Tag Archives: ragweed

Fall is here in three days! When should you start your medications to help with fall allergies?

Can you believe, despite the warmth, fall will be here in three days? For many people with allergies, fall is the worst time to be outside. Start taking your medication (antihistamines/steroids) two weeks before symptoms are likely to set in, because once your nasal or airway passages are inflamed, it reduces the chances medication will work. Also, be sure to continue your medication for a couple of weeks after the first frost.

Questions? Call our office today at (502) 882-2063 to make an appointment!





Pollen! What is it and Why Does it Make Me Miserable?

The pollen count

3/22/16: The pollen count is already in the “HIGH” range.

Pollen is one of the most common causes of allergies in the United States. You’ve seen it coating your car, wafting through the air and saturating your sidewalk—-the very fine, powdery, yellowish dusting which thrives in the Kentuckiana area. Our region is known to have prolific amounts of pollen which wreaks havoc and causes an adverse immune response in many of us.

Pollen is produced by trees, grasses, weeds and flowers. It fertilizes plants of the same species. Our immune system is an amazing protector, defending the body from harmful invaders and can prevents sickness. For those with pollen allergies, the immune system mistakenly targets the pollen as unhealthy and produces chemicals in your body to fight the pollen. The pollen has now become an “allergen” and the manifested fight is known as an “allergic reaction,” “hay fever” or “allergic rhinitis.”

Do you suffer in the spring? March and April allergies are almost always due to tree pollen. (It is important to start treatment before pollen season begins.)

Do you suffer around Derby time? Your are likely allergic to grass pollen. Sufferers in the late summer and fall can be allergic to ragweed. Pollen is wind-driven, can travel hundreds of miles and survive a mild winter. (Did you know the ragweed season has increased four additional weeks in the last 10-15 years–some say due to global warming.)

Some suffer pollen allergies year-round. Symptoms include: sinus pressure, facial pain, nasal congestion, cough, scratchy throat, watery/itchy eyes, runny nose, dark circles under the eyes and a decreased taste/smell sensation.

Using Neti pots, vacuuming regularly with a HEPA filter vacuum, frequent and immediate washing of clothes that have been worn outside, closing windows, using the air conditioner in your car and home, using HEPA filters and frequent changing of your home air filters can provide some sufferers relief.

Over-the-counter and/or prescription nasal sprays, antihistamines and decongestants can provide relief for many.

If those do not work, immunotherapy (allergy shots) is shown to reduce symptoms long-term in most children and adults. Call us at (502) 882-2063 to find out your options before the pollen season is upon us!




Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Courier-Journal: Dr. Damin Addresses Fall Allergies and Finding Relief


Sneezy and miserable this fall? Here’s why.

Ragweed is rearing its devilish head in the Louisville area, bringing on sneezing, itchy eyes and other irritating symptoms for those who are allergic to it.

The season, which typically begins in August, will last for the next several weeks, said Dr. Wes Sublett, an allergy and immunology specialist with Family Allergy & Asthma.

“All the way through September, you’re going to have high, high ragweed concentrations,” Sublett said. And “ragweed persists all the way until the end of October when we get a couple of hard freezes.”

If you’re miserable, you also could be reacting to other fall weeds, mold or Kentucky’s state flower, goldenrod, said Dr. Derek Damin of Allergy Partners of Louisville.

The allergies can overlap and lead to the same kinds of symptoms, such as itchy nose, runny nose, sneezing, postnasal drip, itchy and teary eyes and even asthma flares, said Damin, an allergist. Some people also complain of headaches and ear issues.

“Without skin testing, it’s hard to say specifically” which allergy the person has, he said.

While some people may get adequate relief from taking a generic Zyrtec (cetirizine) on an “as-needed basis,” others may need multiple categories of medications year-round to get the best results, Damin said. “It depends on the individual.”

Getting a jump on the season by, for example, starting sublingual tablets (Ragwitek under the tongue) three months in advance, can be helpful, Damin said.

But if you didn’t do that, there is hope. “A lot of your antihistamines can kick in, in as little as an hour,” he said. “It’s never too late to start.”

Many, including Allegra (fexofenadine), are available without a prescription, he said.

Other medications that might be helpful include nasal steroids such as Flonase (fluticasone) and Nasacort (triamcinolone), antihistamines such as Claritin (loratadine), and eye soothers, such as Zaditor (ophthalmic ketotifen) and prescription Pazeo (olopatadine hydrochloride), Sublett said.

Some nose sprays may take a couple of weeks to provide a noticeable benefit, but “even starting them now will help you well into September and October,” Damin said.

Nasal sprays and oral decongestants may help people who get allergy-related headaches, Damin said, but patients with severe symptoms may need to see a headache specialist or a neurologist.

When choosing a medication, be sure to familiarize yourself with the side effects. For example, drowsiness can be a significant issue with some drugs, such as Chlor-Trimeton (chlorpheniramine) and Benadryl (diphenhydramine), Damin said.

