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fiinalgiirls · 5 years ago

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GENERAL INFORMATION.

FULL NAME - ramira beatriz reyes bustamonte NICKNAMES - ram, mira GENDER / PRONOUNS - she/her DATE OF BIRTH - february 12, 1990 PLACE OF BIRTH - el paso, texas CITIZENSHIP / ETHNICITY - cuban-american RELIGION - agnostic SOCIOECONOMIC STATUS / POLITICAL AFFILIATION - upper middle class, liberal. MARITAL STATUS - single. SEXUAL & ROMANTIC ORIENTATION - pansexual. EDUCATION / OCCUPATION - horror author, librarian in some verses LANGUAGES - spanish, english

FAMILY INFORMATION.

PARENTS - diego and paola reyes SIBLINGS - tbd OFFSPRING - none PETS / OTHER - none NOTABLE EXTENDED FAMILY - step-family

PHYSICAL INFORMATION.

FACECLAIM - jeanine mason HAIR COLOR / EYE COLOR - black / brown HEIGHT / BUILD - 5′7″ / slender TATTOOS / PIERCINGS - ears DISTINGUISHABLE FEATURES - red lips and a winning smile, long dark hair

MEDICAL INFORMATION.

MEDICAL HISTORY - none KNOWN ALLERGIES - nkda VISUAL IMPAIRMENT / HEARING IMPAIRMENT - none NICOTINE USE / DRUG USE / ALCOHOL USE - has a bit of a party problem in her past, now is trying to drink more responsibly and limit drug use to the occasional joint

PERSONALITY.

TRAITS - friendly, imaginative, enthusiastic ; a little vapid, distant TROPES - tbd TEMPERAMENT - sanguine ALIGNMENT - chaotic good CELTIC TREE ZODIAC - rowan, the MBTI - esfp HOGWARTS HOUSE - slytherin VICE / VIRTUE - tbd LIKES / DISLIKES: leather jackets and designer boots, red lipstick, the sound of a keyboard clicking, drop shots, stephen king and clive barker / doctor’s offices, family gatherings, ubers QUOTE: ❝strip a writer to the buff, point to the scars, and he’ll tell you the story of each small one.❞

FAVORITES.

FOOD - shrimp raviolis DRINK - red wine and black coffee PIZZA TOPPING - pesto chicken COLOR - red MUSIC - dark synth BOOKS - horror, thriller MOVIES - horror, thriller CURSE WORD - tronpon SCENTS - coffee, pasta, cloves, and pine

BIOGRAPHY,

trigger/content warnings: divorce mention, horror

ramira reyes was almost a household name by the time she’d finished her third book, but only her family called her beatriz. the sound of her birth name on their lips producing goose flesh as easy as the creak of a door in a house void of people. it had been a wise, yet impulsive, decision she’d made prior to her first publication that, were she to gain any small fame at all, she might like to keep some part of herself to herself. that she might want to some day found her own world absent of perfection without them. if nothing else, she could at least have her name and that small piece of autonomy and power that came with keeping it safe someday on the lips and hearts of her siblings, even if many of them did not appreciate or understand her chosen subject matter.

diego and paola met in artemisa, cuba in diego’s dental practice. paola was a dental hygienist with dreams of modelling and diego thought she had the most beautiful smile he’d ever seen. the pair were perfection, because they were both obsessed with perfection. despite the infidelity, no one could find a single flaw between them. beatriz was born eight months later and diego thought she and paola could offer him a more beautiful life than the one he already had. no hairs out of place, no stains on white couches. beautiful enough that he left his wife, and the children he’d already had with her, bringing his new bride and daughter to el paso, texas where they could start anew.

since the very first book, beatriz devoured the written word. she read every book she could get her hands on. she read in spanish and english. she read poetry and prose. she read history and the classics and all of shakespeare’s collected works by the time she was ten. it was stories like macbeth and the raven she loved most and she searched for their peers. disturbed by their daughter’s love of the macabre, paola threw out her stephen king paperbacks as easily as she found them and diego insisted she read more sophisticated authors. her parents’ efforts did little to sway her and, as her siblings were born after her, she was able to fly under their radar a little more with each birth.

