Every day, I see patients that are having trouble with their allergic symptoms. For some individuals, over the counter medications such as antihistamines help but does not give sufficient relief for the comfort of the patient. Others have tried prescription medications which include stronger antihistamine and medications that reduce the inflammatory process, such as montelukast or steroids, with varying results and side effects.

Understanding seasonal allergy triggers. To achieve effective treatment, it is important to understand the cause or triggers of the symptoms you are experiencing. Avoidance or reducing exposure is the first step in treatment.

In Texas, that is almost impossible. There are airborne pollens year-around, differing in spring, summer, fall and winter. Winter brings Mountain Cedar in December, January and February. In spring, pollens are in grasses and trees. Summer has carryovers from spring and then ragweed begins in August thru October. Fall pollen contains different trees from spring tree pollen and weeds.

The most significant weed is ragweed that carries over from late summer. Molds are present year around with levels elevating with wind and damper conditions. Additional allergens that may add to the individual’s allergic load are dust mites and animal dander, such as dog, cat and feathers (birds or pillows).

Reactions for some individuals may be very specific, such as dust mite or ragweed. Others may have more extensive allergies and have symptoms year around.

Reducing your allergic reactions. Blood tests for IgE allergy (Type 1 allergic response) can define the worst offenders. Skin tests also define those reactive substances and may be more sensitive picking up the less reactive but troublesome items.

Once a person knows what specific items are causing them problems, reducing exposure is important to decrease symptoms during that individual’s high pollen season. Staying inside during peak pollen times, exercising indoors and traveling with windows up and air conditioner on recirculate helps reduce exposure.

Many newer cars have cabin filters that help reduce the in-vehicle pollen. If your vehicle has one, be sure to change it on a regular basis. Home air purifiers, especially in the room where sleeping, helps also. This gives the person six to eight hours of cleaner air.

Another simple process to reduce exposure is to use nasal saline to rinse out the pollen in the nasal passage before going to bed and after being outside.

Natural substances may be helpful in reducing symptoms. Vitamin C, taking at least 3 grams a day, is reported to have antihistamine effects. Quercetin also is reported to help.

Steroids either by shot or oral administration generally reduce symptoms quickly. Long term use may have significant side effects and are generally only given by physicians once or twice a year for a short period of time for symptoms not resolving with antihistamines.

Immunotherapy, allergy shots or sublingual drops (called SLIT- sublingual immunotherapy) builds up your body’s tolerance to the specific pollens. This therapy is specifically designed for you from your blood or skin testing results and administered on a frequent basis, usually weekly, over three to five years.

Consulting a physician for additional treatment options. If over the counter medication is not helping and you are miserable, consulting a physician to discuss additional treatment options is important to improve your health in a safe and effective manner.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

The post Lowdown On Seasonal Allergies appeared first on Johnson Medical Associates.

“Peoples Pharmacy” had a recent article in The Dallas Morning News reporting that dietary intake may increase acne. This stimulated me to add additional information on foods and the potential adverse health effects.

The CDC has numerous articles and guidelines on Food Allergy and Digestive Allergy from foods. The most dramatic and life threatening are the anaphylactic shock reactions such as acute asthma, laryngeal edema, body swelling and hives.

Ninety percent of these reactions are produced by eight foods: milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat. The main treatment is avoidance and to be prepared to treat with Epinephrine injection and antihistamine with immediate transportation to the hospital for stabilization.

Food allergies link to other conditions. Individuals with this type of food allergy are two to four times more likely to have other allergic conditions like asthma, eczema and seasonal allergies. In this situation often tolerance can be developed over time to the seasonal allergies by using allergy shots called allergy immunotherapy. This is done thru skin testing by physicians to determine the item you are sensitive to and then preparing a specific formula for your treatment protocol. Tolerance to allergic items is achieved over time.

Digestive Allergy involves foods that trigger abdominal pain, swelling, cramping, constipation or diarrhea. Secondary effects of adverse food reactions may also include fatigue, less mental clarity (“brain fog,”) joint pain, rash and itching. The eight foods listed above may be the trigger or other commonly eaten foods such as corn, rice, garlic, onion, pepper and peppers, potatoes, tomatoes, and all the grains that contain gluten. Elimination is again the treatment.

