Our Asthma, Allergy, and Immunology Blog

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If you live in Florida, you already know this: spring allergies don’t wait for spring. Tree pollen season often starts earlier than expected, and right now across Florida, tree pollen counts are already in the medium to high range. Here in the Bradenton area, oak trees are a major culprit. Oak pollen is heavy, airborne, and well known for causing severe allergy symptoms. COMMON SPRING ALLERGY SYMPTOMS Tree pollen allergies commonly cause allergic rhinitis symptoms such as: - Nasal congestion or stuffy nose - Runny nose - Post-nasal drip - Sneezing and frequent sniffling Eye symptoms are also very common and include: - Itchy eyes - Watery eyes - Red or irritated eyes WHY OVER-THE-COUNTER MEDICATIONS OFTEN DON’T WORK Many people start with over-the-counter allergy medications and keep switching from one to another hoping for relief. Sometimes they help, sometimes they don’t, and often they only provide partial relief. If allergies are not properly controlled, they can lead to complications such as: - Sinus infections - Bronchitis - Worsening asthma symptoms Each allergy season can feel worse than the last if the course of allergies is not modified. KNOW WHAT YOU ARE ALLERGIC TO Treating allergies without knowing the trigger often leads to frustration. Professional allergy testing helps identify exactly what is causing your symptoms. At Allergy Affiliates, we test for common allergens in our area including: - Tree pollens (such as oak) - Weeds and grasses - Mold - Dust mites - Cat and dog dander - Other household allergens LONG-TERM RELIEF WITH ALLERGEN IMMUNOTHERAPY Allergen immunotherapy helps desensitize your immune system to the allergens causing your symptoms. Over time, this can significantly reduce symptoms, decrease the need for medications, and help prevent worsening allergies in future seasons. ADDRESSING ALLERGIES AND ASTHMA If your allergies are making your asthma worse, we can also perform breathing tests and help manage asthma with appropriate medications to improve breathing and quality of life. DON’T LET ALLERGIES CONTROL YOUR SPRING Spring in Florida should be enjoyed, not endured. If your allergies are persistent, getting worse each year, or affecting your sinuses or lungs, it may be time for a professional evaluation and long-term treatment plan.

Itchy skin (also called pruritus) is a very common complaint. While many people assume itching is caused by dry skin or allergies, itching can have many different causes. Identifying the root cause is important to ensure proper treatment. Common Causes of Itchy Skin Medications Certain prescription and over-the-counter medications can cause itching, sometimes even without a visible rash. This may be due to allergic reactions, histamine release, or effects on the liver or kidneys. Antibiotics, pain medications, blood pressure medications, and cholesterol medications are common examples. Contact Allergens (Contact Dermatitis) Direct contact with substances such as soaps, detergents, fragrances, cosmetics, metals like nickel, latex, or topical medications can cause contact dermatitis. This often presents as itching with small, raised, palpable bumps. If the rash is bumpy and itchy but not hives, it is often dermatitis. Environmental Allergens Environmental allergens such as pollen, dust mites, mold, and animal dander can also contribute to itching, especially in individuals with allergies, asthma, or eczema. Supplements and Herbal Products Natural supplements and herbal products can also trigger itching. These products can cause allergic reactions or interact with medications. It is important to inform your healthcare provider about all supplements you are taking. Medical Causes of Itching High Eosinophils Eosinophils are allergy-related white blood cells. Elevated eosinophil levels can cause itching and skin inflammation and are commonly associated with allergic and inflammatory conditions. Atopic Dermatitis (Eczema) Atopic dermatitis is a chronic inflammatory skin condition that causes dry, itchy, and irritated skin. It often runs in families and is associated with allergies and asthma. Autoimmune Conditions Autoimmune diseases such as thyroid disorders and lupus can cause itching. These conditions may also present with fatigue, joint pain, or other systemic symptoms. Serious Causes That Must Be Ruled Out In rare cases, chronic itching may be associated with cancer, liver disease, or kidney disease. Persistent unexplained itching should always be evaluated by a healthcare provider. Infections and Infestations Before diagnosing allergies or dermatitis, conditions such as scabies, bed bugs, flea bites, and other skin infections must be ruled out, as they require different treatments. Conclusion Itchy skin is a symptom, not a diagnosis. The cause can range from simple contact irritation to complex medical conditions. Proper evaluation helps guide effective treatment and long-term relief.

