Welcome Fall Allergies

Happy Friday! I find this to be such a fun time of the year. There’s something about school supplies, organization and routine that just gets me so excited. Our little O started pre K this year, and she is already loving it!

I hope that you and your little ones are adjusting to the new schedules and routines. And I truly hope your little ones have a wonderful, fun and strong year!

Well, it’s still blazing hot here in central Texas, so it doesn’t quite feel like fall out there yet. But guess what is still starting to peek through on our pollen counts? Those fall weed pollens! They show no mercy! If you’re a fall allergy sufferer, get ready, because the season has officially started.

Question for you: Does it seem that with each passing year, the allergy seasons are starting earlier and seeming to last longer? And does it seem that your allergies are worse than ever? Well, you’re not crazy to think that way. In fact, much of that is due to the effect of climate change.

You see, as the Earth gets hotter, this provides a more favorable environment for growth of tree, weed and grass pollens. Therefore, the allergy season grows in duration because of the luscious growth of these allergen pollens. Another important point in climate change is the effect of carbon dioxide on plants. This by-product of our fossil fuel use (think gasoline, heating/cooling, etc), specifically feeds ragweed growth and production, one of the most potent aeroallergens. So, as we drive more, heat more, and combust more, the carbon dioxide goes up, ragweed grows, our allergies worsen and we suffer.

With this climate change, asthma sufferers also really need to be careful. Climate change results from increased pollutants in the air. So, as there is an increase in airborne allergens, there is also an increase in airborne pollutants. And this combination of airborne pollutants and allergens is especially hard on those with asthma.

What can we do? Well, your allergist can help identify your specific allergy triggers to give targeted allergy tips. Your allergist may also prescribe specific medications or provide options of immunotherapy that may help adjust your body’s response to your allergens. It’s important to treat your allergy and asthma symptoms early and aggressively because unfortunately, as we discussed already, it’s only to get worse every year. For those needing some practical advice, don’t worry. I will highlight some of these important steps you can take to reduce the effect of pollen on your life in an upcoming post. So stay tuned, friends.

Have a wonderful weekend, everyone. Talk again soon.

-Dr. G

Back to school, here we go!

Happy August! Is it just me or does it seem like summer FLEW by…AGAIN?! O starts a new school in a couple of weeks, so it feels like fall is upon us. But we still have a few summer weddings coming up this month, so I’m going to be in denial for just a bit longer and tell myself that summer isn’t over quite yet. I mean, the official end is Labor Day weekend, right? There’s still time! 🙂

Well, with the start of school around the corner, we have to of course start getting into the back to school planning. For those of you with kids with food allergies and asthma, remember to schedule those appointments with your allergists to get those epinephrine auto-injector refills and update the school forms. Those school forms are so important. I know as moms we get LOTS of paperwork to complete. But these forms communicate critical information to your children’s teachers and school nurses.

Here’s a snapshot of what the FARE action plan looks like. Many schools have designated forms but this one is great if yours does not have a designated form.

Here’s a snapshot of the Asthma Action plan from the American Academy of Allergy, Asthma and Immunology.

And then the medications. Don’t forget to refill the epinephrine auto-injectors and designated school rescue inhalers. For the epinephrine auto-injectors, because of the EpiPen shortage, many have turned to Auvi-Q instead over this past year. Both are epinephrine. Both are life saving. But they are a little different in technique. So, make sure you familiarize yourself and your child’s school with the device that will be kept on hand for emergencies.

And for asthma, remember that if your little one is not yet old enough to carry their own rescue inhaler + spacer, he/she will need a designated rescue inhaler + spacer to be kept at school. Most pharmacies are happy to prescribe 2 inhalers, one for home and school.

One final word, remember that if a food allergy diagnosis is in question, your allergist may want to complete an oral food challenge soon. Oral food challenges are incredibly informative, but they take time in the office. Ours often take 2-3 hours to complete. So, now is a good time to schedule that challenge before school starts back up in a few weeks.

Ok. Whew. The to-do list has started. You’ve got this! We are here to work with you and help make this a great and safe school year for your little one. See ya’ll soon!