Figuring out which foods are causing you issues. Defining which foods are the trigger is often difficult. The quick onset reacts can generally be determined by skin tests or IgE blood tests. Delayed reactions are harder to be isolated.

One method is the “4 Day Rotation Diet” involving eating two to three foods per meal and not repeating any of the foods in the four-day time period. While doing this it is important to keep a diary of the foods eaten and how you feel recording the reactions. Reactions can be delayed by hours or extend into the next day. (There is help with this diet on the internet).

Celiac Disease is the absolute intolerance to gluten which is in all grains except corn and rice. Individuals with this Disease must strictly avoid all gluten containing foods to avoid the severe symptoms experienced by an exposure, severe abdominal pain, cramping and diarrhea that may go on for days.

Other individuals may have gluten intolerance and experience milder symptoms of bloating, constipation or diarrhea, fatigue, poor mental clarity, generalized aching, headache, rashes and swelling. Often these individuals have additional foods intolerances or allergies that make the job of getting relief difficult due to the many food variables.

Skin and blood testing for foods can help to define the specific foods. However, this testing often misses many reactive foods and it is necessary to use the “4 Day Rotation Diet” as a challenge method to define which foods for you are causing your symptoms. Then avoid those triggering foods for optimal health. For those individuals with many food allergies/intolerances staying on a rotation with avoidance is the best treatment.

Additional help for digestive allergies.

Help for individuals with Digestive Allergy is available through genetic testing, especially for gluten intolerance and Celiac Disease. Enterolabs at enterolabs.com offers a buccal swab test that will define your specific genetic makeup defining how you handle gluten. You acquire one set of genes from your mother and one set from your father. The combination of these two gene sets determines how your body will potentially handle ingested gluten, true celiac verses intolerance. With a physician’s guidance this can be a big help in how you regulate your diet for optimal health.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

The post Foods And Adverse Health Effects appeared first on Johnson Medical Associates.

With school out and government restrictions lifting, many of us are slowly getting back to our new “normal.” While many of our kids are excited to get out of the house and potentially back into sports, it’s important that we stay focused on safety. Whether it’s running, playing games in the neighborhood or participating in school activities, hitting our heads, falling, or colliding with someone in a contact sport can be a risk. In severe cases, that collision can result in a concussion, which is technically a form of Traumatic Brain Injury (TBI).

A sudden impact to the head may produce injury manifest feeling confused or having memory problems, sensitivity to light and loud noises, nausea and vomiting, problems maintaining balance, feeling groggy, foggy or sluggish, feeling pressure in the head or headache and blurry vision or balance issues.

If you or your child has any of these symptoms and seems to be a little “off” the normal, questioning them about recent activity and the possibility of being struck in the head is important. If the symptoms are not resolving within a couple of hours or are getting worse you should seek medical evaluation immediately. The CDC has recommended rest, light activity, moderate activity and then back to regular activity.

Rest. You or your child should rest the first few days after being injured while symptoms are severe. Physical activity as well as thinking or remembering activities should be limited in order to avoid worsening symptoms. Lastly, allow naps throughout the day if needed and make sure to get a good night’s sleep.

Light activity. Once you or your child starts to feel better, you may gradually return to regular activities, as long as they are not strenuous. Kids may also return to school and activities. If symptoms do not worsen, it is OK for your child to participate in that specific activity. However, if symptoms do worsen, time spent on that activity should be cut back. Screen time and loud music should be limited before bed and fixed sleep schedules should be followed. Naps can be reduced or they can return to their regular napping schedule, depending on their age.

Moderate activity. When symptoms are almost gone, you or your child can return back to most regular activities. Breaks are only needed if concussion symptoms worsen. At this stage, kids can also return to a regular school schedule.

Regular Activity. Recovery from a concussion is when you or your child are able to complete daily activities without experiencing any symptoms. Regular activity may resume at this point.

More information on concussion recovery can be found at cdc.gov.

Treatment can vary depending on injury and person. In general, the focus is to limit activity, stay in a low light and sound environment, and get as much rest as possible. In mild cases, symptoms can resolve within hours to a few days. Keep in mind, the length of time of recovery is not related to the severity of the impact and careful observation is necessary. If you’re feeling that symptoms and discomfort are persisting, additional medical attention is recommended and, in many cases, needed.

