[Allergy & Asthma Corner]

Last year the FDA (Food and Drug Administration) made recommendations to the makers of Xolair (Omalizumab) regarding risks of anaphylaxis (severe allergic reaction). Warning labels have been formed by Novartis and Genentech in response to the FDA bulletin.

 In short:

1) Patients on Xolair injection therapy should be aware that there is a risk of having a severe allergic reaction.

2) The FDA recommends an initial waiting period of 2 hours. How long you should wait after the initial shots depends on the advisory of the physician in charge.

3) Xolair injections should only be given in settings where anaphylaxis may be treated with appropriate medications and  by staff skilled in recognizing and treating anaphylaxis.

4) Clinical trials revealed that anaphylaxis may occur more than 24 hours after injection, and after any injection. For this reason it is recommended that all patients on Xolair have a means of self injecting epinephrine (Epi-Pen or Twinject).

5) There was a 0.1% incidence of anaphylaxis observed  in approximately 40,000 patients on Xolair across the nation. This relates to about a one in one thousand chance of having a potentially severe allergic reaction. There were no deaths reported in the analysis.

Bottom Line:

Xolair therapy continues to be a welcomed addition to the treatment options for people 12 years or older with moderate to severe asthma, that are not adequately controlled on low to medium dose inhaled steroids. Candidates for Xolair therapy must be allergic to at least one perennial allergen and have a certain level of IgE antibody in their blood.

Experience has shown that Xolair may significantly reduce asthma symptoms, asthma attacks and the need for high dose inhaled and oral steroids.

A more comprehensive review of Xolair and links to other sites may be found on an earlier posting (Xolair: for some patients with difficult to control asthma- June 10th, 2007)

We are in the cough, cold and flu season that annually plagues people in this part of the country. Many children and adults awaken with stuffy nose, sniffles and post nasal drip. Some with allergy problems find it hard to separate their indoor allergy problems from symptoms of the common cold.

Of more concern is whether the nasal symptoms and headache represent a sinus infection. Millions of people in the U.S. present to doctor’s offices each winter requesting antibiotics for sinusitis (sinus infection). Probably less than half the time an antibiotic is actually indicated.

“Why didn't my doctor give me a prescription for an antibiotic after I complained about sinus congestion, headache and yellow mucus?”

It may have been because:

1) The common cold is frequently mistaken for a sinus infection. Viral infections which are the cause of colds, do not respond to antibiotics.

2) Treatment of the common cold or allergy symptoms with antibiotics is inappropriate and may contribute to the emergence of resistant strains of bacteria

3) The unnecessary ordering of antibiotics exposes a patient to the risks of antibiotic side effects. In many cases this includes stomach upset, diarrhea and a host of other possible effects.

4) Drug allergy most often develops from a previous exposure. The sensitization process is silent (meaning you don’t feel it). After sensitization subsequent intake of the specific antibiotic may be associated with skin rash swelling or more severe allergic reaction.

5) If you have symptoms of an upper respiratory tract infection for less than 7-10 days there is a good chance it represents a viral syndrome (common cold). Your immune system should ward off the cold within 7-10 days.

Your doctor decides whether an antibiotic is necessary after examining you. There may be evidence on the physical exam that suggests a bacterial infection (which would warrant an antibiotic). Otherwise it may be determined that conservative measures such as steam, fluids, acetaminophen (Tylenol) and rest are all that is needed for the time being.

Bottom Line:

Many upper respiratory tract infections are caused by viruses and do not require antibiotics. Good sinus ventilation is disrupted by the common cold as well as by allergic rhinitis (hayfever). Sinus infections are a common complication of colds and nasal allergy. If you think you have a sinus infection get evaluated by your doctor for confirmation.

Remember, colds should run their course within 7-10 days. Medications which reduce nasal congestion and relieve bothersome nasal drainage are not curative but may reduce the annoying symptoms of the common cold. Such treatment may also decrease the risk of subsequent sinusitis.

Learn more from these sites:

www.webmd.com/cold-and-flu/cold-guide/cold-becomes-sinus-infection

www.clevelandclinic.org/health/health-info/docs/0700/0753.asp?index=6171