“Kids who go to school on sedating antihistamines may have a 10 percent decrease in their academic performance,” Damin said.

Consider seeking the advice of a qualified medical professional for guidance.

“If you know that you’re having problems during August and September and you suspect that it’s ragweed, the best thing to do is to see a board-certified allergist to confirm your ragweed allergy and then talk about therapy options, which may include medications or immunotherapy,” Sublett said.

Allergy shots are a type of immunotherapy. The American Academy of Allergy, Asthma and Immunology describes them this way: “Allergy shots work like a vaccine. Your body responds to injected amounts of a particular allergen, given in gradually increasing doses, by developing immunity or tolerance to the allergen.”

In other words, immunotherapy can help to “change your immune system to get rid of the problem,” Sublett said.

However, the shots don’t work right away. There’s a build-up phase that may include getting shots once or twice a week for say three to six months, then taking maintenance shots (with a longer period between shots) once the effective dose has been reached, according to the academy.

Damin noted that “oftentimes, when patients first start allergy shots, until those shots become therapeutic, (patients) will still have to rely pretty heavily on their medications to suppress their symptoms.”

A small percentage of people don’t benefit from allergy shots, but patients should give their shots “at least a good six months at maintenance levels before they deem themselves a non-responder,” Damin said.

If your shots don’t seem to be working, there’s also a chance that you were misdiagnosed or that the dose isn’t high enough, he said.

Beyond shots and medications, allergy sufferers may get some relief from avoidance measures, such as keeping windows closed, wearing a mask (preferably the NIOSH 95 type) for yard work, taking a shower afterward and using a high-efficiency air filter on their heating and air-conditioning systems, Sublett said.

Some asthmatics benefit from avoidance as well as various treatment strategies, from steroid inhalers to short-acting medications that ease bronchospasms and wheezing, Damin said.

“We’ve seen numerous patients where the fall allergy season is causing significant respiratory symptoms and asthma symptoms, leading to loss of workdays and a diminished quality of life in terms of being able to breathe on a normal basis,” he said.

Reporter Darla Carter can be reached at (502) 582-7068, dcarter@courier-journal.com or on Facebook at DarlaCarterCJ.


See a board-certified allergist for advice.

Try over-the-counter or prescription drugs.

For longer-term benefit, consider allergy shots.

Ask about taking sublingual tablets before your allergy season starts.

Use avoidance measures, such as keeping your windows closed and wearing a mask during yardwork.

Consider using a nasal rinse. If you don’t have a sterilized solution, use boiled water or distilled water to reduce risk of infection.

Sources: Louisville allergists Derek Damin and Wes Sublett

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Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

2014 Allergy Year in Review

Untitled-3The new year has arrived and it’s often a time to reflect on trends and highlights from the previous year. Below is my list of the highlights in the world of allergy in 2014. Enjoy and may you have a healthy and happy 2015!

  1. Allergy Partners of Louisville Opens: On January 2, 2014, I opened my own solo allergy practice with a wonderful staff and team. The office moved to its permanent location next to Wild Eggs in the Landis Lakes Shopping Center in June. The new office is even more patient-friendly with large HD monitors in every exam room with multiple viewing options, fewer “pokes” with allergy testing and shorter conventional allergy shot build-up schedules without having to pre-medicate with steroids.
  2. Nasal steroids moved to become available over-the-counter (OTC): Nasacort was approved for the switch from prescription to OTC and became available as such in February 2014. Steroid nasal sprays are considered first line treatment for moderate to severe allergic rhinitis. Look for others to follow suit in 2015. Flonase is expected to be on retail shelves in early 2015.
  3. Asthma inhalers continue to shift toward emphasizing smaller particle sizes: Aerospan became available in the US after Meda Pharmaceuticals bought Acton in late 2013. Better, deeper lung deposition is thought to be the benefit of inhalers with smaller particle size. Look for specialists to increase their use of Aerospan, Alvesco and Qvar, the three inhalers with the smallest particle sizes in 2015.
  4. FDA-approved sublingual immunotherapy (SLIT) becomes available in the US: Look for the products Grastek, Ragwitek and Oralair to be marketed heavily in 2015 and directly to consumers. You too have probably seen Grastek’s countdown to grass season whole page ads  in the Courier-Journal and other publications. The main benefit is home administration. Barriers include cost, potential side effects, need for an injectable epinephrine device and the requirements of receiving the 1st dose in the physician’s office. Better discount programs should improve usage in 2015.
  5. The end of Maxair: Under the Montreal Protocol, all CFC-containing, ozone-depleting inhalers were phased out by the FDA as of December 31, 2013. Maxair could not be made or sold after December 31, 2013. This means any Maxair still in your drawers or purses should be properly disposed of, as they are expired and no longer compliant. If you’re still carrying Maxair or the old CFC version of Combivent, see your doctor to discuss alternatives. If you are still carrying an old white generic albuterol inhaler made by Wallace or Warrick, you may need to go through your medications more often!
  6. Xolair receives indication for Chronic Idiopathic Urticaria (CIU): Omalizumab or Xolair is a biologic antibody that has been available since 2003 for the treatment of allergic asthma. Xolair was approved for CIU in 2014 and will provide another step in the treatment options for hives sufferers before having to consider medications with more significant side effect profiles.
  7. Affordable Care Act to further drive consumer awareness of the cost of health care: As my family compared health insurance options for 2015, the changes brought on by the ACA were noticeable. Look for premiums and deductibles to rise. Shorter build-up shot schedules and smaller test panels without sacrificing quality will position Allergy Partners of Louisville as one of the most cost-conscious allergy choices in the Louisville market.
  8. Component Food Allergy Testing: More and more allergists are using component resolved diagnostic testing to aid in clinical decision making for food allergy sufferers. Component food allergy testing uses allergy specific blood testing to look at the components of specific foods like peanut, egg and milk. Knowing if a patient is allergic to casein or ovomucoid in milk and egg, respectively, can help a family know if they will tolerate cooked milk and egg in products. Knowing a patient’s Ara h2 level for peanut allergy is much more precise in knowing whether a patient will tolerate an oral peanut challenge. Look for component resolved diagnostics to become standard of care in making decisions for reintroduction of known food allergens.

