For some patients with asthma avoidance of triggers and inhaled (and oral) medications are not enough to control their asthma.  Recently, several new medications, known collectively as “biologics,” have been approved for the treatment of moderate-to-severe asthma. The term “biologic” is used for medications and other healthcare products that are made from living animals, plants, or cells, instead of through a chemical process. Biologics include a wide range of products, such as vaccines and blood products, as well as medications used to treat certain medical conditions (e.g., insulin for diabetes). Biologic therapies offer new ways of treatment because they target different molecules in the body that contribute to asthma. Biologic therapies can treat some types of severe asthma by helping to stop body processes that cause inflammation of the airways. This inflammation that may be caused by allergies or by high levels of a cell in the body called an eosinophil. Eosinophils are a type of white blood cell linked to inflammation. People with severe asthma sometimes have high levels of eosinophils in the blood.

If your provider is considering using a biologic to treat your asthma, the biologic would be added to the reliever and controller medications you are currently taking. Biologics do not replace these medications, although some people may find that they are able to reduce the dose of their controller medication after several doses of a biologic. Please note that you should only reduce the dose of your controller if your specialty provider tells you to do so.

Several options are available for biologic therapy in treating severe asthma with the so called allergic or eosinophilic phenotype. Severe allergic asthma where severe symptoms are triggered by allergies. This type of asthma mostly starts in childhood. Omalizumab is a biologic that targets severe allergic asthma, reducing the allergic response. Eosinophilic asthma where severe symptoms are triggered by higher levels of cells called eosinophils. This type of asthma is usually associated with adult-onset asthma. Mepolizumab, reslizumab and benralizumab are all biologics that target severe eosinophilic asthma, by reducing eosinophils.  Severe asthma with type 2 inflammation where severe asthma symptoms are driven by both allergies and high levels of eosinophils. Dupilumab is a biologic targeting severe type 2 inflammatory asthma. It works by damping down the inflammatory response. The most recently approved biologic is a drug known as Tezepelumab. This targets an entirely different aspect of the asthma inflammatory cascade.  Most of the therapies are given as an injection, either in the office, or using pre-filled syringes at home. Reslizumab is given through an intravenous infusion. Biologic treatment is given as an injection at your doctor’s office or special clinics, usually every 2 to 4 weeks, depending on the particular medication.

As with all medicines, biologic treatments can have risks and side effects. Some common side effects (affecting up to 1 in 10 people) include: headache, sinus pain, sore throat, soreness at the injection site (this should pass in a few days and may improve after you’ve had the injection a few times). Biologic treatments for asthma have an increased risk of a severe allergic reaction (anaphylaxis). The risk is rare (1 in 1000 or more) and more likely if you have a history of allergic reactions or anaphylaxis.  This is not a complete list of the side effects that may happen with biologics; if your doctor is considering a biologic for you, please make sure to ask about the possible side effects that could happen with the specific medication you will be using.

There are currently no set recommendations on how long a patient should be on a biologic.  Guidelines recommend trialing the medication for at least four months to see if it is helping improve your asthma.  Your specialist may use tests to assess your status such as spirometry, FeNO, and blood tests. Whatever biologic you are prescribed, you will need to review your treatment regularly with your provider. Your doctor will work with you to decide how long to keep you on a biologic if your asthma is under good control. Contact your healthcare team if your asthma symptoms are not improving or are getting worse. Do not stop taking either your usual asthma medicines or your biologic treatment unless your doctor tells you to. If your treatment’s not working for you, or you’re getting difficult side effects, your specialist may stop treatment and look at other options.

When suspicion is raised about a possible allergy, your allergist will first get more details from your history. Do the symptoms suggest an environmental allergy such as sneezing, nasal congestion and itchy eyes? Perhaps symptoms developed after ingestion of food or after an insect sting. He or she will want to know about any symptoms of asthma as well as family history. The medical history serves as a basis for the allergy diagnosis and may then lead to confirmatory testing. There are 2 primary forms of testing, the skin test – which gives the fastest and most accurate results – and the allergy blood test.