-Dr. G

Friday update: OIT

Happy weekend, everyone. How is it already mid-July? I just realized that O starts her new school for pre-K in exactly one month. Whhhat? I know it’s so cliche, but truly, time flies so very fast. Trying to soak up all the special moments with these kids!

I’m sorry it’s been a while since I’ve posted. We have been a little busy both at home and work recently so I haven’t been as faithful on here as usual. I appreciate your patience and understanding because sometimes, believe it or not, I would rather be making memories with those kids than spending time on the computer. It’s a balance and I’m working on it! 🙂

Well, today is a big day for us. As you are reading this, I am taking O up to Dallas for an introductory visit about oral immunotherapy (OIT). If you have a child with a food allergy, you probably know what OIT is. If you don’t, let me explain. I’m sure most of us are aware of allergy shots. You, your mom, your grandmother or your neighbor down the street has probably been on or currently is on allergy shots. What and how does that work? The concept behind allergy shots is to gradually introduce allergen to your body and teach your immune system to develop “tolerance” to that allergen. It is very standardized, and we base it on FDA established guidelines for dosing and scheduling until you reach a “maintenance” dose that you will continue for about a 3-5 year duration, again based upon evidence supported recommendations.

Well, what about OIT? OIT is using the same concept of allergen immunotherapy (or allergy shots) to gradually develop tolerance for food allergy. This is obviously a very exciting approach for those with food allergy. Unfortunately, OIT is not yet standardized as research is still ongoing to establish that standardized dosing and scheduling. In fact, my training hospital of Texas Children’s is one of the academic sites that has been very active in OIT research. Click on these links to read about one of the drugs in process for FDA approval with AI immune and the peanut patch study . But there are many private allergists who have been trialling the concept of OIT in their practice for many years and with good success. One of those allergists is in the Dallas area, and so that is why we are headed up there this morning.

So, yes, this allergist is going to see another allergist for her daughter’s food allergy. The reality is that I may not have all of the answers yet for O. But I will work hard to get there. I’m also not sure this is going to be the best approach for O or that she will be a good candidate for OIT. But all I can do is educate myself. I would also like to see if we can incorporate any of the OIT into my practice here in Waco. So, stay tuned, Waco. You know that I only will pursue what is supported by evidence and beneficial to our patients. I’m keeping my fingers crossed for sure!

Have a fabulous weekend everyone. I may take O for some shopping after our appointment. What’s a Dallas trip without a little shopping, right? 🙂 See you again on here soon…hopefully next week! 🙂

-Dr. G

Skin Care Refresh

Happy Friday, everyone! It has been a busy couple of weeks for us, but we sure are enjoying summer. O and I had a girls weekend last weekend in Cincinnati, Ohio for my good friend’s wedding. My friend is from India originally, and her wedding was most definitely one of the most beautiful weddings we have ever been to let alone be a part of. I always love experiencing different cultures and this one surely did not disappoint. O did a great job as a flower girl and looked as cute as can be. Congratulations again, Shivani, and thanks for letting us be a part of your special day!

I mentioned briefly in the last post about E’s eczema. Thankfully, his skin has been under much better control and so much of that is because of the careful attention to his skin care. A few years ago, I did a two-part series on skin care. Check it out here and here for part two. Ezcema is something I see literally everyday in my office and now we have to deal with it on a personal level with E’s skin. It always brings so much joy to see my little patients come back with clearer skin after mom and dad have implemented the plan. But, trust me — I get it that following the full eczema skin care plan is no cake walk. For most kids, following the skin care plan that your allergist provides very carefully will 9/10 times clear your little’s skin so well. There will inevitably be the few that will struggle a little more and that’s why working with a board certified allergist/immunologist is so important to make sure that there are not any underlying immune deficiencies or other allergies to consider as part of that little one’s treatment plan. For the majority, however, stick to the plan, mama. Because it will work!

Here are a few key highlights on the skin care plan. Be sure to check the previous posts for the full details.

  1. Avoid ALL fragrance/dye from touching your little one’s skin. This include baby shampoos, body washes, detergents, essential oils, etc. Any and all of these are irritating to your little one’s sensitive skin.
  2. Moisture, moisture, moisture. The more moisture you give with a thick, goopy emollient, the better you little’s skin will be.
  3. Itch control. Eczema is called the “itch that rashes”. Control that itch with antihistamines. Start with the long acting antihistamines (Zyrtec, Claritin, etc) and use the short acting (Benadryl) for when the itch is more severe.