In fact, the CDC states that 20 percent of people suffering concussions have symptoms after 30 days. Many athletes injured are out of school for days to weeks recovering unable to tolerate bright lights, loud noises, physical activity or cannot concentrate. While this isn’t always the case, and others may have headaches, lethargy and cognitive difficulties that only last for a few weeks.

Using technology to monitor concussion recovery. As technology in the health and wellness industry is advancing, there are some exciting things on the horizon in terms of technology to help with concussion monitoring and recovery.

For example, a new mobile app is now available for free called HitCheck. Users can download this app and do a baseline concussion assessment right on their phone or other mobile device. When an athlete has a suspected injury, repeating the testing will pick up symptoms and signs that may not be easily recognizable indicating a concussive event probably happened. This app can be used also to determine when abnormalities have resolved.

Speeding up recovery with hyperbaric oxygen treatments. Luckily, there are alternatives for those trying to get on their feet quicker. A recent study, presented at the Hyperbaric Medicine International Meeting in Charleston, SC, showed that hyperbaric treatments speed up recovery with 80 percent of the individuals being symptom free after five daily one-hour sessions in a hard-sided chamber. For an individual with continuing problems following a concussion, Hyperbaric Oxygen has also been helpful in longer recovery.

For those new to Hyperbaric Oxygen, this treatment involves breathing pure oxygen in a pressurized chamber. In this condition, your lungs can gather more oxygen than under a normal air pressure, which ultimately can help promote faster healing.

Dr. Alfred Johnson, D.O. is a physician practicing in Richardson, specializing in internal medicine, environmental medicine and chronic disease. For more information, visit johnsonmedicalassociates.com.

The post Sports Activity In Sync With Concussion Awareness appeared first on Johnson Medical Associates.

Previously, we have broached the topics of mold exposure and housing situations that produce sickness. The same symptoms discussed were fatigue, fever, headaches, joint and muscle pain, nausea, visual disturbances, rashes, shortness of breath, “brain fog,” cognitive dysfunction, numbness and tingling of skin.

These can be caused by other underlying factors and it is especially frustrating when all the standard laboratory tests are negative and physicians have instated trials of therapy with little or no health improvement. People many times resort the self- treatment with vitamins, minerals and herbs with varying results but no resolution.

Labels attached to these individuals may include Chronic fatigue, Chronic Fatigue Syndrome, Fibromyalgia, Chronic Mononucleosis (EBV), Chronic Lyme Disease, different chronic virus or bacterial infections (CMV, etc.), leaky gut, parasitic infection or Mast Cell Activation syndrome. A diagnostic label gives some people comfort but little help in resolving the problem.

This situation presents a challenge to both patient and physician as determining the specific cause becomes even more important so that a cause directed treatment approach can be instated.

How is this done? A timeline history of health problems along with living and/or work situation needs to be recorded to determine time and place of symptom onset. This allows us to determine changes in environment that occurred area of country, different allergens in new area or amount in current residence/work, different lawn, pesticides, or cleaning products (always read labels for content), emissions from close by factories, natural environmental factors and disease vectors in the area like carriers such as tics, mosquitoes and fleas, contact with others with like symptoms, Mononucleosis or other transmittable diseases, potential exposure at work due to chemicals, mold, or poor air quality and travel in a time close to the onset of symptoms.

By creating a timeline of health and illness, a better idea of the time and place of onset can be determined and then discussed with your physician. The environmental and industrial changes surrounding the onset of your illness may need to be researched thru the EPA, Toxic Waste sites and also be discussion the physician.

If your physician is unwilling or does not have the time or interest then it is important to find one that is focused on doing specific diagnostic testing to find the underlying cause, generally one with internal medicine and environmental training.

Specific tests for acute infection are generally PCR (genetic) based showing presence of the organism in blood or secretions. An example of this is the COVID 19 nasal swab, a PCR test. Upon exposure, the body also reacts by producing antibodies to the individual insults. The immediate response is an IgM (immunoglobulin M) response.