A skin prick test, also called a puncture or scratch test, checks for immediate allergic reactions to as many as 50 different substances at once. This test is usually done to identify allergies to pollen, mold, pet dander, dust mites and foods. In adults, the test is usually done on the forearm. Children may be tested on the upper back. Skin prick testing provides results in about 20 minutes. A liquid containing a tiny amount of the food allergen is placed on the skin. Your skin is pricked with a small, sterile probe, allowing the liquid to seep under the skin. Multitest devices now allow for 8 or 10 tests to be applied simultaneously, making the process even easier. To see if your skin is reacting normally, two additional substances are scratched into your skin’s surface. Histamine (positive control) – in most people, this substance causes a skin response. If you don’t react to histamine, your allergy skin test may not reveal an allergy even if you have one. Glycerin or saline (negative control – in most people, these substances don’t cause any reaction. If you do react to the negative control, you may have sensitive skin. Test results will need to be interpreted cautiously to avoid a false allergy diagnosis. The test isn’t painful.  You won’t bleed or feel more than mild, momentary discomfort. The test is considered positive if you develop a raised, red, itchy bump (wheal) that may look like a mosquito bite. The nurse will then measure the bump’s size and record the results. Next, he or she will clean your skin with alcohol and may apply a topical steroid. When the test is over, the doctor or nurse will clean your skin and put some cream on it to help with any itching.  Any swelling from a reaction usually goes away within 30 minutes to a few hours. Some medicines can get in the way of the tests. Check with your doctor to see if you need to stop taking any medication before the test.

If you take medicine that could affect allergy test results, have sensitive skin, or have had a bad reaction to a skin test, your doctor might do a blood test instead. A sample of your blood is sent to a lab, and your doctor will typically get the results in about a week. Allergy blood tests, which are a bit less exact than skin tests, measure the amount of IgE antibody (“allergic antibody”) to the specific allergen being tested and are reported as a numerical value. This is typically more expensive than a skin test.

Your allergist will use the results of these tests in making a diagnosis. If an allergy test is negative, you aren’t allergic to that substance. It’s rare to get a false (incorrect) negative allergy test result (meaning the test says you don’t have an allergy when you actually do). A positive test however does not mean you have an allergy – or at least react to that allergen. A false positive test result is possible, especially from a blood (IgE) test. A false positive means the results show you have an allergy when in fact you don’t.

In some cases, a skin or blood test is not available, or the results are not conclusive. In those cases, an allergist may recommend an oral challenge. This is considered the most accurate way to make a food allergy diagnosis. During an oral food challenge, which is conducted under strict medical supervision, the patient is fed tiny amounts of the suspected trigger food in increasing doses over a period of time, followed by a few hours of observation to see if a reaction occurs. Because of the possibility of a severe reaction, an oral food challenge should be conducted only by experienced allergists in a doctor’s office or at a food challenge center, with emergency medication and equipment on hand.

Preparing for Allergy Skin Testing

There are certain medications that can interfere with the performance of an allergy sin test and therefore limit its value. For that reason, it is important to review the list below.

Medications MUST be stopped for at least 7 to 10 days prior to allergy testing

Antihistamines – “Allergy medications”  (Brand name / Generic name)

• Allegra (fexofenadine)
• Chlor-Trimeton (chlorpheniramine)
• Zyrtec (cetirizine)
• Xyzal (levocetirizine)
• Claritin (loratadine)
• Clarinex (desloratadine)
• Benadryl (diphenhydramine)
• Atarax (hydroxyzine)
• Astelin/Astepro (azelastine) allergy nasal spray needs to be stopped
• All allergy eyedrops need to be stopped

Medications used for Heartburn may be an antihistamine and must be stopped

• Pepcid (famotidine)
• Zantac (ranitidine)
• Tagamet (cimetidine)

Please contact the office if you are taking any of the following medications:

• Oral steroids (prednisone, methylprednisolone, dexamethasone)
• Tylenol PM (And all other “PM” medications) – these contain Benadryl
• Antidepressants (amitriptyline, nortriptyline)

If you have ANY questions about your medications, please call the office 774-420-2611

Shortness of breath, known as “Dyspnea” (pronounced disp-nee-ah) is a debilitating symptom that is the experience of unpleasant or uncomfortable respiratory sensations. It is a common symptom of many medical disorders, particularly those involving the cardiac and respiratory systems. Shortness of breath on exertion is the most common complaint for people with respiratory impairment. Importantly, shortness of breath is a symptom experienced by an individual. It is not a noticeable or measurable sign. Although the exact mechanisms that lead to shortness of breath are not fully understood, some general details have been found. Common causes of shortness of breath include: Asthma, chronic bronchitis, emphysema, Chronic Obstructive Pulmonary Disease (COPD), pneumonia, heart failure, coronary artery disease, obesity, deconditioning and pregnancy. Some less common causes of shortness of breath include: Pulmonary fibrosis, pulmonary embolism, lung cancer, cystic fibrosis, pleural effusion, pulmonary hypertension.

Your MLA physician will approach your shortness of breath by taking a careful history, performing a physical examination as well as reviewing or ordering a chest x-ray, and any other information that you bring to the office visit. Based on these findings he may order additional studies such as pulmonary function tests, or a cardiac evaluation, and may prescribe appropriate medications for your condition.

A chronic cough is one that has persisted for more than 8 weeks. There is a very large number of diagnoses that can cause a chronic cough, but only a handful cause most of the problems. These include chronic bronchitis from cigarette smoking, post nasal drainage, asthma and gastroesophageal reflux disease. Your MLA physician is experienced in the evaluation and management of chronic cough. He will take a thorough history and perform a physical examination. If you have not had a chest x-ray recently one will likely be performed just prior to your visit. Otherwise, you will be asked to bring a copy of your x-ray. Based on this initial evaluation you will likely be treated for the entities that are suggested by your history and physical examination findings. You will likely also be scheduled for additional tests which may include pulmonary function tests, a barium swallow x-ray and others. In individuals with a chronic cough, it is not uncommon for the cough to be caused by more than one entity, and until all are identified and treated, the cough may persist.

Allergic rhinitis, commonly known as a runny nose, or when due to pollen exposure, “Hay Fever” is the medical term describing irritation and inflammation of the nose. This results in a variety of symptoms including runny nose, sneezing, stuffy nose, sore throat, itching of the nose, mouth and eyes, as well as tearing of the eyes. An allergen is something that triggers an allergy. When a person with allergic rhinitis breathes in an allergen such as pollen or dust, the body releases chemicals, including histamine. This causes allergy symptoms. Hay fever involves an allergic reaction to pollen. A similar reaction occurs with allergy to mold, animal dander, dust, and similar inhaled allergens. The pollens that cause hay fever vary from person to person and from region to region. Large, visible pollens such as those from colorful, showy flowers are seldom responsible for hay fever. Tiny, hard to see pollens more often cause hay fever. Examples of plants commonly responsible for hay fever include trees, grasses, and weeds, in particular, ragweed. Though allergies (and allergic rhinitis) are common, many people who suffer from the symptoms above actually do not have allergy! When consulting your MLA physician it is likely that allergy testing will be performed. This will tell you if in fact your symptoms are due to an environmental allergy and if so, which particular ones. Skin testing (“scratch test”) is the most common method of allergy testing. If your doctor determines you cannot undergo skin testing, special blood tests may help with the diagnosis. These tests can measure the levels of specific allergy-related substances (antibodies), especially one called immunoglobulin E (IgE). Based on the results of the allergy testing, your physician will be better able to recommend various treatments, including avoidance strategies, medications and allergy shots (immunotherapy) to help control your symptoms.

