1. The Impact of Climatic and Environmental Factors for Asthma ER Visits in NYC Cindy Law Mary Lee-Wong, MD

2. What are Allergies? An abnormal sensitivity to an allergen that is inhaled, eaten, or touched Misidentification of a harmless substance as harmful

3. Common Types of Allergies Allergic rhinitis Food Medication Insect stings Latex chemical

4. Allergies and the Immune System B-lymphocytes &T- lymphocytes Lymphocytes identifies a foreign invader Foreign antigens cause production of antibodies 5 types of immunoglobulins

5. Allergy Cascade

6. Places and Symptoms of Reactions The sensitized immune system produces antibodies against allergens which cause the release of histamines into bloodstream

7. What is Asthma? Chronic lung condition with Inflammation of the airways Increased sensitivity of the airways Obstruction of airflow

8. Normal Bronchial Tubes

10. Airways

11. Symptoms of Asthma Coughing Wheezing Chest tightness Shortness of breath Faster/ noisy breathing

12. What causes Asthma? Allergens Irritants Others

13. Levels of Asthma Mild intermittent Mild persistent Moderate persistent Severe persistent

14. Spirometry Test Measures how much and how fast air can move into your lungs 60%-79%; mild 40%- 59%; moderate <40%; severe

15. Inhalers

16. Pollen Count Rotorod Sampler 0-14; low 15-89; moderate 90-1499; high <1500; very high

17. Pollen Grains

18. Objective Seasonal variables such as increased temperatures, relative humidity, mold counts and pollen counts may contribute to increased ER visits for asthma and other upper respiratory symptoms. Previous studies have reported increased ER visits for asthma due to increased air pollution at different times of the year. Since pollen can cause asthma exacerbation, we investigated whether there is a strong correlation of asthma exacerbation when pollen counts are at their highest.

19. Bibliography.Sullivan TJ. Drug Allergy. In: Midleton E, Jr. ed. Allergy, principles, and practice. 4th ed. St. Louis: CV Mobsby Co, 1993: 1725-1746.Ohman JL, Jr. Clinical and immunologic responses to immunotherapy. In: Lockey RF, Bukantz SC, eds. Allergen immunotheraPY. New York: Marcel Decker, Inc, 1991: 209-232.Yunginger JW. Insect Allergy. In: Midleton E, Jr, ed. Allergy, principles, and practice. 4th ed. St. Louis: CV Mobsby Co, 1993: 1511-1514.Patterson R, De Swarte RD, Greenberger PA, et al. Drug Allergy and protocols for mangement of drug allegies. N Engl Reg Allergy Proc 1986; 7: 325..In: The extra pharmacopoeia. 29th ed. London: The Pharmaceutical Press, 1989, 1189-1195.Monaghan MS, Glasco G, et al. Safe administration of iron dextran to patient who reacted to the test dose. South Med J 1994: 87(10): 1010- 1012.Fishbane S, Ungureanu VD, Maesaka JK, et al. The Safety if intravenous iron dextran in hemodialysis patients. Am J Kidney Dis 1996: 28(4): 529-534.Novey HS, Pahl M, Haydik Y, Vaziri ND, Immunologic studies of anaphylaxis to iron destran in patients on renal dialysis. Ann Allergy 1994; 72(3): 224-228.Patterson R, De Swarte RD, Greenberger PA, et al. Drug Allergy and protocols for managements to drug allergies. Allergy Proc (Spanish edition) 1995;9(2):13.Bridges KR, Bunn HF. Anemias with distributed iron metabolism. In: Isselbacher KJ, Braunwald E, Wilson JD, et al, eds. Harrison’s. Principles of internal medicine. 13th ed. McGraw-Hill, 1994; 1721-1723.Patterson R, De Swarte RD, Greenberger PA, et al. Drug Allergy and protocols for managements to drug Allergies. N Engl Reg Allergy Proc 1986; 7: 325-342.Sullivan TJ, Yecies LD, Shats GS, et al. Desensitization of patients allergic to penicillin using orally administered beta-lactam antibiotics. J Allergy Clin Immunol 1982; 69:275-282.Stark BJ, Earl HS, Gross GN, et al. Acute and chronic desensitization of penicillin. J Aallergy Clin Immunol 1987; 79: 523-532

20. Special Thanks to: Harlem Children Society Dr. Sat Dr.Mary Lee-Wong Beth Israel Medical Center