The holiday season is a time for joy, gatherings, travel, and of course food. From festive dinners to office parties and family potlucks, celebrations often revolve around meals. For individuals and families living with food allergies, this time of year requires extra planning and awareness. With the right precautions, you can enjoy the holidays safely and confidently. 1. Always Read Labels - Every Single Time Even if you’ve purchased a product before, read food labels carefully every time. Ingredients and manufacturing processes can change without notice. Be especially cautious of: • Shared manufacturing facilities (cross-contamination warnings) • Seasonal or limited-edition products • Imported foods with different labeling standards Watch for Hidden Allergens: Some allergens may not be obvious at first glance. Common examples include: • Milk or butter in baked goods • Nuts or nut oils in sauces and desserts • Soy or wheat in gravies, marinades, and processed foods • Sesame, which may be hidden in spice blends or toppings When in doubt, do not eat it. 2. Ask Questions When Eating Outside the Home At parties, restaurants, or family gatherings: • Ask how the food was prepared • Confirm all ingredients, including garnishes and sauces • Avoid foods where preparation details are unclear Never assume a dish is “safe,” even if it looks familiar or someone says it’s allergy-friendly. 3. Always Carry Emergency Medications If you or your child has food allergies: • Carry an antihistamine for mild allergic reactions • Always have an epinephrine auto-injector (EpiPen) available if there is a history of severe reactions Keep medications easily accessible not in a car or checked luggage and make sure family members or friends know where they are and how to use them. 4. Act Fast During Severe Reactions For symptoms such as: • Difficulty breathing • Swelling of the lips, tongue, or throat • Dizziness or fainting • Repetitive vomiting • Widespread hives with other symptoms Give epinephrine immediately and call 911 right away. Do not delay treatment. Early use of epinephrine saves lives. It is always better to treat sooner rather than later. 5. Be Careful Outdoors: Insects Can Be a Hidden Risk Holiday travel and outdoor activities especially in warmer climates can increase exposure to insects. Fire Ants and Bee Stings: • Fire ants can cause severe allergic reactions in some individuals • Bee or wasp stings may trigger anaphylaxis in those with venom allergies Safety Tips: • Wear closed-toe shoes and socks when outdoors • Avoid walking barefoot on grass, sand, or near picnic areas • Be cautious around trash cans, outdoor food areas, and flowering plants If you have a known insect venom allergy, carry your epinephrine at all times, even if food isn’t involved. 6. Plan Ahead for Peace of Mind A little preparation goes a long way: • Bring safe snacks or dishes to share • Inform hosts about allergies ahead of time • Travel with a written allergy action plan • Ensure medications are not expired Final Thoughts The holidays should be about connection and celebration not stress or emergency room visits. With vigilance, preparation, and prompt action when needed, individuals with food allergies can enjoy the season safely. Stay informed, stay prepared, and don’t hesitate to act quickly if a reaction occurs. Wishing you and your family a safe, healthy, and joyful holiday season.

