The Allergist AnewsletterfromtheOklahomaAllergy&AsthmaClinicFall2016

The Allergist

Brought to you by

@okallergyasthma

(continued on page 4)

New Norman Location Coming Soon!The new Norman OAAC medical office building is nearing completion, says OAAC COO Scott Dennis, MHA. The building is located at 3580 R.C. Luttrell Drive off the Healthplex Parkway in Medical Park West.“We hope to be up and running in the building by January,” said Dennis. The new building will be 6,660 square feet with 4,600 of that dedicated to the OAAC practice. Two 1,000 square foot leases will be available to make up the remainder of the space. Three of OAAC’s allergists serve patients at the current Norman location and will continue at the new building: Patricia Overhulser, M.D., Richard Hatch, M.D., and Shahan Stutes, M.D.

Guest post by Dr. Brandon Humble

As many Oklahomans know all too well, the season that typically runs from late summer through late fall is accompanied by an increase in mis-ery for allergy sufferers. Ragweed is the main culprit during this period. It is a very potent allergen in which a single plant can release more than a billion spores of pollen. Although low levels of ragweed pollen (also known by its scientific name Ambro-sia) can be present for many months, the Oklahoma Allergy and Asthma Clinic set out to find out at what

Fall Ragweed Season Causes Miserytimes of the year ragweed levels are generally the worst here in central Okla-homa. OAAC is a cer-tified pollen counting sta-tion, which means the l a b o r a t o r y professionals who do the daily work of counting allergens are rigorously tested for their ability to identify pollens and molds that are causing patient symp-

toms. This data is then compiled and reported on our website, and shared on our social media.

© Can Stock Photo Inc. / blueskies9

2

Aspirin Exacerbated Respiratory Dis-ease (AERD) is also called Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition where an asthmatic patient shows sensitivity to aspirin and other non-steroid anti-inflammatory drugs also known as NSAIDs. Approxi-mately 10 percent of asthmatic adults and 40 percent of asthma patients who also have nasal polyps are sensitive to aspirin and NSAIDs.Typical symptoms of this disease in-clude asthma, nasal congestion and na-sal polyps. Many times, people with this disease don’t respond to conventional treatments. “Chronic sinus infections and the loss of smell can also accompany these symp-toms,” said Laura Chong, M.D., OAAC board-certified allergist. “The one thing that differentiates AERD is that there is a reaction triggered by aspirin or other NSAIDs.”

“Those who have AERD should avoid using aspirin or any other NSAIDs,” Dr. Chong said. “Acetaminophen, also known as the brand name of Tylenol, can be tolerated at low doses of below 1,000 milligrams. It can be used as pain

Aspirin Sensitivity Causes Issues for Asthmatic Patients

Laura Chong, M.D., OAAC board-certified allergist

reliever but some people might have a mild reaction if higher doses are taken. Medications such as Celebrex can be safely used.”Despite avoidance of aspirin or other NSAIDs, those with AERD can still ex-perience asthma, nasal congestion and sinusitis and nasal polyps, Dr. Chong added.Those who have AERD need medica-tions such as daily inhaled corticoste-roids to control their asthma symptoms. Intranasal steroid sprays or nasal-sinus steroid irrigation can also help control

Reactions could include:• nasal congestion or stuffiness• eye watering or redness• cough, wheezing or chest tightness• frontal headache or sensation of

sinus pain• flushing and/or a rash• nausea and/or abdominal cramping• general feeling of discomfort,

sometimes accompanied by dizziness

symptoms of chronic rhino sinusitis and nasal polyps.Leukotrienes are chemicals the body re-leases when the immune system senses an allergen. These inflammatory chemi-cals cause the airways in the lungs to tighten as well as cause the production of excess mucus and fluid. Medications that block production of leukotrienes can help treat AERD symptoms and help decrease the reaction severity to aspi-rin and NSAIDs. Some with AERD will re-quire polyp surgical removal, however the polyps generally reoccur.Aspirin desensitization is another treat-ment option that can help AERD pa-tients. Patients who are desensitized to aspirin and continue aspirin therapy are shown to have less nasal congestion, less polyp regrowth and improved sense of small and an improvement in their asthma symptoms. Desensitization is a process in which the immune system is exposed to gradually increasing doses of a sub-stance in order to modify or stop the al-lergic response.“This procedure should be done at a medical facility or in a hospital,” said Dr. Chong, “The goal is to gradually in-crease doses of aspirin until the patient can tolerate a full dose of aspirin. Then the patient can safely taken aspirin or other NSAIDs.”For more information about AERD, talk to your OAAC allergist. Source: aerd.partners.org

3

“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 (continued on page 4)

Meet Lisa Byers who supervises the ra-diology and clinical lab. She has worked for OAAC for five years. In addition to her role as a supervisor, she does all of the x-rays and CTs for the clinic. A lifelong Oklahoman, Lisa has lived in Norman her entire life. She graduated from Norman High School. She gradu-ated from Rose State College’s x-ray school and then received a Bachelor of Science degree in Medical Imaging and Radiation Sciences from the University of Oklahoma. Lisa holds four registries with the Ameri-can Registry of Radiologic Technologists which include; Radiography, Computed Tomography, Mammography, and Qual-ity Management.In her off time, Lisa is passionate about her volunteerism at the Oklahoma City Zoo for the last eight years. She volun-teers in the Great Escape, an exhibit that features large primates such as go-rillas, orangutans and chimpanzees. She has also recently taken up photog-raphy which goes hand in hand in her volunteerism at the zoo.What does she like best about working at the OAAC?

Lisa Byers Enjoys Monkeying Around in her Spare Time

“I like that we are a big family,” said Lisa, “I really like all of our doctors. You can’t ask for a better group of people to work with.”

