Steven Machtinger MD & Associates, Inc

Mask unto others as you would have them mask unto you. It's a simple courtesy like covering your mouth when you cough. Should be pretty simple to understand.

CAN DIET PREVENT ASTHMA? In a study of vitamin D supplementation during pregnancy, Lee-Sarver & colleagues observed a lower rate of asthma and wheezing in three-year-old children who at birth had higher levels of vitamin D in their blood. Higher newborn vitamin D levels were also associated with higher blood levels of the polyunsaturated acids (PUFA) omega-3 and omega-6. These findings suggest a beneficial role for augmenting maternal and infant diet with PUFA and vitamin D to decrease episodes of wheezing and perhaps asthma in young children. Read more at: https://www.aaaai.org//New-Research-from-JACI-I/fatty-acid.

PREVENTION OF FOOD ALLERGY While American parents report an adverse reaction to food in about 1/3 infants and young children, the rate of true food allergy is only around 10%. But don't say "only". For incompletely understood reasons the frequency of food allergies in infants, children and adults is increasing in the developed world. Maternal diet during pregnancy and while breast-feeding as well as the diet of infants may each play a role. Caesarean section - regardless of r...eason - appears to elevate the risk of the infant developing a food allergy. Earlier introduction of highly allergenic foods like peanut, cow's milk and hen's egg reduces, although does not eliminate, the risk of developing a food allergy to one or more of these foods. Especially if either parent or a sibling has food allergies, eczema or asthma your next child may benefit from a discussion of these issues with your pediatrician, pediatric nurse practitioner, or allergist. See more

THE OFFICE IS OPEN. We have been open on a part time basis since San Mateo County began sheltering in place. We are now open Monday through Thursday for allergen immunotherapy and biologic injections. Our physicians are available for tele-medicine and in-person office visits. In-office skin testing and oral allergen challenges have resumed. To maintain the safety of social distancing all visits, including visits for injections, are by appointment only. Call 650-696-8230 for information and to make an appointment.

Is the Flu Worse than COVID-19? In the U.S as of April 15, 2020 there have been 634,975 reported cases of COVID-19. 27,940 people have died of this viral respiratory disease. Worldwide there are over 2 million cases, an increase of 79,000 from the previous day, and 133,000 people have died. The first person to die of this infection was a resident of Wuhan, China. That death occurred late in December, 2019. By comparison: The 1918 H1N1 influenza pandemic caused 500,000-70...0,000 deaths in the United States. 30-40 million people died worldwide. About the same number of people died in World War 1. The 1957 H2N2 influenza pandemic caused an estimated 70,000 deaths in the US while an estimated 34,000 Americans died from the 1968 H3N2 influenza pandemic. The World Health Organization estimates annual influenza epidemics result in about 3-5 million cases of severe illness and about 250,000 to 500,000 deaths worldwide. The CDC estimates that between 1976 and 2006 annual flu-associated deaths in the US ranged from about 3000 to 49,000. Is COVID-19 less severe than the flu (influenza)? Consider these points. Quarantine was only employed for the 1918 H1N1 pandemic. Sheltering in Place has a clear impact on decreasing the number of people infected. The US epidemic is only two months old. Influenza reports are for an entire year. We haven’t hit the peak of new infections yet. Corona virus infection may not follow the flu pattern of abating in warmer months. As a killer COVID-19 is likely to be second only to the 1918 H1N1 Pandemic.

GETTING THE MOST FROM YOUR NASAL SPRAY Anyone can swallow a pill but is there a better way to use a nasal spray? Those who stop using nasal sprays do so for two major reasons: the medication goes down their throat or they get nosebleeds. You may like this technique that we’ve recommended in our practice for 23 years. 1. Hold the tip of the container about below your nostril. That’s right; don’t stick it in your nose. 2. Point the tip straight up; don’t point it towards on...e ear or the other. 3. Hold your head erect and spray. 4. Sniff gently, not hard, and only if the medication feels like it’s going to drip out. I find this method nearly eliminates nosebleeds (you’re not sticking hard plastic up your nose). Holding the tip back allows medication to spread out in your nose staying there rather than going down your throat. No one has complained of getting medication in their eyes. Try See more