Chronic obstructive pulmonary disease (COPD) refers to chronic bronchitis and emphysema two commonly co-existing diseases of the lungs in which the airways (bronchial tubes) become narrowed. This leads to a reduction of the flow of air to and from the lungs causing shortness of breath. Unlike in asthma, the reduced airflow is poorly reversible and usually worsens over time. COPD is caused by noxious particles or gases, most commonly from cigarette smoking, which leads to inflammation in the lung. Inflammation in the larger airways results in chronic bronchitis (which is characterized by cough and sputum production). Inflammation in the air sacs (alveoli) causes destruction of the tissues of the lung, and this results in emphysema. The natural course of COPD is characterized by occasional sudden worsening of symptoms called acute exacerbations, most of which are caused by infections or air pollution. COPD is the 4th leading cause of death in the U.S., and the economic burden of COPD in the U.S. in 2007 was $42.6 billion in health care costs and lost productivity. The primary risk factor for COPD is chronic tobacco smoking. In the US, 80 to 90% of cases of COPD are due to smoking. Exposure to cigarette smoke is measured in pack-years, the average number of packages of cigarettes smoked daily multiplied by the number of years of smoking. Other factors include exposure to certain workplace dusts and chemicals, air pollution, and genetics. The diagnosis of COPD is considered in anyone who has shortness of breath, chronic cough or sputum production, and/or a history of exposure to risk factors for the disease such as regular tobacco smoking. No single symptom can adequately confirm or exclude the diagnosis of COPD although COPD is uncommon under the age of 40 years. The diagnosis of COPD is confirmed by lung function testing (spirometry). Spirometry can also help to determine the severity of COPD.

Your MLA physician will evaluate COPD by taking a careful history, performing a physical examination as well as reviewing or ordering a chest x-ray, and any other information that you bring to the office visit. If not already done pulmonary function tests will be ordered. COPD management not only consists of appropriate medications but attention to lifestyle change (exercise, smoking cessation), pulmonary rehabilitation, nutrition and if needed, supplemental oxygen therapy.

What is Asthma

Asthma is a chronic disease that inflames and narrows the airways (the tubes that carry air into and out of your lungs).  Asthma causes recurrent wheezing, chest tightness, shortness of breath, and cough.   Asthma affects people of all ages, but it most often starts in childhood.  In the United States, more than 22 million people are known to have asthma.  Inflammation in asthma makes the airways swollen and very sensitive. They tend to react strongly to certain substances that are breathed in.  When the airways react, the muscles around them tighten. This causes the airways to narrow, and less air flows to your lungs. The swelling also can worsen, making the airways even narrower.  Cells in the airways may make more mucus than normal.  Mucus can further narrow your airways.

Sometimes symptoms are mild and go away on their own or after minimal treatment with an asthma medicine.  At other times, symptoms continue to get worse. When symptoms get more intense and/or additional symptoms appear, this is an asthma attack.  It’s important to treat symptoms when you first notice them. This will help prevent the symptoms from worsening and causing a severe asthma attack. Severe asthma attacks may require emergency care, and they can cause death. Asthma cannot be cured. Even when you feel fine, you still have the disease and it can flare up at any time. With proper treatment, most people who have asthma can expect to have few, if any, symptoms either during the day or at night.

How is Asthma Diagnosed?

Asthma is often diagnosed clinically – a diagnosis based on signs, symptoms and examination. The diagnosis however, even if made by a physician, may not be correct. Asthma is more accurately diagnosed with a breathing test, called a PFT – pulmonary function tests. The most common PFT is called spirometry. Your provider though may want you to have a more specific test known as a methacholine challenge test.  Follow the links for more information.

https://www.thoracic.org/patients/patient-resources/resources/pulmonary-function-tests.pdf

https://www.thoracic.org/patients/patient-resources/resources/lung-function-studies-methacholine.pdf

How is Asthma Treated?