Lisa Byers gets to explore her love of primates and her hobby of photography at the Oklahoma City Zoo. Byers serves as the OAAC supervisor of the radiology and clinical lab.

Your sinuses are delicate parts of your nasal system. They can become in-flamed, infected and can even develop an allergic reaction to mold. Over the years, allergic fungal sinusitis (AFS) has been mistaken for a sinus tumor. Now allergists believe it to instead be an al-lergic reaction to environmental fungi. In the past, fungal disease could result in an invasive, deadly disease before it was properly diagnosed.

“The infecting fungi or mold result in a reaction of thick fungal debris, sticky mucus and a blocked infected sinus,” said Brett Haymore, M.D., OAAC board-certified allergist. “Those who have AFS may have allergies, nasal polyps and even asthma.”

If AFS stays untreated, it could lead to displacement of the eyeball and vision loss.

“It’s more common in adolescents and young adults,” Dr. Haymore said. “Many AFS patients develop chronic sinus-itis and this can end up affecting their sense of smell.”

AFS patients may have allergies, nasal polyps, chronic sinusitis and some may also have asthma.

“Diagnosis is found by checking for the presence of allergic mucin that is found in nasal secretions and tissue,” he said. “A sample of mucus is examined by the laboratory to see if there are signs of fungi among other tests.”

The most effective way to treat AFS is to surgically remove the thick fungal de-bris and muci in the infected sinuses by using the method of debriding, which is the medical removal of dead, damaged, or infected tissue to improve the heal-ing potential of the remaining healthy

Untreated Allergic Fungal Sinusitis Could Lead to Vision Loss

Brett Haymore, M.D., OAAC board-certified allergist

tissue. Steroids may be prescribed be-fore the surgery. “AFS can reoccur and may require ad-ditional surgeries,” Dr. Haymore added. “Also, anti-inflammatory medications are used to help treat AFS.”Furthermore, research has shown aller-gen immunotherapy (shots) to fungal allergens may be effective in the treat-ment of symptoms of AFS and may de-crease the rate of postoperative exacer-bations and further operations.

AFS...(continued from page 3)

In 2014, ragweed levels increased from the 6th August to the end of that month and stayed elevated un-til the 22nd of October. Levels began to fall in late October, although the first freeze was not until the 11th of November. In 2015, low levels of ragweed were present in August, where from the 6th to the 31st there was a steady increase in the count. Ragweed levels remained high until late October when they began to de-cline, approximately the same time as the first freeze.In 2016, ragweed started appearing the 4th of August while very high

A life-saving medical device that injects the medication epinephrine has been a top news story due to an enormous price increase making the price more than $600 per EpiPen. The manufac-turer Mylan N.V. has been highly criti-cized for making the price of out of the range of many consumers. EpiPens are only good for one year to 18 months and then must be replaced. The price has hiked more than 500 percent from $94 since 2007 when Mylan acquired the product. After public outcry, Mylan recently introduced a coupon to reduce the price covering up to $300 off the pa-tient’s co-payments. The allergists at the OAAC advise against purchasing an EpiPen from any source other than a recognized pharmacy. Due to the price increase, EpiPens have been showing up on Craigslist and Ebay. Due to the controversy over the cost, Mylan will give free EpiPens to unin-sured patients with incomes below 400 percent of the federal poverty level (per Mylan, the limit would be $97,200 for a family of four). Patients have to apply for this every year and provide finan-cial documentation (rxassist.org). Also there is a $300 savings card available on www.epipen.com/copay-offer/ along with a plan to release a generic version of the EpiPen for around $300.

OAAC Board-Certified Allergist Dr. Flo-rina Neagu points out there are other alternatives to the Mylan EpiPen. Ad-renaclick is designed to deliver an emergency shot of epinephrine. Ac-cording to Consumer Reports, the Ad-renaclick delivers the same drug, in the same dosages, but the auto-injecting mechanism works slightly differently. It lists for about $450 for a two-pack, but they found that you could get it for as low as $140 at Walmart with a coupon from GoodRx.com. Your insur-ance might also cover it with lower co-pay than brand-name EpiPens, and you might qualify for further discounts us-ing coupons through the manufacturer. Adrenaclick may not be readily avail-able at your local pharmacy. You may need to place the order and then wait a few days to receive it.Trying to get FDA approval for an EpiPen alternative is Windgap Medical and their product called Abiliject. This product supposedly will have a longer shelf life than the EpiPen which must be replaced more often. It is also smaller, about the size of a cigarette lighter. Windgap hopes to have it in the mar-ketplace in 2018.Also under FDA approval, Adamis Phar-maceuticals is also working on a pre-filled syringe system, eliminating the need for determining the proper dos-

EpiPen Controversy Continues to Swell

© Can Stock Photo Inc. / piedmont_photo

age. The company says it will cost at least 40 percent of the current price of EpiPen pack. They are expecting to start selling their product in 2017. “We know this is a financial struggle for many families who have multiple members who must carry them,” said Dr. Neagu. “Epinephrine can be a life saving medication and accessibility to such medication is of vital importance. We hope with the spotlight on EpiPen’s prices and emerging alternatives, this situation will improve.”alert levels started the 9th of Sep-

tember.Although management of every al-lergy season should ultimately begin with a visit to your allergist, knowing when your symptoms may be wors-ened will better help you and your allergist treat your symptoms. Dr. Brandon Humble is currently a PGY-1 in residency in Internal Medi-cine at LSU-Shreveport. He com-pleted his Bachelors in Biochemistry at Oklahoma State University and medical school at the University of Oklahoma.

Fall Ragweed Season...(continued from page 1)