SPECIALTY CLINICS
At the beginning of 2007 Mariner Medical Center opened, within its new facility, for the convenience of our patients, a clinic of Specialists. Each one has scheduled regular days and hours for appointments, referred primarily by our own physicians. We offer a broad range of Specialists in fields important to our patients. These include Cardiology, Dermatology, Obstetrics, Orthopedic Surgery and Allergy/Rheumatology among others. An entire section of the Center, including a Specialist waiting room, is designed to provide excellent Specialty healthcare services. Each has a private practice, but being able to be seen at Mariner Medical Center is an added convenience for our patients.
Appointments are handled in the same way as our primary and urgent care services. There also is assigned especially trained support staff to handle patient/doctor relations and appointments for special procedures. If you have a referral to one of our Specialists you may make an appointment at the time you receive your referral or it will take only a phone call to (650) 570-2299 or an email, to schedule an appointment.
April 8, 2009
The 10 Billion Dollar Sneeze
Allergic Rhinitis Is Sweeping the United States
Dr. Umesh K. Sab
The Allergy Epidemic
Everyone seems to be sneezing, and our lifestyle may be the culprit, but help is on its way.
The bright blossoms and tender leaves of spring usually signal a season of joy and renewal, but for millions of Americans it heralds a season of wheezing and sneezing with allergies. Allergies, once the bane of a small sniffling minority, has become epidemic. In this country approximately 30% of adults and 40% of children now suffer from Allergic Rhinitis, the nasal congestion and itchy eyes commonly called “hay fever”. Many are plagued by indoor mites, molds and allergies to peanuts, even allergies to latex are increasing.
In the last three or four decades the incidence of allergies has not only mushroomed in America, but throughout the western industrialized world while decreasing in children living in the rural parts of the globe. Yet, despite being ubiquitous, allergies remain mysterious.
Heredity plays a role, but cannot explain the sharp recent increases in the disease. Many culprits have been proposed, including pollution and changes in lifestyle. The most tantalizing possibility is allergies may be caused by the success of civilization itself. As modern life has become more hygienic with indoor plumbing, immunizations against disease and the use of antibiotics, the human immune system has not much to do except to attack allergens and the body itself.
The economic burden of Allergic Rhinitis and its increasing complications costs Americans over 10 billion dollars a year. Allergies may be viewed as a trivial nuisance disease but they frequently lead to sinusitis, ear infections, nasal polyps, sleep disturbances and cognitive impairment. The result is a substantial reduction in the quality of life.
What are the Symptoms
The common symptoms of these allergies are runny, itchy nose, sneezing, nasal and head congestion. Other symptoms include fatigue, scratchy throat, postnasal drip and itchy watery eyes.
How are they Diagnosed
Usually skin tests are done to find out what the body is allergic to. These are the usual prick tests. The allergist places tiny amounts of suspected allergens under the skin and looks for reactions. These tests will identify which of the many possible allergens are causing the troublesome symptom.
How are Allergies Treated
The initial advice is to avoid the allergens causing the problems. Banish pets, stuffed animals, down comforters, peanuts from the diet and dust relentlessly. Covering the mattress and pillows with plastic often relieves symptoms.
The second step usually is drug therapy treatment. The first lines in this defense are antihistamines and decongestants. Traditional antihistamines cause drowsiness, but the newer ones are less sedating. The third line of defense is the use of nasal sprays like intranasal steroids or antihistamines. The intranasal steroids include such familiar drugs as Flonase, Nasonex, Nasacort and some newer agents. The intranasal antihistamines include Astelin and Patanase. Eye drops such as Patanol and Optivar can be helpful as well.
If the symptoms are severe in spite of medications then allergy shots may be the next defense. These are usually mixtures prepared that contain the allergens identified in the skin tests. By injecting these into the skin in tiny and increasing amounts over the course of many months tolerance to the allergens may build up. In fact allergy shots have been used for over 100 years and remain one of the most effective treatments.
The Future
Researchers also have been able to defang IgE, which is the main antibody which mediates allergic reactions. Xolair, which is a biologic product developed by Genentech, is an antibody against IgE, preventing it from docking on mast cells and stifling the sneeze before it starts. Now available for the treatment of severe asthma only, it is currently being studied in cases of severe allergic rhinitis.
The newer advances in science should be able to decipher the enigma of allergy and usher in a future in which spring will promise nothing but delight to everyone.
About the Author: Dr. Umesh Sab specializes in the diagnoses and treatment of allergies, asthma and rheumatic diseases. He has been practicing in San Mateo County for over 20 years. He has offices in Redwood City and at Mariner Medical Center in Foster City.
Dr. Sab received his specialty training at Scripps Clinic & Research Foundation and the University of California, San Diego. His is board certified in Internal Medicine as well as in Allergy, Immunology and Rheumatology.