Once you are diagnosed with asthma, it is very important that you work closely with your provider to control your asthma. You and your provider can develop an Action Plan that you will follow to treat your symptoms and improve your breathing. Your Action Plan will include when to take your medications, what you can do in your daily life to avoid triggers, and how to monitor your breathing.

One of the central tenants of asthma care is known as Lifestyle Management. This begins with learning what specific “triggers” may be causing your asthma symptoms. Keep a journal to track your day-to-day activities along with any symptoms that you may be having during the day or at night. Once you know what may be causing your asthma, you can then try to stay away from those triggers. Asthma Triggers include:

• Respiratory tract infections
• Allergens (e.g., dust mites, cats & dogs, molds)
• Chronic sinusitis
• Exercise
• Cigarette smoke (1^st and 2^nd hand)
• Vaping and hookah
• Gastroesophageal reflux disease
• Medications (e.g., Beta-blockers, Aspirin)

Stay healthy: Eat nutritious foods and get regular exercise. Avoid people who smoke and those that may have an infection, especially a cold or the flu. Cope with stress: Learn new ways to cope with stress. Coping with stress can help prevent and control your asthma.

Medications will be prescribed that keep your airways open and reduce swelling, so air can move in and out of your lungs more easily. First line therapy is with a short-acting bronchodilator, most commonly albuterol or levalbuterol. This is known as ‘reliever’ or ‘rescue’ therapy and is used as needed for symptom relief. These medications relax the muscles that have constricted around the airway.  Use of an inhaler may not be as easy as it looks. Make sure you review proper technique with your provider. You can follow the link below for additional tips on their proper use.

https://www.thoracic.org/patients/patient-resources/resources/metered-dose-inhaler-mdi.pdf

If your asthma symptoms are more persistent – for example, you require use of your albuterol more than twice per week, or you wake because of your asthma more than twice a month, your provider will start you on what is known as ‘controller’ or maintenance therapy. Unlike the short acting bronchodilator, these medications must be taken every day. The mainstay of therapy is the inhaled corticosteroid (ICS). The medications provide anti-inflammatory therapy to the airways thereby reducing inflammation, mucous production and airway responsiveness (the ability for the airway to constrict too easily). The ICS may be combined with a long-acting bronchodilator (LABA). These are used once or twice per day. The inhalers come in the traditional form of a metered dose inhaler (MDI) or what is termed a dry-powder inhaler (DPI). The medications are identical. Patient preference should guide the choice. Other add on therapies are available if needed to achieve control. Some of these may be in pill form including leukotriene modifying drugs (montelukast, zafirlukast) and theophylline. These drugs are not usually as effective as corticosteroids and long-acting bronchodilators. A new class of specialized asthma therapies are now available for individuals with difficult to control (moderately severe asthma). These are known as biologic therapies. Your provider may order additional blood work or allergy testing to see if you woud be a candidate for these.

What else?

It is important that you work with your provider to find a treatment plan that works for you and controls your asthma. Peak flow monitoring may also be recommended. Measuring your peak flow (a form of a pulmonary function test) by blowing into a peak flow meter can provide a measure of your asthma control. Sometimes your peak flow reading can make you aware that your asthma is worsening before you have symptoms. The goal of peak flow monitoring is to help guide you to prevent an asthma attack. Always carry your rescue inhaler with you. Take your asthma medication exactly as your health care provider has advised. Get a yearly flu shot and a vaccine for pneumonia. Keep your regularly scheduled visits with your provider so that your asthma can be monitored and treated before it gets out of control. Be sure to know how to contact your health care provider and know what to do in case of an emergency. If your asthma is not getting better after you start treatment, you might benefit from seeing an asthma specialist.

Take the Asthma Control Test™ – https://www.asthma.com/understanding-asthma/severe-asthma/asthma-control-test/

Other Asthma Resources

• www.chestnet.org
• www.aaaai.org
• www.nhlbi.nih.gov
• www.aafa.org
• www.thoracic.org
• www.asthmacontrol.com

Mass Lung & Allergy Sleep Center Update:

We are happy to announce the return of in-lab sleep testing in our Worcester Sleep Lab! In accordance with CDC safety guidelines, we are requiring all patients who are having aerosolizing procedures (CPAP, BIPAP, ASV Titration studies) to be tested for COVID-19 72 hours prior to their scheduled appointment. Patients who are fully vaccinated against COVID-19 do NOT need to be tested prior to any sleep studies.