a nervous child since birth, her parents control and idiosyncrasies only served to worsen her anxieties. allowance was not freely given to be spent; purchases had to be reviewed with both parents for approval. she became afraid to step out of line and yet she stepped on every crack in the sidewalk on her daily walk home from school. not because she believed some playground rhyme, but just to spite them. just to feel the imperfection underfoot as she plastered on her wooden smile. reading was her greatest escape and the school library her only refuge. it was there she discovered terrifying covers and flawed heroes. there was comfort in the frightening fantasies spun by horror greats. whatever her worries were, they were never as intimidating as the battle of good versus evil in the stand or the serial terror of books of blood. soon she was writing her own stories–sending shivers up the spines of girls at slumber parties and earning concerned, but approving glances from her creative writing teachers.

despite their dislike of her interests, both diego and paola were loving and supportive, they told her so. there was a long list of careers they had planned for her. she could follow in her father’s footsteps, she could be a model and fulfill her mother’s dreams, she could become a doctor, a lawyer, or go to business school like her uncle. and none among the prestigious careers laid out for her included horror writer. they stroked her hair and assured her it was not her fault when they finally split during her sophomore year in high school. in some ways, it only served to make things worse, but their divorce made it even easier to pursue her passion for writing. they were so focused on sabotaging each other’s happiness, she could easily slither through the cracks. finding herself with a hefty acceptance letter to sarah lawrence, where she’d always dreamed she’d go to escape the monotony and control of life in a dentist’s household in order to become who she’d always dreamed she could be.

college never felt pointless, despite meeting some of the same attitudes shared by her parents–one of the only things they could still agree upon. the nervousness that had driven her to the macabre seemed to dissipate the more she wrote about it. the more she wrote, the more she had to keep going and her first collection of short stories–her thesis project–was published the year she graduated. touted in the horror circles as a debut success, beatriz found herself in a whirlwind and, while her parents refused to read her work they did their best to support her; they told all their friends that they’d always pushed her to write. it burned that she couldn’t share everything she loved with them. that her place in the family was largely tied to her success. even her siblings seemed more afraid of stepping out of line than they did a desire to step out from underneath the reyes patriarch’s heavy thumb. and, as her success grew with each book, she felt further and further away from them. ramira reyes was a household name, but beatriz was the name she left behind with her family.

the distance only grew with her busy schedule and, as christmas neared, she found herself unable to travel back home under the threat of a new deadline for her latest tale of terror. procrastination became seductive with every daily distraction, and she found herself caught up in movie deal negotiations and parties. parties with people who were rarely critical of her, bathing her in the afterglow of sycophantic, unconditional love. after one such night out in a string of forgettable nights, she found herself drunk and lost in a subway car that felt eerily like midnight meat train with a broken phone and lost wallet. it was that morning, when she sat in a diner with last night’s party dress and smudged eyeliner, that she decided it was time to unplug. it was time to be scared again and it was time to write.

the loft apartment didn’t take long to sublet, nor did it take much time for her to pack. ramira had no idea where she was going, but she’d seen some rumors online about the mysterious town of boot hill, arizona and it seemed like the perfect place to unplug and be inspired. she sent her mother and father an email, apologizing to them that she’d likely miss christmas this year, but would make sure to come and see them all in el paso when she’d finished her book. the words were as wooden as her childhood smiles; nothing sounded worse than another christmas back home in el paso.

the flight wasn’t too long, but she was exhausted by the time she got into the rental car. assured by several people along the way that boot hill was simply an urban legend, ramira shrugged them off. it didn’t matter really. boot hill was more of an idea to her than a real place. as long as she found some small town where nobody knew her name and she wouldn’t be tempted by new york city nightlife, she was pretty sure she’d manage. maybe it wasn’t a real place, she thought dreamily, turning the dial on the rental car’s radio as she lost service, after following the directions she’d read on reddit and finding nothing. she could swear to god there’s no southbound highway and she’s barely able to keep awake any longer without any music, even with both windows rolled down.