Hives and swelling can be frustrating, unpredictable, and at times even frightening especially when they come back day after day without a clear trigger. The good news is: most cases are manageable, and most are not dangerous. What Are Hives and Angioedema? Hives (Urticaria) Hives are raised, red, itchy welts that can vary in size and shape. They occur when immune cells in the skin release histamine. Hives may last minutes to hours and often move around the body. Angioedema Angioedema is deeper swelling that often affects the lips, eyes, hands, feet, or face. It may occur with or without hives. Why Do Chronic Hives Happen? Chronic urticaria is defined as hives or swelling occurring on most days for more than 6 weeks. In most patients, it is not caused by allergies. Instead, the immune system becomes overly reactive. Non-allergic triggers include: • Stress • Infections • Alcohol, NSAIDs, narcotics • Hormonal changes • Heat, pressure, scratching Are Chronic Hives Caused by Foods? Almost never. Food allergies cause immediate reactions (within 15–30 minutes) every time the food is eaten. Random hives that come and go are not caused by food allergy. Food allergy testing is usually not helpful and often leads to false positives. Should I Be Tested for Allergies? In most cases, no. Allergy testing rarely identifies a cause for chronic hives and often causes confusion. How Do We Evaluate Chronic Hives? We may perform limited blood work to rule out rare conditions. Over 80% of results are normal. A skin biopsy is rarely needed unless hives last longer than 24 hours, bruise, or are painful. How Do We Treat Chronic Urticaria? 1. Non-Drowsy Antihistamines (First Line) These include cetirizine, fexofenadine, and loratadine. Doses can be safely increased up to 4 tablets/day if needed. 2. Add-On Medications • A second antihistamine • An H2 blocker such as famotidine • A nighttime antihistamine 3. Biologics and Newer Targeted Therapies Omalizumab (Xolair) • FDA-approved for chronic urticaria • Given monthly • Often life-changing for patients who do not respond to antihistamines Dupilumab (Dupixent) Now available for chronic spontaneous urticaria. • Helps reduce hives, swelling, and itching • Works through a different immune pathway (IL‑4/IL‑13) • Useful for patients who do not respond fully to Xolair Remibrutinib (Oral BTK Inhibitor) A major advancement in chronic urticaria treatment. • Oral medication • Works by blocking a key inflammatory pathway • Rapid improvement in clinical trials • A great option for patients who prefer pills over injections 4. Immunomodulatory Medications For severe cases: • Cyclosporine • Sulfasalazine 5. Short Courses of Prednisone We avoid long-term steroid use due to side effects, but short bursts may help during severe flares. When Should I Seek Emergency Care? Seek help immediately if you experience: • Difficulty breathing • Wheezing • Throat or tongue swelling • Severe abdominal pain • Lightheadedness or fainting These symptoms are not typical of chronic urticaria and may signal a serious allergic reaction. Final Thoughts Chronic urticaria can disrupt daily life, but it is treatable. Most patients achieve excellent control with antihistamines, biologics, or newer therapies like remibrutinib. With the right plan, symptoms improve significantly—and often resolve over time.

Winter is just starting, but we’re still seeing fall allergies hanging on much longer than usual. Patients are walking in congested, with red, itchy eyes and nonstop sneezing people who normally start feeling better by now. A lot of moms are saying, “My child was fine last year, but now he wakes up stuffed every morning.” And it’s not just kids adults are feeling it too. 1. Allergy season is starting earlier and sticking around longer Winters aren’t staying cold for long, and plants like that. Trees start releasing pollen sooner, and they don’t stop as fast. So instead of a short, sharp season, it’s turning into a long slow grind. What that means in real life: people are walking around tired, with brain fog, because they’re basically inflamed for months. What helps (simple things first): - Please don’t wait until you feel miserable. Start your allergy meds before your worst month. - Keep car windows up on high-pollen days, especially on school drop-off and pickup. - Shower and change clothes after yard work or sports. Pollen sits in hair and on skin and keeps irritating you. - If you’re doing all of that and you’re still sniffling every day, that’s usually when we talk about allergy shots or sublingual therapy. 2. Food allergies are showing up in more ages (not just little kids) We are seeing more adults suddenly reacting to foods they ate for years with no problem. Nuts and shellfish are still big, but sesame is becoming a quiet troublemaker because it’s in breads, sauces, dressings, seasoning blends, etc. What to do if you think you reacted: - Take it seriously the first time. Don’t “test it again tomorrow just to check.” - Read labels. Sesame can hide under names like tahini, “spices,” etc. - If you’ve ever had mouth/throat swelling, trouble breathing, or hives after eating something you need to be seen. 3. Florida makes allergies louder Because it’s warm and humid, plants and mold don’t really “shut off.” Up north, you might get a true break in winter. Here, we don’t get the same reset. So for many of our Lakewood Ranch / Sarasota patients, allergies feel “year-round,” not “seasonal.” How to live with Florida air and still function: - Rinse your nose with saline at the end of the day. - Wash pillowcases more often. - Run a HEPA purifier in the bedroom at night. 