Martin Dubravec, M.D.  



The Hilltop Allergy Letter


Volume 15    Number 3 



June - August 2016






              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. 




Possible Benefit Of Zithromax (azithromycin) Other Than Antibiotic Benefits


A recent study looked at the benefits of Zithromax (azithromycin) in treatment of 72 children ages 1 to 3 years with recurrent asthma-like symptoms.  The use of Zithromax in these children was associated with a significant reduction in their number of symptomatic days.  Symptom duration was reduced by 63% with Zithromax vs. placebo.  This was noted to be even a higher percentage if Zithromax was started within six days of the onset of symptoms.



The author suggests that this may be the result of Zithromax’s  ability to reduce inflammatory white blood cell counts in the airway.  One concern of using Zithromax and other antibiotics has been concerns of bacterial resistance.  Bacterial resistance refers to the phenomenon where bacteria will develop ways to prevent being killed by an antibiotic.  Resistance can also occur with viruses.  Viruses can also mutate to prevent being killed by antiviral medications. 

This is a valid concern, not only for physicians but for researchers.  However, it should be noted that many of the studies looking at bacterial and viral resistance are looking at patients who have multiple medical problems, are on a wide variety of medications and often come into contact with highly-mutated viruses and bacteria that often reside in hospitals.  Therefore, for patients who do not have frequent admissions to the hospital and/or do not have prolonged hospital stays, it is questionable as to whether or not bacterial or viral resistance is as much of a concern as is often presented in the media.



Patients who have any questions regarding their antibiotics or antiviral medications should check with their doctor.  Like any medication, antibiotics should only be used in patients for which there is a perceived significant benefit vs. risk with regard to the use of the medication.  Source:  Lancet Respiratory Medicine, 2006 (that old?) volume 4, pgs. 19-26.





Venom Allergy

            The overall mild winter that we had may have played a role in more reports in our office of patients who have had bee stings this Spring.  Extremely cold weather and significant snow can help to kill off hibernating hives of bees, wasps and hornets.



Any patient with a significant reaction to a bee sting should be carrying epinephrine at all times and should be evaluated by an allergist/immunologist for the possibility of a life-threatening venomous insect sting allergy.  Treatment with allergen immunotherapy (allergy injections) for venom-allergic reactions is a safe and life-saving therapy to hopefully stop and/or virtually erase the risk of an allergic reaction. 




Nasal Congestion



            A stuffy nose (nasal congestion) can be due to a variety of causes.  These causes include allergies, infection, medications, hormones and pregnancy as well as structural issues in the sinuses.  All of these causes increase blood flow to the nose which then causes the mucous membranes in the nose to become filled with blood and then stuffy.  Nasal decongestants work by causing the blood vessels in the nose to get smaller (constrict). 



The major decongestants on the market include Sudafed (pseudoephedrine) as well as phenylephrine and Afrin (Oxymetazoline).  Afrin is a nasal spray.  The other medications come in liquid or pills.  Sudafed is currently not readily accessible as it is an ingredient in methamphetamine and must be obtained either with a physician’s prescription or with the patient signing a special form.  Phenylephrine is available over-the-counter. 

Although phenylephrine is widely used as a nasal decongestant, its effectiveness has remained unproven.  A recent study looking at the benefits of phenylephrine show that it is no better than placebo, i.e., it does not seem to be effective in treating nasal congestion. (Source:  Annals of Allergy, Asthma and Immunology 2016, volume 116, pgs. 66-71.