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Dr. Kevin Most: Allergies and “All of Us” research program

Dr. Kevin Most

We talked a few months ago about the “All of Us” research program. At that time, it was just in its infancy and had not been rolled out to the entire country, but that is changing this coming weekend. All of Us gets rolled out this coming Sunday at Millennium Park. They are having a big kick off event, Sunday May 6th, from 11 am – 5 pm at the Chase Promenade in Millennium Park. This research program plans to be one of the major health iniatitives in our lifetimes. To put it in perspective, their simple mission is to speed up research and broaden the opportunities for all scientists and researchers.

The goal is to collect health information and genetic information on at least a million individuals across the United States. Northwestern, U of C, UIC and Rush are the participants here in Chicago. They are looking for individuals who are interested in participating in changing medical advancements. We have talked about illness research frequently, in that research, they are looking at indiviudals with a condition and how to treat or monitor and illness. This program hopes to advance the time lines on many other areas of research. With the data of a million people, can we now develop tests to identify illness sooner or perhaps before it occurs, can we prove which medications will work on a specific person, allowing for lower doses, less side effects, quicker treatment down to the individual level. It is termed Precision medicine and it is the future of medicine.

Hopefully we will get many individuals from the Chicago area to step up and participate. The kick off is this weekend, so if you are really interested stop by. This again is just the program launch, you will begin to see more and more about this program and where you can go to learn more, sign up and if needed have any questions answered.

It is projected that this wide based program will impact researchers across the country as the data from a million individuals will be available to advance the treatment of illness, predict medication success or perhaps find a way to identify an illness in your yet to born grandchild before they have the illness or suffer. Hopefully you all will consider joining, you will help make a huge impact in the future of healthcare and help generations to come from suffering in many illnesses.

More information http://www.joinallofus.org

Allergies

We all make fun of Chicago seasons, often it is we two season Road construction season and barriers with no construction season. This year is a bit different, it appears that we are going to have 2 seasons for weather. Looks like we are going from Winter directly into summer, bypassing spring altogether. Some of you may say, Great ! No spring allergies!. Ummmmmm, Sorry that is not the case. In fact it appears that this may be a bad allergy season as many of the predictions show that the plants that would normally be spread out will be stack on each other and the recent rain and snow will add to the possibility of mold counts going high quickly as well.

Considering we just had snow 10 days ago, the tree pollen counts are getting pretty high already. This season may be a bit compacted but it appears that it will carry a big punch. Think about it 14 days ago we had snow on the ground and now Tree pollen counts are already moderate and ready to go higher. As we have talked about in the past, the best time to start allergy medicine is 2 weeks before the season actually begins. Many with spring allergies probably did not consider starting their medication as we had snow and cold weather. Now with the sudden change in temperature we will see rapid growth in trees , grass and mold. So allergy season will be on us very quickly, in fact it is.

Estimates are that 75 million people in the US suffer from allergies bad enough to take medication.

We talk about how to treat allergies and we will discuss medications but first lets discuss some simple things you can do around the house. One will be difficult to do, and that is keep the house closed down as much as possible. Although we all want to open the doors and windows and get some “fresh air” in the house. Remember that “fresh air” is full of pollen at this time. Keeping the doors and windows closed for a few more weeks may help your allergies more than any medications. Keeping the pollen from settling in the house will minimize the longer exposure. Another thing to do is to shower at night, especially if you have been outside all day. The pollen attaches to your skin and hair and bringing that to bed with you only assures that you will be exposed to pollen all night. A quick rinsing shower in the evening will help as well. Removing the clothes you were wearing when outside and putting them in the laundry again will minimize the amount of pollen in the house.