I’ve certainly noticed that when I forget to goop E up or give him his allergy medicine, his eczema reappears. But when I stick to that plan, his skin looks fabulous.

Well, have a wonderful weekend, everyone. We are doing a little Dallas adventure and then hoping to see Toy Story 4 at some point. Anyone else seeing it this weekend??

See ya’ll next weekend!

Dr. G

E’s Allergy Story

Happy Friday! Hope ya’ll had a great week. I am so looking forward to spending some extra time with the family this weekend. So thankful for these precious little angels and the family God has given us.

Well, as promised, I wanted to talk about our experience with E and his food allergy. Now, because of big sister’s tree nut allergy, I had my radar up in regards to the tree nuts. I followed the recommendations from the LEAP trial in how I approached food introduction for E. Prior to introduction of the nuts, I did have E allergy tested to the nuts. I did this due to the immediate family history of allergy as well as his history of mild eczema. He had some positive skin testing findings, particularly to peanut and almond. But what I know as a board certified allergist and what I stress so much to my patients and to you, my readers, is that a positive skin test does not necessarily mean allergy. Since E did not have any exposure yet to the nuts, this positive finding correlated with sensitization only. Around 7-8 months, I did go ahead and introduce him to peanut, and guess what? He remained completely symptom free. He later had honey nut cheerios, almond butter as well as almond milk and had no reactions. He still LOVES peanut butter and is regularly exposed to the nuts. I’ll be honest in saying that he has not had much pistachio or cashew exposure, simply because none of us really eat those any more because of O’s allergy.

So, success story with the nuts. Unfortunately, we still discovered a food allergy for E. At around 4 to 5 months old, we introduced E to egg. Again, early introduction. I didn’t skin test him to egg first because, quite frankly, I had no concern for egg allergy. I made him soft boiled eggs almost every morning, and he did great with it. A little later (and now I can’t recall how old he was exactly), my sitter called me frantically shortly after E had eaten breakfast. She had served him scrambled eggs, something I had also served frequently him. About 15 minutes after E had eaten the scrambled eggs, she had found a few hives on his skin, and he had become more fussy and started rubbing his eyes vigorously, almost as though he was already ready for a nap — an hour and half after waking up. Of course, I asked her to give him some benadryl and rushed over from clinic. I got there within about 15 minutes. The hives had improved but E was truly sleepy. He otherwise looked fine — no swelling, wheezing, vomiting or any other symptoms. So, I laid him down early for his nap and he slept normally. He did fine the rest of the day.

Egg allergy? Really? No way. But he had eaten eggs SO MUCH. I waited a week or so and tried the scrambled eggs again…two more times, actually. He got hives both times and sleepy again with one of those events. So, we stopped the scrambled eggs, or what we allergists call “unbaked egg”. He was still doing great with baked goods containing egg, so we continued that. I finally had E allergy tested and sure enough — egg allergic. Just as I had sadly suspected.

Now, the statistics for outgrowing egg allergy, particularly if a child is already tolerating baked egg products, are very good. So, I don’t have that gut wrenching feeling that E will carry this diagnosis for the rest of his life. But I won’t lie…it still is frustrating. Nevertheless, I’m definitely counting my blessings for being in my field of Allergy and Immunology. So, we are strictly avoiding unbaked egg and moving forward for E. Every year, we will re-address his allergy to see if he has outgrown it. But for now, strict avoidance.

I had hoped to share some pictures of the testing process yesterday, but I didn’t get to snap any photos with both kids getting pricked at the same time. Yes, O was pricked again — but this time for environmental allergies. I’ll share about that soon. If you check out my clinic’s Instagram page (@aacow), look at the highlight story for allergy testing. It’s quick and simple. If you’re in the Waco area, we would love to see you and help you diagnose and treat those allergies.

Well, have a wonderful weekend, friends. Planning on enjoying the warm weather again this weekend with these kids. Enjoy your littles, and see ya’ll next week.

