Written by: Dr. Aikaterini Anagnostou

Resources for Texas Schools

Food allergy is a growing public health issue that impacts almost every school across the United States. Nearly 6 million children in the U.S. – which equates to 1 in 13, or roughly 2 in every classroom – have a food allergy. In Texas, Senate Bill 66 was passed through the Texas Legislature in June, 2015 and SB579 and SB1367 were passed in May 2017 allowing for stocking of epinephrine auto-injectors in Texas public schools, publicly funded charter schools, private schools and public colleges to be used in a life threatening severe allergic reaction. Physicians can write an epinephrine prescription to a school or school district.

Schools should develop policies to manage food allergies appropriately, including information on handling medical emergencies and taking preventative measures to avoid a student’s exposure to a known food allergen. Physicians, families, and school staff should work together to formulate reasonable and practical plans that will keep students with food allergies safe.

A variety of resources are available to schools to be used to help train school personnel to use epinephrine auto-injectors in an appropriate situation. These include:

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 300 board-certified Allergists/Immunologists in Texas.
An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.
A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

A board-certified or board –eligible allergist can help define for you what may be bothering you and thus help you make your plans for your season. Staying indoors with the doors and windows closed is the easiest but often the most inconvenient. Your allergist can make other recommendations to improve your quality of life. For more information about allergists in your area, look at the Member Directory of TAAIS.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 300 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

More Education Articles

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

Unproven Approaches in Allergy

As the name states, this article covers allergy related approaches of evaluation and treatment that are not proven or disproved by medical research. None are FDA (Food and Drug Administration, the federal agency which regulates this area) approved as an allergy approach and are not generally accepted by experts in allergy, the Board-Certified Allergist. Individuals seek wellness and sometimes enticements by media, friends and even some health care workers and practitioners influence individuals to make questionable and poor choices. These choices of unproven approaches in allergy which will be discussed in this article cover the spectrum from experimental research appearing helpful to the allergic patient to other methods with placebo false results, and some at worst, dangerous. Beware of testimonials professing remarkable or even miraculous benefits from methods described in this article. Finally, this article describes several unproven approaches in allergy but should not be considered a comprehensive review.

Homeopathic and low dose Immunotherapy – Medical studies have proven this method of administering allergy solutions is no more effective than placebo. Those receiving allergy injections may ask to see the allergy vial(s) from which they are receiving injections. Ask whether the vial is the “maintenance concentrate” vial, also known as the highest concentrate from which a patient will receive the doses of allergy injections. If the vial is colorless, like water, and is the “maintenance concentrate”, it is likely low dose or homeopathic allergy treatment.

Allergen Immunotherapy, by injections, oral drops, or any form of administering a “treatment” for rashes including hives, chemicals, hormones, viruses, bacteria, smoke or petrochemicals is not FDA approved. Injections for food allergy have been shown to be dangerous and are not recommended.  

Pet Exposure – as a way of inducing an allergy tolerance and preventing pet allergy. There is some positive evidence in studies but certainly is considered preliminary. More studies are ongoing to validate, or not, and define details. A caution, if someone is already allergic to a pet, exposure to try and induce tolerance is counterproductive, causing an increase in allergic symptoms.

Computer Based Allergy Treatment Program – a newer form of an allergy treatment scheme marketed on the internet. This theoretically flawed and potentially dangerous approach claims to treat any and all allergies. The approach utilizes a behavior modification program, FDA approved for behavior modification. If an allergic patient falls victim to this approach, the consequence may be fatal. Consider the severely allergic child with peanut allergy, severe shellfish allergy or penicillin allergy to name a few.

“Bee Pollen” pellets or granules ingested for allergy treatment – Not proven effective and potentially harmful to the allergic patient. Since this product is considered a nutritional supplement, the concentration of ingredients varies widely. The problem occurs when a highly allergic patient inadvertently ingests a high amount of the allergen(s), pollen in the pellets, to which he/she is allergic. A much lesser allergen exposure is in honey, which likewise is not an effective allergic treatment and there have been rare allergic reactions associated with its ingestion.