4. Allergy care is getting more personal Now we can be much more specific. We test to see exactly what you’re reacting to oak vs grass vs dust mite vs pet dander vs certain foods and we build a plan around you, not 'people like you.' Inside the clinic, we’re also using tools that help track triggers and symptoms over time so we’re not guessing. That way, if you tell us, “Every afternoon around 3 I start getting pressure here,” we can line that up with pollen data, indoor exposure, even what you ate. 5. Prevention is the main difference between “annoying” and “miserable” This is the most honest advice we can give you: allergy care works best when you don’t ignore early signs. If you’re waking up stuffy every morning, if your child is rubbing their eyes all day at school, if you’re losing sleep because you can’t breathe through your nose that’s the moment to come in. Here’s what we tell our own families: - Know what you’re allergic to. - Start treatment before your worst month. - Control the air in the rooms where you spend the most time. - Stay on top of it. Allergies are not “one and done.” When should you call us? Call us if: - Over-the-counter meds stopped working. - You’re getting constant sinus pressure or headaches. - Your child is coughing at night or wheezing with activity. - You had a possible food reaction and now you’re nervous to eat that food again. We can test, treat, and build a real plan not just “take Zyrtec and hope.” We’re local, we know this pollen, and we see this every single day.

Eosinophilic Esophagitis (EoE) is a chronic allergic inflammation of the esophagus—the tube that carries food from the mouth to the stomach. It occurs when certain foods or environmental allergens trigger the immune system, leading to an abnormal build-up of eosinophils (a type of white blood cell) in the esophageal tissue. Over time, this inflammation can cause the esophagus to become stiff and narrow, resulting in difficulty swallowing and food impaction. Symptoms to Watch For Patients with EoE often describe food getting stuck in the throat or difficulty swallowing. They may eat slowly, take small bites, and drink water frequently during meals. In severe cases, food may become completely lodged, requiring emergency room intervention to remove it. Common symptoms include: • Difficulty swallowing (especially solid foods) • Chest discomfort or food impaction • Heartburn or reflux-like symptoms • Slow eating and frequent sipping of water during meals How Is EoE Diagnosed? Diagnosis is confirmed by performing an upper endoscopy with biopsy. The tissue sample is examined under a microscope, and the presence of 15 or more eosinophils per high-power field (HPF) confirms EoE. Because EoE can mimic acid reflux, it’s essential to consult an allergy specialist who can help distinguish between these conditions and identify potential allergic triggers. Causes and Triggers EoE can be caused by both food and environmental allergens. Common food triggers include milk, wheat, soy, eggs, and nuts. Environmental triggers such as pollen, dust mites, and molds can also play a role. At Allergy Affiliates, Dr. Geetika Sabharwal helps patients identify their triggers through detailed allergy testing and elimination strategies. Treatment Options If the specific trigger cannot be identified, several evidence-based treatments are available to control inflammation and prevent progression: • Proton Pump Inhibitors (PPIs): Reduce acid production and help with esophageal healing. • Swallowed Topical Steroids: Medications such as fluticasone or budesonide are swallowed to coat the esophagus and reduce inflammation. • Biologic Therapy (Dupixent): Dupilumab is an injectable medication that targets allergic pathways in EoE. It can be self-administered weekly at home. • Allergy Immunotherapy: Allergy shots aimed at environmental triggers can reduce overall allergic sensitivity and improve EoE symptoms in select patients. Why Early Treatment Matters If left untreated, EoE can lead to scarring, strictures, and in rare cases, perforation of the esophagus. Early diagnosis and treatment not only prevent these complications but also significantly improve swallowing function and overall quality of life. Compassionate, Personalized Care in Bradenton At Allergy Affiliates, our mission is to help patients eat comfortably and live confidently. Dr. Sabharwal and her team combine expert diagnosis with personalized allergy care to find the root cause of inflammation. Many of our team members and family members have personally experienced allergies, and we understand the challenges chronic allergic conditions can cause. Ready to Find Answers? If you or your loved one experiences difficulty swallowing, food getting stuck, or unexplained reflux, schedule an appointment at Allergy Affiliates in Bradenton. With accurate diagnosis and a tailored treatment plan, you can enjoy food again without fear or discomfort.

