Martin Dubravec, M.D.  


The Hilltop Allergy Letter

Volume 20    Number 4

December 2019 – February 2020



              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. 


A Possible New Way To Decrease Cat Allergy By Treating Cats.

                A very interesting study was recently completed regarding cat allergy.  In this study, cats were treated with a protein to decrease the amount of allergenic chemicals they produce.  This protein then worked to neutralize the allergen that cats make.  Levels of allergen in cats were shown to be significantly reduced.  Whether this allows cats to be less allergenic remains to be seen.  These cats were not yet tested with highly cat allergic humans to see how these humans would respond to these cats.


Asthma Continues To Be A Significant Issue In Pregnancy.

                A major study was recently completed regarding pregnant women with asthma.  In this study of over 100,000 of pregnant women, 19% of the patients with asthma in this study had severe asthma.  Only 40% of patients were listed as being adequately treated for their asthma with appropriate medications.  Asthma medications are safe in pregnancy.

                Any risks of using asthma medications in pregnancy are theoretical at best.  However, uncontrolled asthma can be deadly in pregnancy.  It should be noted that approximately one-third of women will have a worsening of their asthma with pregnancy and one-third will actually have an improvement in their asthma in pregnancy.


                        Postnasal Drip and Mucus From Milk

                A very interesting study was recently done to look at the effect of a dairy diet on postnasal drip and throat mucus production.  Milk consumption has been reported for years to cause an increase in mucus of the throat.  This has been labeled as the “milk mucus effect”.  Limited studies have failed to confirm the existence of this effect.  In this study, 108 subjects with the feeling of excess mucus production were studied.  They kept a daily food and symptom diaries and mucus scores.  After four days, they were put into two groups.  One group would receive a daily milkshake of disguised soy milk or cow’s milk.  One group would receive a daily milkshake of disguised soy milk.  The other group would receive a milk shake of cow’s milk.  The flavor was disguised and 70% of patients were unable to guess which group they were in.  These patients were then watched and after one week the patients reported their symptoms of mucus. 

                In this study, a dairy free diet was associated with a significant decrease in self-reported levels of throat mucus.  There is so far no good theory that can explain this.  These patients are not considered allergic to milk.  It could be that these symptoms actually represent some form of acid reflux from milk. 



                At the American College of Allergy, Asthma, and Immunology annual convention in November, an interesting presentation was given regarding the use of E-cigarettes.  E-cigarette use is rising rapidly in teenagers and young adults.  It is used more often in males than females.  In a study looking at E-cigarette use versus cigarette use, mouth and throat irritation were more prevalent in the E-cigarette group.  More nausea was noted in the nicotine group.  Lower rates of cough and mucus production were noted in the E-cigarette groups.  E-cigarettes were noted to be more effective for smoking cessation than nicotine replacement therapy.

                The opinion of the presenters at this conference was that daily E-cigarette individuals were more likely to have quit smoking cigarettes or reduce the use of cigarettes compared to nonusers.  E-cigarette users had a lower risk of wheezing and other lung problems compared to smokers.  According to the presenters, although not recommended, E-cigarettes are preferable to smoking.  Finally, the presenters remarked that recent concerns regarding E-cigarettes use and vaping with regard to deaths of individuals using these products seem to be associated with very toxic illegal substances being inhaled through these devices versus the act of vaping or E-cigarette use itself.


Prebiotics and Probiotics

                Recent attention has been given to the use of prebiotics and probiotics in preventing allergic disease.  Studies seem to favor the use of probiotics, but the problem is which probiotics, what strength of probiotics, and what type of bacteria in probiotics are best for patients.  Unfortunately, there are no strong recommendations regarding these issues.  Perhaps there are certain groups of individuals that will benefit from probiotics versus other individuals.




December 2019

Martin Dubravec, MD


What’s Wrong with American Health Care – Part 2


            In the last newsletter, I introduced the concept of healthcare being a service, and not a right.  The United States has the best healthcare of any country in the world.  However, it certainly has its challenges.  Like any system, it certainly could be better.  Much of the challenges in our healthcare revolve around the cost of the care.

            There are four major groups that interfere with the ideal healthcare system in our country.  These are big government, big hospital systems, the pharmaceutical industry, and the insurance industry.  In this newsletter, I would like to touch upon the first of these.

            The role of government in society is to maintain a safe and to the best extent possible, harmonious society.  The American governmental system is unique in that it was the first system ever in world history to recognize personal freedom as the foundation for its functioning.  Over the years, however, the government has become increasingly involved in activities that would otherwise be the responsibility of citizens.  When government takes over what should be individual responsibility, problems can rapidly arise.  This in no way should mean that the government should not help its citizens.  Rather, it should limit itself to helping those who truly cannot help themselves or receive help from others such as other family members, churches, community organizations, and local governmental agencies. 

            When government takes over aspects of healthcare, we see the problems, especially financial.  For instance, the Medicaid system was originally set up to help poor people pay for their healthcare.  It has grown into a huge bureaucracy, is increasingly expensive, and Medicaid fraud is too often noted as unethical physicians or businesses try to take money from the state government unnecessarily.  The Medicare system is also financially in big trouble and is scheduled to go broke within the next 15-25 years depending on what economist is quoted.  An option to help decrease state Medicaid expenses would be to have health savings accounts for Medicaid patients.  This was tried in Indiana.  This gave patients the opportunity to have some control over their healthcare dollars.  This saved the state of Indiana 30% when this process was undertaken.  Unfortunately, the federal government barred this form of healthcare aid as it stated it was in violation of Obama rules for healthcare.

            Another source of significant government overspending and waste is the VA system.  A very simple fix of the massive problems in the VA ( including fraud and poor quality healthcare) would be simply to allow all veterans to have a choice of private insurance and offer them reimbursement for a private insurance premium.

            In summary, governmental aid for healthcare should be limited to those who are truly in need due to severe poverty as well as patients with rare, complex, life-long severe diseases requiring extensive and daily medical therapy.  Like so many other aspects of our economy, if we let doctors, patients, and private charitable organizations handle most of the healthcare needs of our patients, healthcare costs will go down significantly and allow patients more choice, selection, and responsibility with regard to their healthcare decision making.