Martin Dubravec, M.D.  

The Hilltop Allergy Letter

Volume 20  Number 3

June – August 2021



              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. 


Summertime allergens

              The major summertime allergens include mold spores, grass, and weed pollens.  With the exception of pine pollen which can pollinate through June, the main sources of airborne allergies include rye grass, Kentucky blue grass, and ragweed, among others.

              Mold spores are the most common and numerous airborne allergens floating in the air in the spring, summer and fall.  They have been noted to be particularly associated with asthma flare-ups in some allergic individuals.



A variety of new therapies have been developed over the past few years to treat severe asthma, severe atopic dermatitis, and severe hives.  These medications are classified as biologics.  Biologics are proteins that are manufactured to block specific inflammatory proteins made by the immune system.  Unlike regular medications (pharmaceuticals), biologics are monoclonal antibodies, i.e., specific proteins that mimic anti-inflammatory proteins that the body produces.  Biologics block a variety of inflammatory proteins in the human body.  This results in a significant decrease in inflammation.

                Inflammation is the major driving force in causing the negative effects of asthma, atopic dermatitis (eczema) and hives.  Inflammation can be described as excess heat. 

                When an engine does not have enough oil, but is still able to run, the excess heat produced could be described similar to the inflammation that the body produces when the immune system is inappropriately stimulated. 

                Biologics have been used to treat cancer for many years.  However, in the past few years, biologics have become widespread in the treatment of a variety of disorders such as severe migraines. 

                Concerns about the development of cancers has always been thought about in the development of biologics.  Fortunately, some of the biologics used for allergic diseases have been around for a long time and we are not seeing a rise in cancers or other diseases with the use of these therapies.

                The major biologics are as follows: 

  • Xolair – Xolair is used to treat asthma.  It was the first biologic that received FDA approval to treat severe asthma.  More recently, Xolair has been approved to treat chronic hives.  It is an excellent treatment for severe hives.  Most recently, Xolair has been FDA approved to treat nasal polyps. 
  • Side effects of Xolair can include serious allergic reactions.  Xolair may be administered at home after a trial of receiving it in a doctor’s office. 
  • Nucala – This biologic is used to treat asthma and a rare disease called hypereosinophilic syndrome.  Nucala is given on a monthly basis.
  • Nucala is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home. 
  • Fasenra – Similar to Nucala, this medication is used to treat severe asthma as well as hypereosinophilic syndromes.  Fasenra can be given every two months after three months of monthly therapy.
  • Fasenra is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home. 
  • Dupixent – Dupixent was first approved to treat severe eczema.  It was one of the few new therapies in the past ten years to treat severe eczema.  It is an excellent drug to treat severe eczema. 
  • Dupixent is given as a first dose in a doctor’s office and then can be given either in a doctor’s office or at home. 
  • It has also been FDA approved to treat asthma and to treat nasal polyps.  Side effects of Dupixent can include irritation of the eyelids.  This is rare, but we have seen it in our office. 
  • Cinqair – Cinqair is similar to Nucala and Fasenra, but is given as an IV infusion on a monthly basis.  It is effective in treating severe asthma.


Around the Mitchell House

                One of the grandchildren of Charles and Mary Gleason Mitchell visited with her husband this spring.  She was last in this house when she was five years old.  Fortunately, she was able to remember much of this house and reminisced about her visits to Cadillac from Oregon where the son of Charles Mitchell, William Mitchell, raised his family.  We were happy to host them and give them a tour of Cadillac.