Total Environmental or Universal Allergy Syndrome, “20th Century Syndrome”, Total Immune Disorder Syndrome, and other names – to explain the person’s variety of adverse presentations and symptoms to any and sometimes claiming to all common chemicals, irritants, allergens and other exposures. Treatments have proposed to dramatically seclude these individuals in special “homes” with limited materials and contact with the “outside world”. Some are recommended injections to substances and approaches that have been proven not effective and have been covered in other sections of this article.

“Yeast Connection” or yeast or Candida overgrowth – as a form of allergy causing a multitude or problems and symptoms. Disproved.

Food Additives, Artificial Food Coloring, Food Associated Salicylates, Sugar – as a “common” cause of allergy symptoms, toxicity or behavior problems. Except for rare cases, disproved. There are a few exceptions, for example sulfite and monosodium glutamate (MSG).

“Provocation – Neutralization” of allergy symptoms with injections or drops under the tongue. Disproved.

Reflexology or other Kinesiology Methods of Allergy Treatment – Disproved.

Coffee Enemas – Yes, you read correctly, as a proposed method of food allergen elimination or “detoxifying” by the “colon cleansing” presumption.

And, finally a couple of disproved food allergy diagnostic approaches:

Food Allergy Diagnosed by Blood Tests – 1) IgG Method – this serum based molecule indicates a normal immunologic response to a food (s). Its presence does not indicate food allergy. On the other hand, measuring IgE to a food (s), usually by the RAST or CAP-RAST method is an acceptable method of evaluating food allergy. 2) Analyzing a blood sample’s white blood cells response to a food. If some type of “abnormal” white blood cell response occurs, an allergy to that food is supposedly diagnosed.

The best way to avoid unproven and disproved allergy approaches and even possibly harmful results is to become informed such as through this article, ask questions to your health care provider and certainly the expert in allergy, the Board Certified Allergist.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

Overview

Many Texans are stung by insects every year. Most people will experience pain, redness, itching, and mild swelling at the site of the insect sting, a normal response. In contrast, people who are allergic to insect stings will develop much more severe symptoms that can be life-threatening or rarely even fatal.

What is a Stinging Insect Allergy?

People develop an allergy to a stinging insect by their immune system reacting to the foreign insect venom. After a normal sting, they can develop the allergic antibody called IgE. The next time they are stung by the same type of insect, they may develop an allergic reaction, caused by their immune system over-reacting to the insect venom.

Which Stinging Insects Cause Allergic Reactions in Texas?

The majority of allergic reactions to stinging insects are caused by five types of insects:

• Fire ants
• Yellow jackets
• Honeybees
• Paper wasps
• Hornets

In Texas, fire ants are the most common cause of insect sting allergic reactions. Fire ants are reddish brown to black stinging insects. They are very aggressive and can attack with little warning. Fire ant mounds are typically raised (depending on soil type) and will swarm upon disturbing the mound.

What are the Symptoms of Stinging Insect Allergy?

As indicated above, most everyone who is stung by one of the above insects will develop a local reaction to the sting, which is normal. Fire ant stings cause a unique reaction in that a sterile pustule develops at the site of the sting. These pustules are sterile and should be left alone but can easily get infected by scratching. Pustules from fire ant stings are not an allergic reaction. Allergic reactions to stings are divided into large local and generalized (systemic) allergic reactions.

• Large local reactions: These reactions involve more extensive redness and swelling that extends from the original site of the insect sting. For example, if one is stung on the hand, a large local reaction could involve swelling of the entire arm. Large local reactions typically progress over several hours.
•  Generalized (systemic) reactions: These reactions cause symptoms that are distant from the original sting site and often occur within minutes of the sting. Symptoms may include itching or hives, swelling in the throat or tongue, difficulty breathing, dizziness, stomach cramps, nausea or diarrhea and in severe cases, loss of consciousness and shock. The involvement of many body organs from an allergic reaction is termed anaphylaxis (see anaphylaxis page).

How do I know if I have Stinging Insect Allergy and what can be done?