it seems like it’s time to pull over at the next rest stop and catch some shut eye when she sees the sign. BOOT HILL, ARIZONA. IF YOU LIVED HERE, YOU’D BE HOME NOW! the quaint kitschiness makes her exhale sharply in amusement. fuck you, creepy gas station clerk, she thinks, tightening her knuckles at ten and two on the wheel with renewed resolve. i’m going to write a new bestseller in this town. white knuckled and red eyed, she drives on with the renewed energy of a second wind.

as a small smattering of lights appear in front of her, she can hardly hear the call of something sinister in the outskirts as she drives on. her phone still doesn’t have service, as she looks for an airbnb, but it doesn’t even bother her that she can’t call anyone to let them know she’s made it safely. hell, her publisher will probably lose his marbles until she sends him a draft, but all of that can wait. there’s something so calming about the sleepy town waking up in the wee hours of the morning. there’s something so magical about the pace of this place and ramira thinks, maybe she could write all her books in this town. maybe this is somewhere she belongs.

#ramira.

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fitnessloversharks · 4 years ago

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How to get rid of a sinus infection in 24 hours?

Spring and fall are intended to be celebrated. When You Need to See A Physicians For A Sinus Infection? When is it time to see the physician? Whenever you're having problems with your sinuses that are affecting your daily life. We would like to create an individual treatment plan to provide relief--especially if drug is not making the situation far better. A visit to the physician is particularly important should: * You have chronic sinus problems during the year. * Your sinus issues keep you from doing the things which you like. * You develop regular sinus infections that require antibiotic treatment. * You've found that over-the-counter drugs does not relieve your symptoms. What is the difference between a chronic and also an acute best over the counter medicine for sinus infection and sore throat disease? While the symptoms and signs of chronic and acute sinusitis are very similar, chronic sinus infections persist for 12 or more weeks. During chronic sinusitis, the nasal passages remain swollen and inflamed despite several treatment efforts or usage of over-the-counter drugs. Acute sinusitis is a temporary disease that's most likely associated with a virus or cold. If you have a chronic sinus disease, it's time to schedule a consultation with one of our internal medicine doctors. Not always, and with the growth of"superbugs" which are resistant to antibiotics, this is not necessarily the best solution for treatment. In fact, 85 percent of all sinus infections go away on their own after one-to-two months, according to data from Harvard Medical School. However, if your infection falls to the remaining 15 percent that don't get better, antibiotics are required. According to data from the American College of Allergy, Asthma and Immunology, antibiotics may also be needed if: * There is a thick, vibrant discharge coming from the nose. * You've undergone facial pain for 10 or more days. * Your condition improved but then got worse. * You've got facial tenderness (especially around the eyes or nose ). * You have dental pain. Why are internal medicine physicians the ideal option for sinus infection therapy?Our physicians focus on the full body, paying careful attention to how its systems socialize. This gives our internists a deeply concentrated perspective on not just alleviating symptoms, but prescribing a form of treatment to help relieve your allergies. Often, treatment starts with determining whether your chronic sinus issues are caused by allergies and if so, what substance is causing the aggravation. In this case, allergy testing can provide vital information. Not certain if an allergy test is ideal for you? We created a blog with a listing of 3 questions that you should think about so as to get the answer. How to get rid of a sinus infection in 24 hours? Allergies can be treated with prescription or over-the-counter drugs. However, if you have chronic difficulties, you should consider immunotherapy, which is sometimes referred to as"allergy shots" This procedure allows your body to decrease its sensitivity to specific allergens, providing long-term relief. The advantages of immunotherapy persist after the treatment has finished. If you would like to know more, check out our earlier blog,"What's Immunotherapy for Allergy Treatment?" NEED MORE INFORMATION ON SINUS AND ALLERGY Therapy? Take some time to review our comprehensive library that offers extensive educational blogs about sinus problems and allergy remedies. 5 Ways Allergies Slow You Down 3 Solutions for Frequent Sinus Issues How to Clear Sinus Congestion EXPERTISE COMBINED WITH CONVENIENCE CREATE AN EXCEPTIONAL HEALTH CARE EXPERIENCE We want to be your medical house, and we want to make it as convenient as possible for you to get the attention you need. In addition, we have also implemented Phreesia, which is the country's top Patient Intake Management Option. How to get rid of a sinus infection in a day? This means your payment and check-in process is easier and more compact than before. Schedule a consultation with us today. For at least 45 years, Raleigh Medical Group has served as the Triangle region's premier internal drug supplier. Contact us to schedule an appointment.