Days to weeks later an immunoglobulin G (IgG) response occurs if the individual is not immune deficient. In those individuals they have low IgG and may produce a lower or no response. IgM positive means acute infection. IgG elevated levels mean past exposure or serial elevation may mean reactivation in the case of EBV. Interpreting the IgG tests must be done with caution as a virus or mold IgG antibody may cross react in the test tube causing a false positive in other IgG tests. Just because your IgG level is positive does not mean you have that specific infection now.

An example is in the EBV antibody panel test (acute and chronic Mononucleosis). The IgG portion may be falsely elevated by mold or virus exposure creating confusion of reactivation.

Another confusing test is the Lyme Western Blot Test were IgG antibodies measure the presence of specific proteins. These proteins are found in many organisms, just not Lyme. The CDC has a specific criterion for the number of bands present for the test to be considered a positive IgG test (past exposure) or IgM test (acute exposure). If this criterion is not met, then one is considered negative for Lyme. Treatment failures probably mean that there is another underlying condition.

Hidden causes include toxic substances such as heavy metals, pesticides, carbon monoxide, hydrogen sulfide and volatile organic chemical compounds which include mycotoxins from mold. Toxins affect the body in such an adverse way, at the cellular level including the mitochondria (the energy engines of the body), that until the toxic problem is resolved the body has a difficult time recovering (person symptom free).

Mycotoxins are measured by a urine test thru Realtime Labs, Carrollton in requested by you or your physician.

Once the cause is defined then a treatment plan can be designed for your individual need.

The post Frustrated By Health Issues? appeared first on Johnson Medical Associates.

In my practice, I find mold in homes to be a frequent, yet unknown, problem for many individuals. Unusual odors, damp smell or wall discoloration may be visual clues of a problem. Changes in your health, such as onset of asthma or worsening asthma, aggravation of allergies, headaches or fatigue after moving to a different residence may be an indicator of indoor contamination.

Individuals generally develop an allergy to mold due to an excessive exposure for that individual. Each of us have different tolerance levels and genetic makeup that can cause greater or lesser individual susceptibility. In a “sick house,” only one person can have a problem while the rest are symptom free, or all can be affected.

Different Varieties of Mold Allergies and Where They Reside

Not all mold allergies are created equal, and there are several varieties. Type 1 is the typical IgE allergy (histamine mediated response) causing nose and eye irritation, hives and asthma. The other five types cause variations in an inflammatory response, releasing other mediators, generally creating delayed-type allergic reactions over multiple hours. Symptoms could include fatigue, headaches, memory and cognitive problems, upset stomach, muscle and joint pain and skin rashes.   

Molds produce mold spores and chemical compounds, called mycotoxins, which are released into the air. There are hundreds of outdoor molds that can cause allergy, and they are often worse when the wind is blowing. Generally, symptoms from these molds respond to antihistamines, allergy immunotherapy and short-term use of steroids.

Indoor molds are fewer in variety, but when dampness occurs can cause severe medical problems, both allergic and toxic. In newer homes, the possibility for these molds to develop is enhanced by the tight construction requirements with very little fresh air exchange.

In older homes, damp crawl spaces and leaky air ducts can encourage mold growth. These enclosed environments hold the mold spores that are produced from damp areas in the house, and do not allow for dispersion of the mycotoxins (volatile neurotoxic organic compounds) in the air. These damp areas may be hidden in the walls, under sinks, behind washing machines, in AC closets or in ceilings. These locations are often hard to see, making isolating the problem area difficult.

Receiving Help for Your Mold Problems

Certified Indoor Air Inspectors can measure and define the different types of molds present and the spore concentrations.  With this information, they can calculate the percentage of each type of mold found and measure mold volatile organic compounds (MVOCs).

A physician experienced in treating mold exposure illness is generally consulted to correctly interpret the results as related to the affected person. Increased concentrations and higher percentage of spores from Aspergillus, Penicillium, Stackybotris and Cheatoninum are indicators of a potential problem.

MVOC measurement can help in finding areas that are hidden and growing “black mold” that produce the mycotoxins but not releasing spores into the rooms.