-Dr. G

Fresh Friday: Summer Okra

Ok, so the short work week threw me off and I’m posting on a Sunday instead of a Friday. Sorry, friends! Hope ya’ll have had a great weekend. My sweet O has been with her grandparents and aunt all week. It’s been nice getting to have some one on one time with E but we sure do miss our baby girl! Can’t wait to see her today!

I went grocery shopping yesterday and found these beautiful okra. Yes, you heard that right, okra. In Arabic, the word is “bamyeh”. We typically use the small, bite site okra, but you can typically only find those in Middle Eastern groceries, which surprising as it may seem, are a rare find in Waco, Texas. 🙂 These big okra are a summer staple, particularly here in the South. Now, I know they are delicious battered up and friend, but I want to share a fresh recipe that I think you’ll love.

Ingredients:

  • about 2 pints of okra, chopped into large pieces
  • 1 bunch fresh cilantro, finely chopped
  • 3 tomatoes, chopped into large pieces
  • 5 garlic cloves, finely minced
  • juice of 2 large lemons
  • olive oil
  • salt, to taste

Directions:

  1. Drizzle a large pot with olive oil and saute the garlic until it becomes fragrant.
  2. Add in 2/3 of the chopped cilantro and cook for 2-3 minutes until the cilantro becomes more dull in color.
  3. Add the tomatoes and cook down until the juices begin to come out of the tomatoes. This may take about 10 minutes.
  4. Add the okra and very gently toss with the tomato/garlic mixture n the pot. Be careful not to over-mix as this will make the okra mushy and you want to try and retain their shape.
  5. Add just enough water to cover about 2/3 of the way to the top of the okra/tomato/garlic mixture. Reduce heat to medium, cover and let it cook down. This may take about 15-20 minutes.
  6. Once the okra is almost cooked through, add in the lemon juice, salt and the remaining cilantro. Leave the pot uncovered and allow all of the liquid to be cooked off. This will take about 10-15 minutes.
  7. Remove from heat and enjoy warm with some pita or is equally as delicious cold as an appetizer.
Saute the garlic and cilantro
Add tomatoes
Add the chopped okra and gently toss

Add just enough water to cook the okra
Okra almost done. Now add lemon juice, salt and cilantro and cook the liquid down
Voila. All done. Fresh, delicious, healthy summer meal.

I hope you’re able to enjoy this delicious meal. It used to be one of my favorites from my mom growing up. This same idea is used to make an okra stew with cooked beef or lamb in more of a rich, thick tomato sauce. I prefer this lighter version in the summer when the thought of a stew is a bit overbearing. My little ones aren’t big fans of okra quite yet. But I’m crossing my fingers that they change their minds soon!

See ya’ll next week. I’m hoping to do a recording on Instagram this week about what real-time allergy testing looks like. So, keep a lookout for that coming soon. And I promised more of an update on E’s egg dilemma. We’ll talk about that and more next Friday. Have a wonderful day, all, and thanks as always for checking in!

-Dr. G

Food Allergy and Traveling Abroad Part 2

Happy Friday, ya’ll. Well, we made it back! We can officially say that our children are professional world travelers now. Long airplane rides, different time zones, long days of the double stroller, new foods and customs…we got this! 🙂 Thank you to those who prayed for us and sent your love. The kids truly did so well, and we had a beautiful time together as a family enjoying such a breathtaking place. Italy, you are already missed!

So, the burning question of course is how did we do with O’s food allergy? Thankfully, everything went very well AND we were able to have gelato <almost> daily. Here are some of the things that made navigating around O’s food allergy successful in Italy.