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dipulb3 · 4 years ago

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Teachers wait for Covid vaccines

New Post has been published on https://appradab.com/teachers-wait-for-covid-vaccines/

Teachers wait for Covid vaccines

She scrambled to set up virtual lessons for her fifth-grade language arts students in the spring. By fall, she was excited about returning to the classroom, but on just her second day back she became so concerned at the conditions in her Houston school that she took part in a sick-out with other teachers.

Now, she wants the vaccine against Covid-19 to be prioritized for her and all other teachers to keep them safe at their schools.

“I’m all for teachers being put on a higher list because we are around so many,” she told Appradab.

President-elect Joe Biden has put out a plan to spend $160 billion to execute a national vaccination program, expand testing and mobilize a public health jobs program, among other measures. He’s also asked for $50 billion to expand Covid-19 testing, some of it earmarked to meet his goal of getting schools back open safely.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said getting children back into school and staying there would be one of his key goals when he becomes chief medical adviser to the incoming administration.

“The idea of vaccinating teachers is very high up in the priority, as well as doing surveillance in the schools so that you can get a good feel for the penetration of infection,” he said last month.

Guidelines from the Centers for Disease Control and Prevention put teachers in the second tier of vaccine recipients, recommending they should be vaccinated along with other frontline essential workers like grocery store staff and police officers, once healthcare personnel and residents of long-term care facilities are protected.

But it’s up to individual states to make their own priorities, so while some like California are following CDC guidance, it is not mandatory.

In Florida, Gov. Ron DeSantis decided to open up vaccines to anyone over 65, sparking overwhelming demand.

In Texas, where Gill is teaching, Gov. Greg Abbott said in December he wanted teachers “near the front of the line.” But Appradab affiliate KTRK reported last week that while Houston fire and police officers were getting their shots, teachers were still waiting.

Alarm at deaths of teachers

Evidence suggests that schools, especially elementary schools, are not the superspreaders many feared. Cities that have seen increased positivity rates from coronavirus testing like Miami have managed to keep schools open without a spike in cases among students and faculty.

But teachers have been infected and some have died.

Zelene Blancas, a healthy 35-year-old first-grade teacher in El Paso, Texas, spent months in the hospital before she died of Covid-19 complications.

Philamena Belone, 44, taught third graders in an oxygen mask after first being hospitalized for coronavirus treatment but had to go back when she couldn’t breathe by herself. Also previously healthy, she died in December in Albuquerque, New Mexico.

Stories like these have shocked and alarmed teachers. Gill told Appradab last year she felt like she was being asked to choose between her students and her health.

“I’m walking into a room where I actually don’t really know what I’m breathing in,” she said. “A lot of our schools have really, they’re very old and … their AC units are very, very old.”

Gill says she knows people who are leaving the profession. She is stressed but she’s doing her best to let that go and come to terms with the situation until she can be vaccinated and feel safer.

For now though, she’s using some of the same protective techniques used by frontline medical staff.

“Before I go to my boyfriend’s house, I’ll change my clothes and make sure that I’ll take a shower and stuff because I feel like I might be bringing something to the people that I care about,” she said.

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hviral · 5 years ago

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Why parents are turning to a controversial treatment for food allergies

For families with food allergies, micro-managing daily life to avoid accidentally consuming the wrong food can be a huge burden. They scour labels. They avoid restaurants. They ban their kids from birthday parties, or refuse to enter sports stadiums, worrying that peanut shells littering the ground could trigger life-ending anaphylaxis.

