they can work with their health care providers to get relief.”

The board-certified allergists and medical professionals of AllergySA are committed to caring for adult and pediatric patients with asthma, allergy and immunology issues in San Antonio and South Texas. With the right treatment plan, seasonal allergies can be managed for better quality of life.

If you have never been tested for seasonal allergies, contact AllergySA at (210) 616-0882 to set up a new patient appointment today.

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Cold vs. Allergies

Are you reaching for the tissues with a runny nose, watery eyes and sneezing several times a day? Before you go straight for the cold medicine aisle in your local pharmacy, here are some tips to help you determine if your symptoms are being caused by a common cold or seasonal allergies.

A common cold is caused by a virus and will generally last 7 to 10 days. Symptoms include a sore throat, coughing, sneezing, and a runny or stuffy nose. Fever, fatigue, aches and pains may also be experienced.

Allergy symptoms are immune system responses to allergens (such as pollen) and can last for weeks, or as long as the person is exposed to the allergen. Symptoms include itchy eyes, sneezing, and a runny or stuffy nose. A cough and sore throat may also be experienced, but never a fever.

It is always best to check with a medical professional to determine the cause of your symptoms. If you are experiencing allergy symptoms, make an appointment with one of our board certified physicians today by calling 210-616-0882.

If allergies are the culprit, the best way to handle your symptoms is to know exactly what is causing them. This can be done through an allergy skin test in our office. For more information on what to expect during an allergy skin test procedure visit: https://allergysa.com/what-expect. 

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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

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

Stone Oak

19016 Stone Oak Pkwy #250
San Antonio, TX 78258

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

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

Southside

7500 Barlite Blvd #106
San Antonio, TX 78224

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

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

CONTACT INFORMATION

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