We continue to offer Home Sleep Test device pickups from both our Leominster and Worcester offices.

Home Sleep Testing Instructional Video

Sleep Disorders:

Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a common problem that affects a person’s breathing during sleep. A person with OSA has times during sleep in which air cannot flow normally into the lungs. The block in airflow (obstruction) is usually caused by the collapse of the soft tissues in the back of the throat (upper airway) and tongue during sleep. For more information on OSA click here.

Insomnia

Many people experience difficulty sleeping. Some people have short periods (days to a few weeks) of difficulty falling asleep or staying asleep (called acute insomnia). Others have this difficulty for a month or longer (called chronic insomnia). About 30% of Americans complain of having insomnia. Insomnia can be very disruptive to a person’s life, so understanding insomnia and what can be done to treat it can be helpful to your quality of life. For more information on insomnia click here.

Narcolepsy

Narcolepsy is a neurologic problem in which your brain is not able to control your sleep-wake cycle. It can cause you to have sudden and overwhelming sleepiness any time of the day. This can cause you to fall asleep at inappropriate times, such as while talking to someone, driving a car, eating, or while at school or work. This can at times put you in danger such as when driving. Narcolepsy is a lifelong condition that never goes away. About 1 in 2,000 people have narcolepsy. It affects men and women equally. Most people with narcolepsy will begin to have symptoms between the ages of 10 and 30 years old. For more information on Narcolepsy click here.

Cystic fibrosis (CF) is an inherited condition caused by a defective gene (CFTR – Cystic Fibrosis Transmembrane Conductance Regulator) which causes the body to produce abnormally thick and sticky fluid, called mucus. This mucus builds up in the breathing passages of the lungs and in the pancreas, the organ that helps to break down and absorb food. This collection of sticky mucus results in life-threatening lung infections and serious digestion problems. The disease may also affect the sweat glands and a man’s reproductive system. Millions of Americans carry the defective CF gene, but do not have any symptoms. That’s because a person with CF must inherit two defective CF genes – one from each parent. An estimated 1 in 29 Caucasian Americans has the CF gene. The disease is the most common, deadly, inherited disorder affecting Caucasians in the United States. It’s more common among those of Northern or Central European descent. Most children with CF are diagnosed by age 2. A small number, however, are not diagnosed until age 18 or older. Occasionally, relatively mild symptoms may lead to frequent misdiagnosis or no diagnosis at all unless the symptoms become worse. The condition may be misdiagnosed as emphysema, asthma or chronic bronchitis. These patients usually have a milder form of the disease. About 30,000 Americans and 70,000 people worldwide are living with cystic fibrosis. Only a few decades ago, children with CF seldom survived elementary school. Today, thanks to earlier diagnosis and improved treatments, the median survival for those with CF is 47 years of age. With new, novel therapies known as CFTR modifiers this number is likely to climb.

Dr. Schaefer helped to establish the Adult Cystic Fibrosis Program at the UMass-Memorial Medical Center. He sees patients with CF at the CF Center at UMass-Memorial University campus, as well as in MLA’s Worcester office.

UMass-Memorial / UMass Chan Medical School Adult Cystic Fibrosis Program

The UMass-Memorial Adult Cystic Fibrosis Center, accredited by the national Cystic Fibrosis Foundation, specializes in the management of adults with cystic fibrosis. We provide a team approach to care that includes medical, nurse, registered dietician, physical therapy, social worker, and respiratory therapy cystic fibrosis specialists. We collaborate closely with our colleagues in the UMass-Memorial Pediatric Cystic Fibrosis Center to assist adolescents and young adults in the transition from pediatric to adult care.