The resulting angst has driven some families and physicians to try a therapy that has done well in early studies but has unclear long-term effects and is not yet approved by the Food and Drug Administration (FDA). The controversial treatment is called oral immunotherapy (OIT).

Conceptually, the method works like allergy shots, which for 100 years have reliably treated pollen and other environmental allergies by desensitizing the immune response to these triggers.

Instead of injecting allergens through the skin, OIT involves consuming a bit of the forbidden food each day, at gradually increasing doses, so the immune system can learn to put up less of a fight.

Over the past decade, the number of OIT providers has grown from just a handful of doctors nationwide to a small, influential cohort of more than a hundred today. Thousands of food allergy patients who have tried oral immunotherapy in the United States and abroad swear by the treatment, often calling the results life-changing. And with an FDA decision expected by early 2020 for Aimmune Therapeutics’ “peanut capsules,” OIT could soon go mainstream.

But at the moment, allergists remain deeply divided over the treatment, which doesn’t work for everyone and carries uncertain risks. In contrast, the traditional approach — avoidance of the trigger food — achieves safety for the vast majority of individuals. In fact, someone with a food allergy has a greater chance of being murdered than dying from an allergic reaction. And yet that fact belies the hidden stress and fear that grips many of the estimated 32 million Americans with food allergies. For them, the possibility of a life-ending reaction looms large, and many are eager to see the FDA approve a drug that advocates say could put those fears to rest.

But with many researchers dismissing the science as thin and the treatment unnecessary, the schism over oral immunotherapy — among both physicians and food allergy families — may not easily resolve. “This is a very weird field,” said allergist Kari Nadeau of Stanford University School of Medicine. “I’ve been in oncology. I’ve been in autoimmune disease. And just over the past 13 years I’ve been in allergy.” There are lot of different physicians with varying levels of training, Nadeau said. “It’s a little strange to have such a divergent climate.”

Though OIT is relatively new, the science behind desensitization therapy dates back more than a century, when the term “allergy” had barely entered the medical vocabulary. In 1905, a German doctor described treating “milk idiosyncrasy” in infants by feeding incrementally increasing drops of milk. Three years later, a London physician reported giving daily doses of egg to calm a teen boy’s “egg poisoning.” By 1940, clinicians had published a total of nine papers describing the use of similar methods to treat dozens of people with allergies to milk, wheat, egg, orange, tomato, and cocoa.

In the mid-1960s, scientists discovered the molecular culprit: immune-system antibodies called immunoglobulin E (IgE). Each IgE recognizes a specific allergen — ragweed, say, or peanut. When the allergen gloms on, IgE travels to other immune cells, leading them to unleash histamine and other chemicals that set off an allergic reaction in the nose, lungs, throat, or skin.

Beyond these isolated advances, food allergy research got little attention for decades. This was, in part, due to the low prevalence rate. As recently as the early 1980s, less than 1 percent of people in the United States were thought to have a food allergy. “For a long time, the easy answer was just to avoid the food if you were allergic,” said Christina Ciaccio, a pediatric allergist at the University of Chicago Medicine who has consulted and helped run studies for companies developing peanut allergy treatments.

If a reaction did escalate to something more serious, such as full-body hives, throat tightness or trouble breathing, a shot of epinephrine — FDA approved as an auto-injector under the name EpiPen in 1987 — could start to bring relief within minutes. As manufacturing practices changed, Ciaccio said, people started eating more processed foods, and it became increasingly difficult to avoid accidental allergen exposures.

In the late 1980s, initial reports of anaphylactic deaths due to peanuts trickled into the medical literature. In 1992, Denver physicians published a small study in which they treated food allergy patients with skin injections, the approach routinely used for environmental allergens. But the study came to a halt when a formulation error caused a subject in the placebo group to die of anaphylaxis. “That slowed food allergy research for over a decade,” said Ciaccio.

While research stagnated, media stories brought the terror of food allergies into the public consciousness. In 1995, The Wall Street Journal ran the headline “Peanut Allergies Have Put Sufferers on Constant Alert.” Later that year, a British daily tabloid newspaper published a story titled “Nut Allergy Girl’s Terror; Girl Almost Dies from Peanut Allergy.”

