Martin Dubravec, M.D.  

The Hilltop Allergy Letter

Volume 18    Number 2

March 2019 – May 2019



              We welcome all new and established patients to our newsletter.  This is formulated four times a year to inform patients and the medical community with regard to new developments in asthma, allergies, and clinical immunology.  Please feel free to take this home with you and share it with family and friends. 


Seasonal Allergens


Spring brings about the beginning of our outdoor plant allergy season. Trees typically pollinate March through May. They will not pollinate until we have sustained temperatures above 32 degrees. If March is cold, then tree pollination will often be pushed into April. Tree pollination typically ends at the end of May. The one exception is that of pine pollen which tends to be significant in May and June.

Grass pollination will start in May and goes through August. Grass pollination often overlaps with tree and weed pollination.

Weed pollination is typically noted July through the first frost. The most common weed pollen is that of ragweed and it tends to pollinate in very large amounts from the first week of August through the end of September.


Make Sure Your Epinephrine is not Out of Date


Epinephrine is the only medication that can stop a severe allergic reaction (anaphylactic shock). Therefore, for patients with severe allergic reactions to bee stings or foods, epinephrine should always be available for immediate use. Epinephrine that is beyond its expiration date may not work as well and is not as potent as epinephrine that is up to date. The patient should check their epinephrine prescriptions to make sure they are not outdated. When picking up an epinephrine kit at the pharmacy, we recommend that it not expire for at least a year to prevent significant cost to our patients.

For infants, there is now an FDA-approved dose for children less than 22 pounds. If you have any questions, please do not hesitate to contact our staff.



Eosinophilic Esophagitis


Eosinophilic esophagitis (also known as EoE) is becoming more widely known as a non-life threatening food allergy syndrome. In this disease, certain white blood cells called eosinophils tend to hang out in the esophagus for unknown reasons. These eosinophils will then falsely become stimulated by a certain food or foods that a patient eats. This causes irritation of the esophagus.

In young children, EoE often presents as vomiting or heartburn. In adults, EoE often presents as heartburn or with food getting stuck in the throat. It is more common in men than women. No one knows how this disease starts. It tends to be a chronic disease.

If left untreated, eosinophilic esophagitis can lead to scarring and chronic narrowing of the esophagus and can lead to chronic difficulties with eating. The diagnosis of EoE involves a scope put down a patient’s throat. Biopsies of the esophagus are then taken to look for eosinophils.

Treatment of EoE can significantly improve patient’s symptoms. Treatment involves antacid medications as well as swallowed steroids. Unfortunately, the only way to make the diagnosis of EoE is with a scope. Also, the best way to follow patients to see if their EoE is improving is to have follow-up scopes. This can be very impractical and problematic. The challenge is that many patients can have significant swelling of their esophagus without even feeling it until the swelling becomes so severe that food gets stuck.

Continued research into EoE will hopefully allow us to find ways in which we can manage patients without the need for repeated scopes and biopsies of the esophagus. If you have any questions regarding EoE, please do not hesitate to contact one of our staff.


Around The Mitchell House


This year, we will be working on some chimney work with regard to the Mitchell House. These chimneys are showing their age. They receive a lot of weathering on top of the hill (traditionally known as Piety Hill. This was where the first residential settlement of Cadillac took place). Hopefully, this will keep the chimneys in good shape for many years to come. We are dedicated to maintaining this wonderful historical property which was the home of George Mitchell, the founder of Cadillac.