Tests Available to Help Identify Mold

If you are concerned that you are having symptoms from mold in your home, there are multiple lab tests available to help. Individual exposure and toxicity can be measured by urine tests for the excreted mycotoxins. IgG antibody blood tests can be used to document exposure to the individual species of mold. Skin allergy tests can determine the allergic component and specific cultures to determine type and amount of infection in sinuses or lungs.

In addition to diagnosing your specific issues via testing, effective treatment begins with avoidance of further exposure. If you have persistent symptoms and illness, the specific testing is necessary to determine the type of treatment needed. Continuing to live and work in a contaminated building only will make the medical condition worse. The good news is that there are numerous treatment options to improve your health if you find yourself struggling with symptoms from mold exposure – it’s a situation that can be remedied through a targeted approach tailored to the individual.

The post Can Excessive Mold Exposure Cause Allergic Reactions? appeared first on Johnson Medical Associates.

Now that we are all stuck inside due to the COVID-19 pandemic, how are you feeling physically? Do you find that you are more fatigued, having nasal congestion, difficulty concentrating, allergies feeling worse than normal, an unsteady mental state, bowel changes or unusual shortness of breath?

Certainly, we are all experiencing the anxiety of the unknown, concern for those sick and worry for our extended families during this time. It is especially overwhelming with children, family members and pets under our feet 24/7. However, your health can also be affected by odors and other living contaminants that may inhabit your living space, such as a natural gas leak, dust mites and mold.

I have never experienced a time where we were basically confined to our homes for an extended period. We need to ensure that staying inside is not going to harm us as a potentially toxic environment.

Do you feel better when taking a walk and getting out of your home? If yes, this is a first clue that there may be something in your home that is adversely affecting you. Not everyone may experience the same symptoms or feel anything at all, because individuals have different tolerances and immune symptoms, even in the same family. Everyone’s genetics are different, except in identical twins. The most allergic or sensitive person in a home generally notices the problem first. The canary?

Is there something in your home harming you? Some things to think about that could potentially harm you while you are staying inside in quarantine:

Natural gas leaks. These have that putrid odor of mercaptans-sulfur that is mixed in the natural gas to help detect leaks.

Dust mites. These microscopic insects live off your skin flakes and are generally most concentrated in the bedroom in sheets, pillows and pillowcases.

Mold. Different types of molds hide in the damp areas of your home. They have to have dampness to grow and produce that musty damp smell along with odorless toxins called mycotoxins that affect an individual’s nervous system. Mold can also affect the brain and the extended peripheral nerves to the extremities, intestinal tract and lungs, resulting in the multisystem effects a person may experience upon exposure.

Mold is most likely one of the biggest issues you may encounter, because a lot of people may have it in their home and not realize it. The National Institute of Health published a book titled Damp Indoor Environments, which describes in detail the adverse health effects of mold and mycotoxins. Excessive exposure may cause or exacerbate allergies, cause a mold infection in the sinuses or lungs, or the mycotoxins are inhaled and absorbed and distributed by the blood throughout the body causing neurological symptoms.

Molds grow in damp and dark spaces and are commonly seen as a result of roof leaks, broken pipes, standing water under the house, overflowing bathtubs or toilets, faulty shower pans or shower tile and leaks under the sink.

All these issues contribute to the dampness and potential mold growth frequently resulting in adverse health effects. Many times, the mold isn’t visible as it is in the wall cavities due to water seeping down from a roof leak, or wicking up the wall from the floor.

To determine if your home is having these issues, a Texas state certified Indoor Air Quality inspector is the best person to use to confirm if there is a problem, as they can measure dampness, are trained to visually inspect and do mold spore counts and mycotoxin counts, as well as volatile organic compound analysis of the air inside your wall cavities or other parts of the home.

In my 40 years working as a physician, I have seen all manner of environmental factors that affect patient’s health, oftentimes without their knowledge. Sometimes, the last place we suspect — our homes — may be the culprit when it comes to unexplainable symptoms. However, there is hope. When we ask the right questions and explore all factors that can affect a patient’s health, including their environment, I have seen time and time again that people’s quality of life changed for the better with a specific diagnosis and appropriate treatment.

The post Is Your Home Making You Sick? appeared first on Johnson Medical Associates.