In the years that followed, for reasons not well understood, food allergies became more common among U.S. children. Between 1997 and 2008, peanut allergies more than tripled. In 2002, as part of the first state guidelines for managing food allergies in schools, Massachusetts called for peanut-free lunch tables. In a span of about 15 years, peanut allergies had risen from a virtually unknown medical condition to what some might call a public health emergency. Today, food allergies affect 8 percent of kids in the U.S. and more than 10 percent of adults.

In 2005, five research centers received a National Institutes of Health grant to form a consortium to conduct basic research toward developing food allergy treatments, and to run clinical trials to test them. “We were scared to do peanut,” said A. Wesley Burks, a pediatric allergist at the University of North Carolina School of Medicine and one of the consortium’s lead investigators. Evidence suggests that the vast majority of life-ending food allergic reactions are caused by peanuts or tree nuts.

So as a proof of concept, the consortium’s first oral immunotherapy studies were done with egg. Burks and colleagues conducted a study showing that daily doses of powdered egg white could help people with egg allergy. The method was not a cure. But when the study ended, most participants could tolerate enough egg protein to withstand accidental exposures. In other words, they became bite-proof.

The team then enrolled 39 people in a peanut OIT study using a similar protocol. Those who made it past the initial day consumed store-bought peanut flour — which was pre-measured and sterilized in the lab, then mixed at home into applesauce or pudding or other foods. Dosing started at 50 milligrams and went up 25 milligrams every two weeks. (A few participants had to start at a lower dose and had their increases adjusted accordingly.) Once participants could tolerate 300 milligrams of peanut protein — a little more than one peanut — they began a maintenance phase, steadily increasing their daily OIT dose up to 1800 mg over the next few years.

Nearly a quarter of the original participants ended up withdrawing from the study. Four dropped out because of allergic reactions to the therapy, and gastrointestinal or asthma symptoms. The rest withdrew for other reasons, including transportation issues, parental anxiety, and failure to perform home dosing. But among the 29 participants who finished, 27 successfully passed an oral food challenge with 3.9 grams of peanut protein (about 16 peanuts).

As that initial wave of OIT publications came out, a smattering of private-practice allergists saw an opportunity. They recognized the principles and basic procedures as similar to the allergy shots they routinely administered for airborne antigens. “Any trained allergist would know how to recognize and respond to a reaction,” said Richard Wasserman of Allergy Partners of North Texas. Whether triggered by peanut or pollen, “an allergic reaction is an allergic reaction.”

Chatting with an El Paso colleague who was among the nation’s first allergists to administer private-practice OIT, Wasserman was inspired to develop protocols for his own clinic. Wasserman started treating patients in July 2009 and he and the colleague presented their early OIT experiences in a 15-minute oral poster session at a national immunology meeting a few years later.

“The room was overflowing out the door,” Wasserman recalled. His results were eye-opening and would soon be backed up by published studies. Among individuals who try OIT, about 80 percent become bite-proof.

In such reports of preliminary results, many parents saw a potential escape from daily struggles characterized by fear, isolation, and invisibility.

Shea Tritt discovered her son’s peanut allergy when he was 13 months old. Moments after licking peanut butter off her finger, he broke out in hives, his eyes and face swelled, and his tongue got “so big he couldn’t close his mouth,” she said. From that point, “I was just so petrified of reliving that moment that I just cut off anything new,” said Tritt, a gymnastics coach in Abingdon, Virginia. Her son has never tasted an orange. “I think he kinda learned, this is what I eat, and we stayed in that really small box.”

Alicia Bales’ son is allergic to dairy, egg, some tree nuts, and some seeds. She worries about an allergic reaction, she said, but her son’s condition has affected their family in other ways, too. Last Thanksgiving, she made a batch of her grandmother’s special egg noodles with her daughter. Her son, Ethan, wanted to play with the dough. “I couldn’t let him,” said Bales. Since Ethan’s diagnosis, some foods now signal danger rather than safety, illness instead of nourishment, fear rather than comfort, Bales explained. “There’s a source of love from my past that I can’t pass on to my son.”