At Allergy Affiliates, families from Bradenton and nearby areas often reach out with concerns about skin rashes, itchiness, or irritation that seem to appear after contact with everyday items. Understanding what causes these reactions and how to prevent them is the first step toward lasting relief. What Is Contact Dermatitis? Contact dermatitis is a skin reaction that occurs when something touches the skin and causes irritation or an allergic response. It’s common in Florida because outdoor activities, swimming, and changes in weather expose the skin to many new substances. There are two main types of contact dermatitis: • Irritant Contact Dermatitis (ICD): This happens when a chemical or physical substance directly damages the skin. Common triggers include soaps, cleaning sprays, pool chemicals, and even rough surfaces on playground equipment. A classic example is poison ivy, which typically causes redness, itching, and a rash. Treatment involves topical or oral corticosteroids to calm the inflammation. • Allergic Contact Dermatitis (ACD): This occurs when the immune system reacts to an allergen that the skin has come into contact with. Everyday culprits include fragrances, hair dyes, gel nail products, and metals like nickel found in jewelry or belt buckles. Treatment for allergic contact dermatitis usually involves steroids for acute flares and long-term avoidance of the allergen once identified. The Common North American Contact Dermatitis Panel At our Bradenton clinic, we use the Common North American Contact Dermatitis Panel, which includes 80 allergens frequently responsible for skin reactions. This comprehensive test detects sensitivities to ingredients found in cosmetics, clothing, metals, and personal care products helping us pinpoint the cause of recurring rashes with precision. The Patch Testing Process: What to Expect Patch testing is the gold standard for diagnosing allergic contact dermatitis. It’s a simple, non-invasive, three-day process designed to identify your specific allergen: • Day 1 (Monday): Patches containing small amounts of allergens are placed on your back. • Day 3 (Wednesday): The patches are removed and the initial reactions are noted. • Day 4 (Thursday): The final reading is performed to confirm which substances triggered a response. During testing, your back must remain dry, so plan ahead and avoid showering or activities that cause sweating. This ensures accurate results and prevents patch displacement. What You Can Do at Home While waiting for your appointment or results, try the following: • Take note of new exposures: Have you used a new lotion, detergent, or shampoo recently? • Avoid known triggers: Remove metal jewelry, switch to fragrance-free products, and wear breathable fabrics. • Soothe the skin: Apply cool compresses and gentle, fragrance-free moisturizers to reduce itching and dryness. Relief and Prevention The goal of patch testing isn’t just diagnosis it’s empowerment. Once you know which allergens affect you, you can confidently choose products and fabrics that keep your skin healthy. Our team provides personalized education on what to avoid and recommends safe alternatives. Compassionate Care in Bradenton • A caring team many of us, including members of Dr. Sabharwal’s family, have personally experienced skin allergies and understand the frustration they cause Ready for Relief? If you or your child are struggling with a persistent rash, don’t wait for it to fade on its own. Call Allergy Affiliates in Bradenton today to schedule your patch test and take the first step toward lasting comfort and healthy skin.

