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April 18, 2014

Carrot Anaphylaxis in a Birch Pollen-Allergic Patient

It is early spring and the trees are budding.  A 28 year old woman presents for evaluation of an allergic reaction.  She has a history of spring hayfever and recently was also prescribed Prevacid for dyspepsia.  A few days later after eating raw carrots she developed widespread urticaria with abdominal cramps.  

She reported no recent NSAID or alcohol ingestion. She has no prior food or medication allergies.   She is still taking Prevacid (lansoprozole). 

Skin testing was positive to tree pollen and birch tree.

Skin testing to carrot was negative.

Did the carrots cause the reaction and why now?   My theory was that her Birch-specific IgE increased during allergy season which in turn crossreacted with carrot, a well know...

Posted By: Gary Stadtmauer  

April 17, 2014

What's So Affordable about the Affordable Care Act?

A few of my patients decided to save money and buy health insurance through the ACA health exchanges.  I can't blame them for wanting to save money but they quickly discovered that neither I nor any of their doctors accept that insurance.  As a result they are now paying out of pocket as they scramble to switch to other plans. This pattern will repeat itself.  People who are unin...

Posted By: Gary Stadtmauer  

April 10, 2014

What Medicare Pays Your Colleagues

The NY Times ran an article yesterday about a very small minority of physicians (none of whom are allergists) who account for a sizable portion of medicare payments.  Surprisingly the top 2% of doctors collect nearly 25% of Medicare payments. 

Posted By: Gary Stadtmauer  

March 25, 2014

SCIT Fatal and Nearfatal Surveillance Study Results

The AAAAI/ACAAI Surveillance Study of Subcutaneous Immunotherapy, Years 2008-2012: An Update on Fatal and Nonfatal Systemic Allergic Reactions was reviewed at the AAAAI annual meeting. There was a single fatal case reported. The patient was a 43 yr old morbidly obese diabetic hypertensive m...

Posted By: Gary Stadtmauer  

March 6, 2014

Doctor, What Triggered My Recent Allergy/Asthma Flare? There's an App for that now!

It's actually more than an app, it's a platform that was the subject of a featured poster at the 2014 AAAAI annual meeting.  Patients enter data on their smartphone (through the Asthma Ally app on Iphone/Android/Windows) which then sends a GPS tag with timestamp to the cloud platform.  The env...

Posted By: Gary Stadtmauer  

February 23, 2014

Misguided by the FeNO

I recently saw a patient for a 2nd opinion.  He was a previously healthy nonatopic man in his 20's who had been experiencing chest pain and dyspnea for a couple of months.  There were no other upper or lower airway symptoms.  He was diagnosed with asthma by a well-regarded pulmonologist.  The PFTs were normal but the FeNO was elevated at 75 ppb which was the basis for starti...

Posted By: Gary Stadtmauer  

February 13, 2014

Adult Eosinophilic Esophagitis: A response to PPI is not diagnostic of reflux

 The patient with esophageal eosinophilia (>15/hpf) may have either reflux or eosinophilic esophagitis (EoE).  Ideally a patient would undergo pH testing and if negative one could conclude that the condition is EoE.  However, many patients are reluctant to have the 24 hr pH study.  As a result the response to PPI has been considered a surrogate for the diagnosis of reflux...

Posted By: Gary Stadtmauer  

January 23, 2014

Why is this man wheezing?

It is wintertime in New York and a 65-year-old man with a history of diabetes mellitus and coronary artery disease, S/P multiple coronary stents presents for evaluation of recent onset nasal congesion, cough and wheezing.   He has no known allergen exposure and has not had a recent respiratory infection.  He has never been diagnosed with asthma per se but has noted slight cough and wh...

Posted By: Gary Stadtmauer  

January 8, 2014

Otolaryngologists Treating Asthma

It was recently called to my attention that the February 2014 edition of the Otolaryngologic Clinics of North America is devoted to the screening, diagnosis, and management of asthma.   The justification is that ENTs who are already providing allergy care should treat asthma as a "convenience" for their allergic patients. ...

Posted By: Gary Stadtmauer  

December 25, 2013

DUPILUMAB: A New Monoclonal Antibody in Difficult to Control Asthma

It's not yet FDA-approved but a promising drug trial for severe asthma was recently published in the NEJM. The drug, dupilumab is an inhibitor of the alpha subunit of IL-4 and effectively inhibits signalling of IL-4 and IL-13.  The study only looked at patients already treated ...

Posted By: Gary Stadtmauer  

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About This Blog

This blog is about allergy from my perspective as a private-practice doctor who teaches, occasionally publishes, and also works in human rights. After over 10 years in practice, it is clear to me that a better understanding of sinus disease and functional laryngeal disorders is required to be an allergy and respiratory disease specialist. I will share my insights with you as I try to bridge the divide between bench and bedside as well as between allergy and otolaryngology. Like my medical practice, this blog is about the clinical, ethical, and health economics issues of the day. Your thoughts and comments are always appreciated.
Disclosure: Gary J. Stadtmauer, MD, has disclosed no relevant financial relationships.

Poll: Have any of your patients died of an asthma attack? Yes, related to noncompliance|Yes, due to asthma severity alone|No|

  • Gary Stadtmauer

    Dr. Gary Stadtmauer is a New York native and a graduate of the Albert Einstein College of Medicine. He trained in internal medicine at St. Luke's Hospital and allergy-immunology at Mount Sinai Medical Center, both in New York City. He holds a voluntary faculty appointment at Mount Sinai School of Medicine where he teaches in the allergy fellowship program. He also maintains a private practice in Manhattan. Dr. Stadtmauer runs an educational Website,, which is dedicated to both patient and physician education about allergy topics with an emphasis on respiratory disorders. Outside of allergy, Dr. Stadtmauer's other professional activity is as a volunteer physician with the human rights clinic Healthright International.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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