Allergy Alert!

It seems the weather patterns of the late winter and early spring have resulted in setting allergy sufferers up for the "perfect storm". Last year, this time, only a handfull of my patients asked if this was a bad year for allergies. Now everyone is asking. Tree pollen season got under way in March and has not let up. The warmer weather, lack of rain and the frequent windy days have allowed pollen to infiltrate the air. I have previously discussed tips on how to prepare for spring allergy season (below).

Here is a video that has a good review on what allergists do on the initial visit: (What Allergists do)

I hope your allergy season is going well. If not, see an allergist soon!

Here are your Seasonal Allergy Tips from last year

Is Your Doughnut Hole Going to Get Smaller or Larger With the New Health Plan?

Most people under age 65 think the doughnut hole is something that cheats us out of the rest of our sweet snack, unless we go to Dunkin Donuts or Panera's and order the "doughnut holes".

In Medicare terminology the "doughnut hole" is reached when a patient (often those 65 years or older and on a Medicare health plan) has passed their spending limit (2010- $2,830.00) for medications. Prior to reaching the limit Medicare patients are often paying deductibles and monthly premiums.

According to my patients, being in the "doughnut hole" is an awful place. Having to pay full price for allergy/asthma medications (for example, almost $300.00 for one Advair Diskus) can break the piggy bank. So, what does President Obama's plan have to offer?

Here is an article that addresses the "doughnut hole" and new health plan changes. My feeling is something needed to be done, and this is a good start. I think the doughnut hole will get smaller, over time, with this plan.

"Healthcare Plan Closes the Medicare Doughnut hole"

J. Thompson, MD

Advair and Symbicort: FDA Targets These Combination Inhalers in a Recent Bulletin

Advair and Symbicort are combination controller inhalers that have been available for treatment for about a decade. Over the same period of time asthma death rates have decreased from more than 5000 people annually in the U.S. to almost less than 4000. Prior to that time (early 80's to mid 90's) death rates in this country had been increasing.

There is no direct evidence that confirms these inhalers have resulted in fewer deaths from asthma but many asthma specialists are intrigued by the association at a time when the FDA (Food and Drug Administration) is recommending more cautious and shortened use of these inhalants.

Stepping down or off these controller medications (Advair or Symbicort) too soon may in fact result in more difficult to control asthma. My experience is that many of my patients have had fewer months and years of exposure to higher dose inhaled steroids and oral / injectable steroids since Advair and Symbicort have been available.

I agree with the FDA's warning that patients should not be on monotherapy (one drug therapy) with Serevent or Foradil (brands of Salmeterol and Formoterol respectively). There should always be an additional anti-inflammatory controller when these LABAs (Long-acting beta agonist= Serevent and Foradil, which are in Advair and Symbicort respectively) are prescribed.

Advair and Symbicort have steroidal inhalants in them which cannot be separated from the LABA element when they are inhaled. Therefore these medications inherently fulfill the warning criteria proposed by the FDA regarding the avoidance of monotherapy.

A co-writer on AsthmaCentral.com has posted a very nice summary on the recent FDA warnings that I fully agree with. See this link.