  1. The chef’s card. This card, written in Italian, was truly a life saver. We presented that EVERYWHERE we went. It told the waiter/restaurant owner/chef about O’s tree nut allergy and to ensure that all work surfaces were cleared for possible cross contamination. If the restaurant was not comfortable due to risk of cross contamination, we simply didn’t eat there.
  2. When eating out, keep it simple. For meals, we did a LOT of margarita pizza and plain marinara spaghetti. For the gelato, we predominantly stuck to the “fragola” flavor — strawberry sorbet. The nut flavored gelatos are made with dairy so by sticking to the sorbets, we were much safer for the risk of cross contamination.
  3. Have safe snacks on hand. I think I became known as the “snack auntie” during the trip because no matter where we went, I had a stash of yogurt puffs, apple sauce pouches, crackers, pretzels, a PB sandwich, etc with me. I think the only thing worse than a hungry, traveling child is a hungry, traveling child who can’t have the available food because of his/her allergy. How depressing would that be?! So, I had a safe stash in my backpack at all times, just in case we didn’t find a pizza shop or a little restaurant for lunch that had safe food for O. Thankfully, that didn’t happen often, but we were ready just in case.
  4. For packaged foods, read the labels. We learned what tree nuts was in Italian — “frutta de guscia” and we looked for that on all the packaged snacks. When we were traveling on the trains, they provided so many snacks for the kids. So sweet, but sadly all of them either contained or were made in the same facility as tree nuts. So, O couldn’t have any of those. But that’s where mom’s stash of safe snacks came in handy as well.
  5. Keep that epinephrine and Benadryl handy. Thankfully we didn’t have to use either. But having that with us at all times was a such security as we traveled around and tried different foods.

Overall, we truly had a blast and could not be more thankful for that special opportunity to travel the world as a family and experience such a rich culture. Italy, thank you for a great time and thank you for being so food allergy aware!

Have a wonderful Memorial Day weekend, everyone. We’ll see ya’ll again next week.

-Dr. G

Food Allergy and Traveling Abroad Part 1

As I mentioned in last week’s post, in a few days, we are taking a “grande” family vacation to the country of Italy. And yes, because we are crazy, we are taking the kids with us. We have been dreaming of a vacation like this for some time and, well, we couldn’t imaging being that far way from the littles, so naturally, they are coming along. We really can’t wait to get some down time together as a family and experience la dolce vita. Part of that dolce vita is eating the incredible food of Italy. Pizza, Pasta and of course, Gelato. What is life without those amazing things, right?

Well, when you have a child with a tree nut allergy — specifically to pistachio and cashew — you get a little extra worried about accidental exposures with all foods of course, but particularly when you are traveling abroad, where English is not the main language, and were tree nuts are used in many dishes including gelato and pesto. But what I stress to my patients and to ya’ll is that a child with a food allergy or asthma really should be able to live that dolce vita without being paralyzed by fear and certainly not be limited to their exposures because of their allergy. So, what can we do? Preparation. It’s key. I’m sharing the few pieces of preparation I have made for our upcoming trip. And when we get back, I’ll be sure to share how it went in real time for those planning a trip to Italy or otherwise traveling abroad.

One of the first things I did to prepare was turn to…what else…google. “Traveling to Italy with a food allergies”. Boom. Great information was just one click.

  1. FARE, Food Allergy Italia and IFAAA (International Food Allergy and Anaphylaxis Alliance), have jointly created a fabulous document that I would highly recommend. Check it out here .
  2. The Food Allergy Italia site is FULL of very useful information. I learned what the emergency number is in Italy (1-1-8), what the Italian word is for epinephrine (Adrenalina), what the Italian equivalence for the “EpiPen” or “AuviQ” is (FastJekt or Jext) and how to say “tree nuts” in Italian (Noci or Frutta a Guscio).
  3. Chef’s Card. Somehow I am not finding this on the Food Allergy Italia site anymore but FARE has published its own version. This is a card in Italian that I will present at all restaurants indicating O’s allergy and instructing special care to ensure absence of tree nuts as well as cross contamination by washing all work surfaces and utensils thoroughly when preparing her foods.
Top is FARE version and bottom is the Food Allergy Italia version.
The Food Allergy Italia version has an English translation on the back.

Of course there is the general preparation that we would always recommend as well…

  1. ALWAYS carry an emergency epinephrine device. I will have 2 2-packs of Auvi Q with me at all times.
  2. I have also packed Benadryl for any mild reactions.
  3. Reading ALL labels for packaged foods and presenting the chef’s card at ALL restaurants. This is not the time to take risks.
  4. Packing non perishable snack items. We will be traveling with plenty of safe snacks, just in case we have any trouble when eating out.
  5. We are staying in Airbnbs during our stay. So, we plan on doing some simple cooking at home if needed. I plan on hitting some of the fresh markets and stocking up on fresh fruits as well to keep healthy and safe snacks while we are out and about.