If you live in Florida, you know that allergy season does not end when summer is over. In fact, one of the worst times for allergy symptoms is the fall season. From September through November, and often stretching into December, many Floridians experience sneezing, itchy eyes, runny noses, and even asthma flare-ups. At Allergy Affiliates, we see many patients during this time who are struggling with ragweed pollen and mold allergies. With the right diagnosis and treatment, it is possible to take control of symptoms and enjoy the season without constant discomfort. Ragweed and Fall Allergies Ragweed is one of the strongest allergy triggers during fall in Florida. The plant thrives in warm weather and can produce an enormous amount of pollen. Each ragweed plant is able to release billions of tiny pollen grains that float easily in the air. These grains travel miles away from the plant and make their way into our noses, eyes, and lungs. For people with ragweed allergies, symptoms usually include a stuffy or runny nose, itchy eyes, frequent sneezing, throat irritation, and in many cases worsening asthma. In Florida, ragweed pollen counts are highest in September and October, but the season often continues into late November because of the state’s warm climate. At Allergy Affiliates, our team provides allergy testing in Florida to confirm ragweed as a trigger and offer treatment options such as prescription medications or immunotherapy. Mold and Allergies in the Fall While ragweed is a major player, mold is another important trigger for fall allergies in Florida. Mold loves damp and humid environments, and Florida’s weather conditions in fall provide the perfect setting. Rain, lingering humidity, fallen leaves, and even storm activity can all increase mold growth outdoors. Mold spores are light and float in the air. When inhaled, they cause symptoms like nasal congestion, coughing, sinus pressure, watery eyes, or skin irritation. Indoor mold can be just as problematic. Bathrooms, kitchens, and areas with poor ventilation often trap moisture, which allows mold to grow. For people with asthma and allergies, mold can be especially harmful since it can lead to serious breathing difficulties. At Allergy Affiliates, we treat patients with mold allergies using advanced testing and personalized treatment plans. Our goal is to help reduce exposure and provide long term solutions, not just temporary relief. Why Fall Allergies Last Longer in Florida In many northern states, cooler weather brings an end to pollen and mold season by late October. In Florida, the climate is much warmer and allergens stay active longer. Instead of ending in November, allergy season often stretches into December. This extended season means Floridians are exposed to ragweed pollen and mold spores for several months. Because of this, many people seek professional help from Allergy Affiliates in Florida to find lasting relief and manage allergy symptoms effectively. How to Manage Fall Allergies in Florida Even though you cannot completely avoid pollen or mold, there are steps you can take to manage fall allergy symptoms. 1. Check pollen and mold levels daily Weather apps and allergy reports provide updates on pollen and mold counts. On high days, limit outdoor time, especially in the mornings when counts are often highest. 2. Keep windows closed It may be tempting to let fresh air in, but open windows allow pollen and mold spores inside. Use air conditioning with a clean filter instead. 3. Clean up after being outdoors Pollen sticks to skin, hair, and clothing. Shower and change clothes after spending time outside to reduce exposure. 4. Control indoor humidity Try to keep indoor humidity below 50 percent. Use a dehumidifier or air conditioner to make it harder for mold to grow. 5. Keep your home clean Vacuum carpets with a HEPA filter vacuum, wipe down dusty surfaces, and wash bedding in hot water once a week. 6. Consider medical help Over the counter allergy medicines may provide some relief, but if your symptoms are strong or persistent, visiting Allergy Affiliates can make a big difference. Treatment Options at Allergy Affiliates At Allergy Affiliates, we specialize in diagnosing and treating fall allergies in Florida. With professional allergy testing, we can identify your exact triggers and design a treatment plan tailored to you. Our services include prescription medications, biologic treatments, and immunotherapy for ragweed and mold allergies. Immunotherapy, also known as allergy shots or drops, helps your body build tolerance to allergens over time. This treatment provides long term relief and reduces allergy symptoms season after season. When to See an Allergist You should consider visiting Allergy Affiliates if your symptoms last for weeks without improving, interfere with your daily life, keep you up at night, or cause frequent asthma flare ups. Our board-certified allergist, Dr. Geetika Sabharwal, and her team provide compassionate care and advanced treatments to help you live free from the constant burden of allergies. Final Thoughts Fall in Florida may not bring cool weather and colorful leaves like other states, but it does bring ragweed pollen and mold spores that cause allergies. These triggers can make September through December tough for anyone with seasonal allergies or asthma. At Allergy Affiliates, we are dedicated to helping patients across Florida breathe easier. With allergy testing, personalized treatments, and long term options like immunotherapy, we make it possible to control allergies instead of letting allergies control you. If fall allergies are affecting your life, contact Allergy Affiliates today to schedule an appointment and take the first step toward real relief.