If you think you are allergic to a stinging insect, you should see an allergist/immunologist who can perform the appropriate testing to determine if you are indeed allergic to a stinging insect, and if so, which one(s) you are allergic to. Your allergist/immunologist can determine if venom immunotherapy (allergy shots) would be indicated. Venom immunotherapy is highly effective at preventing future sting reactions in 97% of treated patients. Depending on the type of allergic reaction, your allergist/immunologist may also recommend self-injectable epinephrine for treatment of generalized or systemic reactions.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.

Sinusitis

What is Sinusitis?

Sinusitis, also called rhinosinusitis, is defined as inflammation, swollen irritated tissue, of the nasal and sinus cavity linings. Both areas are typically involved in sinusitis because the sinus linings can be described as an extension of the nasal lining, a “deeper” area of the upper respiratory tract. Rhinitis occurs commonly without sinusitis but it is uncommon for sinusitis to occur without rhinitis. The Board Certified Allergist is an expert in upper and lower respiratory tract allergy, evaluation and treatment. This includes patients with rhinosinusitis whether allergy is the primary or contributing cause or not.

The sinus cavities are primarily found within the cheek bones, around the eyes and behind the nose. The main function of these sinuses is to moisten and filter the air as an extension of the nasal cavity’s function. There is also a role in voice quality.

Inflammation of the nasal and sinus linings may be caused by allergy to inhalants such as pollens, mold spores, pet dander and house dust components, infections, tobacco smoke or other airborne irritants. Symptoms of sinusitis include mucus drainage, head congestion, fullness, pressure or headaches over the sinus cavities, cough, toothache and occasionally fever. However, also runny nose, mucus drainage, and irritated throat associated with nasal and sinus area headaches can be a common presentation of allergic rhinitis. Many people with “sinus” headaches actually have migraine or other types of headaches; therefore not all headaches localized to the sinuses are due to sinusitis.

Types of Sinusitis

There are two types of sinusitis, acute and chronic. Acute sinusitis is short in duration, typically days to a couple of weeks with symptoms completely resolving. The most common cause of acute sinusitis is a viral infection (e.g. common cold). A bacterial infection is suspected when symptoms persist beyond 10-14 days. Since most acute sinusitis episodes are not related to bacteria, antibiotics are usually not required. Symptomatic treatment may include decongestants, nasal saline irrigation or warm moist inhalation or a mild cough suppressant. If mucus is thick and colored, mucus thinning agents may be administered. If despite these therapies symptoms do not improve, an antibiotic may be considered.

Chronic sinusitis occurs when symptoms are on and off or continual for months and is potentially more serious. A more aggressive diagnostic and therapeutic approach is essential to improve the condition or if symptoms worsen or complications occur. These include progressively worse sinus disease or infection spreading to adjacent tissues and other areas of the respiratory tract. While chronic sinusitis may be related to bacterial infections, non-infectious causes of chronic sinusitis are common.

What is Hyperplastic Sinusitis?

Hyperplastic sinusitis involves inflamed sinus linings and may be seen in association with several conditions including asthma or nasal polyp disease. Individuals with frequent sinus infections may need to be evaluated for other conditions including allergic rhinitis, a structural abnormality such as an obstructing nasal septal deviation, or in some cases immunodeficiency. In addition, various environmental exposures may need to be evaluated. Also, regular or frequent use of decongestant nasal sprays, available without a prescription, can cause rhinosinusitis. The Board Certified Allergist can evaluate all of these areas. Evaluation may include allergy testing, sinus imaging (e.g. CT scan), immune function tests, analysis of nasal secretions or lining, and a flexible fiberoptic scope to more directly visualize the upper respiratory tract. Information from various tests are useful to develop an appropriate treatment plan c. A referral to an Otorhinolaryngologist, also known as Ear, Nose and Throat Surgeon may be needed if the condition cannot be controlled medically and an evaluation for surgical intervention is indicated.

Beware of frequent antibiotic use every time possible sinus symptoms arise as antibiotic resistance and allergy to antibiotics occur. Also, frequent use of oral and/or injected cortisone or steroids can create major permanent medical problems.

Lastly, “sinus headaches” may actually be a nasal related headache, migraine or another type. The Board Certified Allergist is skilled in evaluation and differentiation in these areas and can skillfully develop a more focused treatment plan.

The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.

An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.

A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.