The Hilltop Allergy Letter

Volume 17    Number 2

March 2018 – May 2018




              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. 


Spring Allergies


This relativity mild winter may be significant for an early onset of spring.  Trees begin to pollinate as early as March and typically pollinate through May.  Grass pollens begin often in April or May and go through July with weed pollens being summertime into fall.  We measure the pollens on a regular basis during the week, and those are accessible on our website or at our office.  Since high pollen counts are often correlated with allergic disease, these pollen counts can be very useful in addressing symptoms that patients have with regard to their allergies.  If you have any questions with regard to outdoor aeroallergen exposure or measurements, please do not hesitate to contact one of our staff. 


Infants Eating Eggs – Does This Prevent Egg Allergy?


Three studies were recently completed looking at early introduction of egg protein into the diet of infants to see if this would prevent them from developing food allergies to egg.  This is based upon other studies showing that early introduction of peanut protein may prevent development of peanut allergy in the population.

Unfortunately, in these three studies, early introduction of egg into the diets of four- to six-month old infants did not help prevent the development of food allergy to egg.  The good news is that early introduction of egg protein did not increase the risk of food allergy to egg.

There continues to be quite a bit of interest in the medical community with regard to prevention of food allergy.  This is due in part to the significant rise in food allergy that we have seen in infants and toddlers over the past 10 years.  Nonetheless, there is no consistent scientific evidence across the board to say that eating solid foods before age six months is better than not eating these foods, especially foods that are notorious for causing allergic reactions (peanut, milk, egg, wheat, soy and shrimp).  Further research will need to be done to settle many questions regarding food allergy. 

Dr. Dubravec does not recommend that patients restrict certain foods at an early age nor does he recommend that patients be fed foods such as peanut at an early age.  Current recommendations regarding either practice are lacking in sound consistent science.  Instead, patient should introduce soft solid foods at about six months.  Useful foods to start include meats, fruits, vegetables and grains.  Dr. Dubravec feels that there are a group of patients who may benefit from restricting their dietary intake of a certain food to prevent the development of food allergy.  He also believes there may be another group for which early introduction of a food may help prevent food allergy.  Unfortunately, we do not have the know-how to figure out which group of patients fit in each of these groups.  Perhaps there is no benefit from either restricting or early introduction of a food and that other factors may cause development of food allergy.  Please do not hesitate to contact any of our staff regarding food allergy and management. 


Do You Know How To Use Your Asthma Medicines?


We now have more asthma medications than ever before.  This wide variety of medications is a wonderful benefit for the American population as the variety of medications allows for a more tailored and individual approach to asthma management.

However, with this wide array of available medications comes different ways of inhaling these medications.  There are at least five different types of inhaler devices.  Sometimes, patients may be described three different types of inhalers which can make properly using these medications problematic.  Any patient who has been prescribed an inhaler in our office should be comfortable using this medicine by the time they leave the office.  Also, patients who have follow-up visits to our office are welcome to review their inhalers with our staff.  All of our (nursing?) staff is trained in the proper use of the inhalers.  If you are confused as to how your inhaler or your child’s inhaler is to be used properly, we are always available to review this with you.  The proper use of a medication is often more important than the strength of the medication in helping a patient.


What Makes A Good Doctor?


        Increasingly, patients are finding it increasingly challenging to find good doctors.  Patients have the right to be taken care of by a good doctor.  Patients have a right to seek whatever care they want with whatever doctor they want.  But what really defines a good doctor?  Although each of us may be able to make our own list, an appropriate list includes the following:


1.  A good doctor listens.  Due to time constraints, computers, electronic medical records, and our digital/lack of communication-society, it is increasingly less common for physicians to listen to their patient’s concerns.  At times it seems as if a physician cannot even address a patient’s concerns as the doctor is concerned about something else that may be going on with the patient but is not of utmost concern for the patient.  A good doctor will always list the patient’s concerns first and other pressing concerns will be addressed after the patient’s concerns are first addressed.


2.  A good doctor cares.  Caring is simple.  It is not always easy.  Caring involves being inconvenienced.  Caring involves empathy, i.e., understanding the patient’s concerns but not becoming emotionally involved in the patient’s concerns.  Doctors must have a certain amount of emotional detachment in order to remain objective and be able to help patients, especially in crisis situations.


3.  A good doctor is passionate about learning.


4.  A good doctor is passionate about the profession of medicine.  Good doctors are proud to be doctors, are respectful of others who are not doctors and know their very special and important role in society. 


5.  A good doctor is available after hours.  Illness does not carry regular office hours, Monday through Friday.  Although doctors do need time off and have personal commitments with family, good doctors are available within reason for their patients at all times.


6.  Good doctors respect not only the patients, but their staff and their fellow doctors.  Doctors are some of the most critical of others in their profession.  Doctors are often asked to make second opinions of their colleagues.  This is very reasonable as it gives patients choices and aids them, especially with regard to big decisions.  Walking the line of constructive criticism with our colleagues vs. outright scorn of colleagues is sometimes difficult.


7.  The priorities of a good doctor are as follows:  God, family, patients, staff and community.  All of these are important and a doctor who can appropriately prioritize these in this order is a good doctor.








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