Our services

• Comprehensive cystic fibrosis diagnosis including sweat testing and blood testing for all known mutations related to cystic fibrosis.
• Full range of treatments for all complications related to cystic fibrosis, including those involving the respiratory, sinus, digestive, endocrine, and reproductive systems.
• Up to date therapeutics including use of the newest CFTR Modulators
• Management of cystic fibrosis lung disease, including mucus clearance techniques, mucolytics, and preventive therapy for patients infected with pseudomonas.
• Comprehensive nutrition counseling and care, including pancreatic enzyme replacement therapy, screening for and repletion of vitamin deficiencies.
• Cystic fibrosis education and counseling.
• Close collaboration with Nutrition, Psychology, Respiratory Therapy, Gastroenterology, Endocrinology (diabetes), Transplant Surgery and Palliative Care.

Allergic reactions to flying stinging insects – honeybees, hornets, wasps and yellow jackets – are relatively common. In the southern United States, the red or black imported fire ant now infests more than 260 million acres where it has become a significant health hazard and may be the number one agent of insect stings there. The severity of an insect sting reaction varies from person to person. A normal reaction will result in pain, swelling and redness confined to the sting site. A large local reaction occurs in 10-15% and will result in swelling that extends beyond the sting site. For example, a sting on the forearm could result in the entire arm swelling twice its normal size. Although alarming in appearance, this condition is not dangerous and is often treated the same as a normal reaction. The rarest but most severe sting reaction, called anaphylaxis, occurs in about 0.5% of children and 3% of adults who are stung. At least 90 to 100 deaths per year result from insect sting anaphylaxis.

If you are referred to MLA for evaluation of an insect sting, a careful history will be obtained. Based on this, allergy testing may be performed likely with a skin test, but sometimes through a blood test. As the skin testing for a stinging insect reaction is involved, this will be performed at a separate visit. Based on your history and the results of the testing your physician will be able to recommend the best intervention for you. For those experiencing a severe sting reaction this may include allergy immunotherapy – “desensitization” (see below) as well as self-injectable epinephrine (EpiPen) and MedicAlert® identification.

Avoiding Insect Stings

Knowing how to avoid stings from fire ants, honeybees, wasps, hornets and yellow jackets leads to a more enjoyable summer for everyone. Stinging insects are most active during the late spring, summer, and early fall. Insect repellents do not work against stinging insects. Yellow jackets will nest in the ground and in walls. Hornets and wasps will nest in bushes, trees and on buildings. Use extreme caution when working or playing in these areas. Avoid open garbage cans and exposed food at picnics, which attract yellow jackets. Also, try to reduce the amount of exposed skin when outdoors.

Consider the following additional precautions to avoid insect stings:

• Avoid wearing sandals or walking barefoot in the grass. Honeybees and bumblebees forage on white clover, a weed that grows in lawns throughout the country.
• Never swat at a flying insect. If need be, gently brush it aside or patiently wait for it to leave.
• Do not drink from open beverage cans. Stinging insects will crawl inside a can attracted by the sweet beverage.
• When eating outdoors, try to keep food covered at all times.
• Garbage cans stored outside should be covered with tight-fitting lids.
• Avoid sweet-smelling perfumes, hair sprays, colognes and deodorants.
• Avoid wearing bright-colored clothing.
• Yard work and gardening should be done with caution. Wearing shoes and socks and using work gloves will prevent stings on hands and feet.
• Keep window and door screens in good repair. Drive with car windows closed.

Venom Immunotherapy

The long-term treatment of insect sting allergy is called venom immunotherapy. It is a highly effective program administered by an allergist, which can prevent future allergic reactions to insect stings.

Venom immunotherapy involves administering gradually increasing doses of venom to decrease a patient’s sensitivity to the venom. This can reduce the risk of a future allergic reaction to that of the general population. In a matter of weeks to months, people who previously lived under the constant threat of severe reactions to insect stings can return to leading normal lives.