Fall/Winter Newsletter





CHANGE is the new word for our Allergy Clinical Practice this year.  We have lots to report to you in this issue, and we hope that you will agree that the changes we have made will help us deliver to you the highest excellence in patient care.  On March 29, 2013, our division came under new leadership with the appointment of Dr. Susan MacDonald as our Interim Director.  Dr. MacDonald has been at Johns Hopkins for many years and is also the Associate Chair of the Department of Medicine.  In this issue, you will find information about our doctors, our new clinical postdoctoral fellows, how to contact us as well as new information about our new electronic medical record system, EPIC, and its secure website called “MyChart”.  We have new hours for our Shot Clinic hours and Xolair Clinic, and we have hired an additional nurse and certified medical assistant to make our clinic run more efficiently with full staffing.  We even have new skin testing materials and now offer patch testing as well for our patients.  Later this fall, we should have a completely revised clinical website available for you.  All of this was done with you, the patient, in mind so that we can continue to provide compassionate, state-of-the-art diagnostic and therapeutic care our patients with allergic and immunologic diseases

In most parts of the country, the season begins from the first of August through mid-October.  Now, summer is almost ended, you’re heading into fall. Most cases of hay fever are caused by an allergy to fall pollen from plants belonging to the genus Ambrosia, more commonly known as ragweed.


Many people with pollen allergies may also suffer from allergic symptoms in the winter months because of other allergy triggers.  People tend to spend more time inside during the winter months; indoor allergens can be big problems.

 Fall and winter Allergies:


Allergic Rhinitis (hay fever) refers to inflammation of the nasal passages. This inflammation can cause a variety of bothersome symptoms, including sneezing, itching, nasal congestion, runny nose, post-nasal drip (the sensation that mucus is draining from the sinuses down the back of the throat) and cough.

Common causes of winter allergies


  • Dust mites. These microscopic bugs proliferate in mattresses and bedding, particularly in a warm high humidity environment. When their droppings and remains become airborne, they can cause allergic symptoms in people who are sensitive to them.
  • Molds or fungi. Fungi can grow in damp, humid areas such as basements and bathrooms. When its spores get into the air, they can cause allergy symptoms.
  • Animals.  Most people are not allergic to animal fur, but rather to a protein found in the dead skin flakes (dander), saliva, and urine. These proteins can get inhaled into the nose and lung and cause allergic reactions.
  • Others.  Perfumes, lotions, hairspray, air fresheners, and potpourri can also elicit reactions in people with fragrance allergies and they can worsen breathing symptoms in some people with allergies and asthma.


During a flu season how can you tell whether your sneezes and sniffles are due to a viral infection or allergies? A cold sometime accompanied by a fever as well as aches and pains typically does not last more than 10 days. Allergies, On the other hand, allergy can linger for weeks or even months, as long as the allergen is present. Cold symptoms don't usually occur with allergies.


Management of allergic rhinitis:


Here are several simple precautions can dramatically reduce your ragweed pollen exposure:


  • As much as possible, stay indoors when pollen counts are highest. Typically, that is between 10 a.m. and 4 p.m. Tracking the pollen count in your area can help you take special precautions on high-pollen days.
  • At home and in the car, keep the windows closed and the air conditioner on. Just make sure to change or clean the filters every three months or so.
  • Change your clothes after spending time outdoors.
  • Shower before bed to remove pollen, especially from your face and hair.
  • Try nasal irrigation to rinse out allergens attached to nasal linings.  (See below).
  • Equip your home with HEPA air filters. A filter in each room works best. At the very least, you should have a filter running continuously in your bedroom.
  • HEPA vacuum cleaners can also help.


For treatment of winter allergy and asthma, the best approach is prevention. The following measures are recommended:

·       Keep animals outdoor if possible and wash them once a week.

·       Keep the house dust-free as much as possible. Vacuum the carpet once or twice a week. A vacuum cleaner with HEPA-filter is very beneficial. The curtains and shades must be free of dust. No feather pillows and plush toys should be removed from children's bedroom.

·       Smoking should absolutely be avoided.


Treatments for allergies:


1.     Nasal irrigation.  Rinsing the nose with a salt-water (saline) solution called nasal irrigation helps by rinsing out allergens and irritants from the nose. Saline rinses clean the nasal lining and can be used before applying sprays containing medications, to get a better effect from the medication. Here are some of devices commonly used such as bulb syringes and Neti used to perform nasal rinses. At least 200 mL (about 3/4 cup) of fluid (salt solution made with distilled or boiled water or sterile saline, not tap water) is recommended for each nostril. The treatment can be performed as needed, once per day, or twice daily for increased symptoms.


2.     Nasal glucocorticoids — Nasal glucocorticoids (steroids delivered by a nasal spray) are the first-line treatment for the symptoms of allergic rhinitis. These drugs have few side effects and dramatically relieve symptoms in most people. Studies have shown that nasal glucocorticoids are more effective than oral antihistamines for symptom relief.


3.     Antihistamines — Antihistamines relieve the itching, sneezing, and runny nose of allergic rhinitis, but they do not relieve nasal congestion. Combined treatment with nasal steroids may provide greater symptom relief than use of either alone.


4.     Nasal decongestant.  People with severe allergic rhinitis may need to use a nasal decongestant for a few days (not more than 3 days) before starting a nasal glucocorticoid to reduce nasal swelling, which will allow the nasal spray to reach more areas of the nasal passages. Nasal decongestant sprays should not be used for more than two to three days at a time because they may cause a type of rhinitis called rhinitis medicamentosa, which causes the nose to be congested constantly UNLESS the medication is used repeatedly. This condition can be difficult to treat. To avoid it, do not use decongestant sprays for more than 3 days.


5.     Allergy shots. In most people, reducing exposure to allergens and other triggers, in combination with medication therapy effectively control the symptoms. For people who have still symptoms despite these treatments, allergy shots, also known as allergen immunotherapy can be considered. Shots expose your body to gradually increasing doses of the allergen until you become tolerant of it. They can relieve your symptoms for a longer period of time than oral and nasal allergy drugs.  In addition, the allergen immunotherapy can help prevent developing new allergies and allergic asthma later in life.

Medication Update:


The FDA has approved the first generic versions of Singulair (montelukast sodium) for use in adults and children to control asthma symptoms and to help relieve symptoms of indoor and outdoor allergies. Montelukast is in a class of medications called leukotriene receptor antagonists. It works by blocking the action of leukotrienes, substances in the body that cause the symptoms of asthma and hay fever (allergic rhinitis). For more information, visit http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm314436.htm

© JHAAC 2012