As far as medication, our goal is to block the release of histamine. Histamine is a chemical that is contained in cells in our body that is released when we are exposed to something foreign. It is a chemical that essentially helps us clear our things in our body that are foreign. The side effects of histamines are actually ways the body has to clear the foreign exposure. We don’t like to sneeze, but histamines make us sneeze, why? The body wants to clear the foreign substance from our respiratory tract, it makes our eyes water, why? Because it wants to clear the substance from our eyes, it makes us itch, why, it wants to remove the substance from our skin. I think you get the concept. Histamine is actually trying to protect us, although we see it as an inconvenience.

Antihistamine medications in the past had been limited to simple Benadryl. Although Benadryl is a great antihistamine the side effects are often not tolerated. For many people taking 50 mg of Benadryl will put them to sleep or at least make them quite drowsy, for others it appears to do the opposite and make them hyper. Fortunately the discovery of non-sedating anti-histamines occurred in the early 90’s and patients were able to take symptom relieving medications without falling asleep at their desks. These medications include, Claritin, Allegra and Zyrtec, all of which can be purchased in a generic form. One thing patients need to understand is that they may have success with one of the drugs and no success with the others. They are once a day medications and it is often recommended that you take them daily and monitor the allergen that causes your symptoms, knowing when trees are done pollenating will allow you to know when to stop the medications. Pollen counts can be found on many apps including most weather apps.

Other popular drugs include Flonase or other steroid nasal sprays. These medications act by decreasing the inflammation noted with allergies. It will help to limit the impact of the histamine, it does not block the release of histamine. By limiting the inflammation it helps limit the symptoms, so it will help with congestion, sneezing and itchy. This is a good drug that is often used in concert with the antihistamine to limit symptoms. This is also now over the counter.

There are some new treatments that are being worked on now. We have talked in the past about having our immune system help us fight cancer, well researchers are looking to see if we can use our immune system to also help fight allergies. In order for histamine to be released from a cell another compound must bind to the cell with the histamine, that is the signal to release the histamine. Researchers are looking for the immune system to block the compound that tells the cell to release the histamine. If this can be done, the histamine is not released and the symptoms are not noted. This is still a few years away but may end up being a single medication that could potentially treat all allergies.

With many of the medications available over the counter, patients often self treat and do not look for a physician’s guidance. This is not recommended, however between information on the internet, high deductibles and the availability of medications over the counter it is not unexpected.

Many people know they have symptoms but have no clue what they are allergic to. Is it important to get tested. I would answer that by first asking how bad are your allergies, do they follow a specific pattern and do you want to avoid medication. If they are not too bad and the pattern is specific you can probably self treat and be fine. If you are getting ready to plant some trees in your yard, or getting ready to move to a new area, the information on your specific allergies may be good to know. For example if you are allergic to Poplar trees, no use planting 3 in your backyard, why personally make your allergies worse. If you are planning on moving south, know what you are allergic to, for example North Carolina would not be a good idea if you are allergic to pine pollen.

So if needed, how do we test for allergies. We really have 2 ways to test for allergies, one is with skin testing the other is with a blood test. With the skin testing a physician takes multiple possible allergen’s and scrapes your skin in a distinct pattern. They then look for a local response and when they see it they know the specific culprit. It is felt to be the most accurate when completed by an expert. Most Ear, Nose and Throat physicians as well as Allergists perform this in their office. The other way to test is thru a blood test, although easier it is often more expensive and may take a while to get results and may need to be followed up with a skin test.

Results of these tests will allow you to tailor your medication timing, no need to take Claritin in December if you are allergic to grass. These results would also allow you to get “allergy shots” in the hopes that you can train your body to not react to the irritant. Essentially what is done is the doctor will start with a very low dose of the irritant and as the body tolerates it the dose is increased. Eventually you get to a point where the irritant no longer causes a response in the body and you are essentially “cured” This may take a long time, years in most people, however the elimination of symptoms and the lack of not needing to take medication is often worth the effort. In some people taking the allergy shots is important as medications have not worked, for others the allergy medication may interact with a more important medication so they have to weigh the benefits. Discussing this with your doctor is important.

So get ready for a packed allergy season, start your medications now, and don’t worry it will be snowing again before we know it.