That summarizes my year-end reflections on the ever-changing world of allergy. Thanks to each of you for a rewarding 2014 and going with me on this amazing journey in relationships and providing better health to patients. Best wishes and God bless in the New Year!

Derek Damin, MD

Fall Allergy Triggers and Symptoms

Screen shot 2014-09-17 at 4.53.55 PMRagweed is fall’s main allergy trigger. We can find this weed in parks and fields throughout the Kentuckiana area. Unfortunately, its pollen impacts our allergies mid-August through the first hard freeze.

Mold is another indoor (think humidifiers, basements and bathrooms) and outdoor (think piles of damp leaves) fall trigger.

Dust mites are a year-round trigger, but fall dust mite levels can increase 2-3 times in late autumn compared to summer levels (studies show dust mite allergen peaks were correlated with relative humidity peaks 2 months prior). Additionally, colder temperatures drive people inside where there is little escape from dust mites.

If you suffer with runny nose, watery eyes, sneezing, coughing, sore throat, itchy eyes/nose/mouth, pressure in the cheeks and/or nose, dark circles and/or ear popping, call us at (502) 882-2063. We will work to help you find relief.

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.


Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community.

Courier-Journal Interview: Dr. Damin talks about Sublingual Tablet Immunotherapy

photoCheck out the front page of today’s Courier-Journal Health & Fitness section. Health Wrter Darla Carter interviews Dr. Damin about the new allergy tablets and their use as an alternative to allergy shots. Click here for the full story and video.

First Grass Tablet, Oralair, Approved by the FDA

On Tuesday, April 1, 2014, the FDA approved Oralair, a grass tablet for sublingual use. Initial reports show it will be indicated for those ages 10-65 with seasonal allergic rhinitis with or without conjunctivitis and a confirmed positive skin test or blood test to any the following grasses: timothy, Kentucky bluegrass, perennial rye, orchard and sweet vernal. Oralair, once available, should be dosed once daily and held under the tongue until fully dissolved. Treatment should begin four months before grass season and continued until grass season ends. Additionally, the first dose should be administered in a physician’s office where the patient can be monitored for a period of time after administration. allergy tabletPatients should be prescribed injectable epinephrine and counseled on the signs and symptoms of an anaphylactic reaction. Clinical studies showed an improvement in symptoms between 16 and 30%. It is not without risk, as one-third of adults had oral itching with its use and 12% of kids had mouth swelling.

This is the first sublingual immunotherapy product to be approved by the FDA. There are other sublingual tablets in development including ones for dust mites, ragweed and an additional grass tablet.

It does not appear to be as effective as traditional allergy shots, but head to head studies are lacking. Cost and insurance coverage will definitely affect prescribing habits.

Call our office to get allergy tested and see if this new treatment is right for you. We’ve missed the window for the 2014 grass season in the Louisville area, but use will likey increase in subsequent seasons.

Be sure to subscribe to receive updates by email (scroll up and hit the “Follow” button on the right)? Please “like” my facebook page at www.facebook.com/drdamin, follow me on Twitter and share this page with other allergy sufferers.


Disclaimer: This blog is not intended to create a doctor-patient relationship with any reader. If you need personalized medical advice, contact your primary care physician or other physician in your community. If you need to establish care with an allergist, Allergy Partners of Louisville would love to help you find relief. Call 502-882-2063 for an appointment.