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Hay Fever During the Pandemic What to do about your symptoms of seasonal allergic rhinitis & conjunctivitis without seeing your health care provider: Hay Fever During the Pandemic... What to do about your symptoms of seasonal allergic rhinitis & conjunctivitis without seeing your health care provider: 1. Itchy, sneezy, runny nose? Take a long-acting, non-sedating antihistamine like fexofenadine (Allegra) or loratidine (Claritin). Take one a day, and in a pinch, two a day. Cetirizine (Zyrtec) and levocetirizine (Xyzal) are effective but cause drowsiness in about 1 user in 10. 2. All of the above AND STUFFY NOSE? Add or switch to a topical corticosteroid nasal spray like budesonide (Rhinocort), fluticasone diproprionate (Flonase), triamcinolone (Nasacort) or fluticasone furoate (Flonase Sensimist). To work nasal sprays need to be used daily for several days. Watch for occasional headache or nosebleed. 3. Itchy, watery eyes? Use ketotifen (Zaditor), bepotastine (Bepreve), or olopatadine (Patanol & Pataday). Eye drops may cause eye irritation & headache when initially used but these reactions usually resolve with continued use. 4. There’s nothing wrong with generics. Find them right next to the branded products. 5. Benadryl (diphenhydramine) also works BUT must be taken several times a day for sustained relief. Drowsiness occurs in 50% of users. How drowsy? Diphenhydramine is also marketed as Sominex, a product that helps you fall asleep. The dose is the same as for symptoms of allergy. 6. If these solutions don’t relieve your apparent symptoms of hay fever (allergic rhinoconjunctivitis) in a week or two contact your health care practitioner for advice. They may even be able to evaluate your complaint using telemedicine.

Asthma, COVID-19 and Steroids Asthma is not a single disease. It's the clinical expression (coughing, wheezing, shortness of breath that responds to bronchodilators like albuterol) of a wide range of conditions with various levels of severity, risk, and control. Asthma has been listed as a risk factor for severe COVID-19 outcomes by the CDC and WHO. Data from China and Seattle, however, indicate that asthma is not a risk factor for patients with severe COVID-19 infections.... Early reports of systemic corticosteroids (CS) being associated with death from COVID-19 have been extrapolated to include ALL steroids as being dangerous. Our bodies produce their own CS. In times of stress, like that of the pneumonia caused by corona virus, the adrenal glands release extra CS to help regulate the body’s inflammatory response. This release may dampen or even prevent cytokine storm. Frequent use of CS to control diseases like asthma, lupus, rheumatoid arthritis or inflammatory bowel disease may temporarily reduce the ability of the adrenal glands to release more CS in response to stress. To compensate for this decreased release of our own CS physicians treating COVID-19 infections often add high doses of CS. Inhaled corticosteroids like Flovent, Qvar, Symbicort & Advair have virtually no effect on the adrenal glands. Inhaled CS are safe to use to control asthma and to prevent exacerbations. Systemic (swallowed, injected, intravenous) CS should be used to treat an asthma exacerbation, even asthma symptoms caused by COVID-19. See more

IF YOU HAVE ASTHMA CONTINUE USING YOUR STEROID-CONTAINING INHALERS DURING COVID-19 PANDEMIC. There are reports that patients on "steroids" are at higher risk for poor outcomes to Corona Virus infection. "Steroids" refers to oral or injected corticosteroids that are administered at doses 50-200x greater than that of inhaled steroids used to control asthma. Such high doses may decrease the body's ability to respond to the stress of a serious illness. In such a situation, physicians add additional oral or injected steroids to assist the patient when they become infected. CONTROLLING ASTHMA WITH INHALED STEROIDS HELPS THE LUNGS COMBAT THE INJURY CAUSED BY CORONA VIRUS. DON'T STOP USING THEM.

FDA ISSUES ALERT REGARDING EPIPEN & EPIPEN JR AUTO-INJECTOR PROBLEMS. Today the US Food and Drug Administration (FDA) is alerting patients, caregivers and health care professionals that EpiPen 0.3 mg and EpiPen Jr 0.15 mg auto-injectors, and the authorized generic versions, may potentially have delayed injection or be prevented from properly injecting due to: 1. Device failure from spontaneous activation caused by using sideways force to remove the blue safety release.... 2. Device failure from inadvertent or spontaneous activation due to a raised blue safety release. 3. Difficulty removing the device from the carrier tube. 4. User errors. You can read the entire notice at https://mailchi.mp/a/fda-alert-epipen-auto-injector-errors. IF YOU HAVE AN EPIPEN, EPIPEN JR OR GENERIC EQUIVALENT CONTACT US TO DISCUSS SAFER AND MORE RELIABLE TREATMENT OPTIONS.