So, that is just a little bit of the preparation we have already done. I’d be lying if I said I wasn’t still a little nervous. But I am trying my best to trust God and that our preparation will serve us well during our trip. I’ll be sure to share our real-time tips when we get home!

Have a great weekend, all! I’ll be taking a break from blogging while away. Ciao for now! 🙂

-Dr. G

Easter blessings

This is one of my favorite times of the year. Isn’t it truly breathtaking to watch the trees bud new life and then show off all those beautiful flowers? On our back patio, we have an old pond that we ended up keeping intact with the big renovation of our fixer upper. That pond was built sometime between 1940 and 2017, when we bought the home. It’s super old, and I’m sure has seen some better days. My husband has worked very hard on the pond, especially this past spring. On most days, he loves it. But there are other days when all the work involved in keeping a pond fresh and clean is not as fun. Nevertheless, it’s there and staying (at least for now).

One of the things I love about that pond is that it attracts so many birds. Every morning, we have what seems like several hundred birds singing their morning songs outside our bedroom window. For this morning person, it’s beautiful! They sweetly encourage me to get up and going with the day. My day can be quite busy with the babes and a full clinic load. So, hearing that sweet morning chorus is a pretty special way to get the day started.

I’ll be talking next week about all the planning that has been involved in taking my food allergic girl to Italy. That’s right. We are ALL taking a family vacation to Italy. It’s slightly crazy, but we were planning on going to Europe this summer and couldn’t imagine being that far away from our little ones so a European adventure it is! 🙂 I’ve been working on educating and preparing myself for what traveling with a food allergy looks like in Europe. I’ll certainly share our stories when we return, and I’ll also share a few highlights next week on the blog.

Well, have a wonderful Easter weekend, friends. May the truth of the resurrected Jesus be a constant hope to you always! Happy Easter!

-Dr. G

Food allergy and Birthday Celebrations

We had a really great weekend celebrating our precious Olivia and Ethan with our family and friends. What a joy it is to be their mom and watch these babies grow. I love seeing their personalities develop and seeing more of that little person come out. 🙂 My sister shared something so sweet this week on her Instagram. As she was watching my niece open her birthday gifts (because, yes, her birthday is this week too!), she heard God whisper into her ear that He loves to see us receive sweet gifts too. How precious, friends. May we joyfully accept every blessing, including these sweet little angels, that we have been given.

This year was the first birthday party for O after her tree nut allergy diagnosis that I finally felt comfortable enough to have some outside food present at the party. This mainly was a result of O asking for a unicorn birthday cake for her party. There are many things that I can do. A unicorn birthday cake is not one of them…or not well at least. So, I searched to find a bakery that could make my girl’s birthday dreams come true AND keep her safe from any accidental exposures.

What’s the risk? Well, remember that for an IgE mediated food allergy, any exposure, even cross contamination, can potentially result in a life threatening reaction. So, a cake that was baked with the same uncleaned bowl, spatula, or pan as a cake using tree nuts could potentially be bad news for our girl. What were the questions I asked the bakery?

  1. Do you use any tree nuts in your cakes? If so, which ones? If the bakery used pistachio or cashew, I did not use it as those are her highest allergens.
  2. How can you ensure that there will not be any cross contamination of any other cakes with my cakes? The bakery I chose said that they would make the cake the very first thing that day with completely clean baking equipment and surfaces and then separate that cake from the others once completed.

I was very happy to find a bakery that accommodated my requests. O certainly loved her cake. But you better believe that I still watched her like a hawk the whole time, making sure that she did not have any adverse reactions, because you can truly never be too sure. And yes, that Auvi-Q was close by. Thankfully, the weekend celebrations proceeded without any food allergy reactions and all had a great time!

When planning a party for your little one with a food allergy, remember these helpful tips. It is possible to have a wonderful celebration but it just takes a little planning and checking.

Well tomorrow is O’s actual birthday. Four year old. Wow. We are headed to San Antonio for the weekend to celebrate. Fingers crossed that the weather stays good so we can enjoy the river walk and have fun celebrating our little girl!

-Dr. G