Families dealing with food allergies also report feeling misunderstood because people tend to lump their life-threatening condition in with a slew of other diets, health concerns, and ethical reasons for restricting certain foods. To help others understand, food allergy patients may stress that they have a “life-threatening” food allergy, Ciaccio said. “These individuals then get unfairly called out for hyperbolizing.”

Sometimes the most painful misunderstandings occur within extended families. “They’re navigating aunts and uncles, sometimes even grandparents, who don’t get it — or they get it and choose not to respect the guidelines. And so that’s another source of potential anxiety,” said Tamara Hubbard, a licensed counselor in the Chicago area who works with food allergy families and maintains a website that includes a directory of nationwide food allergy counselors.

Bales often has to remind her father-in-law about her son’s allergies, sometimes multiple times a day — explaining that dairy is found in ice cream and many baked goods, and often in chocolate. She doesn’t blame him, she said, because he didn’t grow up around food allergies. When her son first got diagnosed, Bales said, she felt as though he was playing at the edge of a cliff: “No one could see the edge except for me.”

For some, oral immunotherapy offers a sense of control. Parents want “to do something about it right now,” Bales said — even when a treatment carries a high risk of unpleasant side effects.

They hear stories and read medical reports about success with oral immunotherapy and “then they start questioning their allergist or physician: Why can’t I take it?” said Thomas Casale, chief medical advisor for operations at Food Allergy Research & Education (FARE), a non-profit that helped launch Aimmune.

The answer differs vastly, depending on the physician. Some insist that OIT is still experimental and needs further study to ensure it works consistently and safely. Others contend they have enough experience treating environmental allergens to configure an approach for desensitization to foods. “Those are the two different arguments, Casale said. “There’s merit with both.”

Over the years, these two camps have grown more vocal. In 2010, researchers in the NIH-funded consortium published a commentary titled “Peanut Oral Immunotherapy (OIT) is Not Ready for Clinical Use.” On multiple occasions consortium investigators and Wasserman have taken the stage at national meetings, debating OIT’s pros and cons.

Because food allergy rates have risen dramatically in just a few decades, the divide is in part generational. “I think some people are guarding the old,” said Nadeau, who directs the Sean N. Parker Center for Allergy and Asthma Research at Stanford University, which has helped conduct trials of food allergy products being developed by Aimmune and DBV Technologies.

Yet OIT does carry risks. An analysis of 12 clinical trials involving Aimmune capsules or store-bought peanut flour found that people on treatment were three times as likely to go into anaphylaxis compared to those on placebo or avoidance. Some experts interpret these findings, published in The Lancet in April, to suggest OIT is more dangerous than avoiding the food. “It’s one thing to say you’re willing to take risks for a treatment that’s going to offer a cure or complete resolution of the disease,” said Corinne Keet, a pediatric allergist at the Johns Hopkins University School of Medicine. “But, right now, it’s pretty clear that for most people, at least in the short term, oral immunotherapy doesn’t lead to a cure. It leads to a temporary desensitization that still carries with it a risk of ongoing reactions.”

Other doctors point to a tradeoff. When consuming a “food you’re allergic to, you’re going to have some side effects along the way. We know that. Ninety-five percent of people have side effects,” said Nadeau. But “at the end of the game, if you reach that endpoint, you can start eating food and not be worried about an accidental ingestion.”

Although oral immunotherapy can cause more frequent allergic reactions, Keet said, some families may prefer the predictability over the rarer surprise reactions that happen with avoidance.

Many experts do not consider OIT medically necessary, and very few allergists offer it. The therapy is not yet FDA approved, and has no insurance billing code, said Brian Schroer, who directs allergy and immunology at Akron Children’s Hospital in Ohio. Some allergists who offer OIT have billed it as related procedures such as an oral food challenge or a drug/venom desensitization procedure.

Plus, based on a recent analysis by the Institute for Clinical and Economic Review, it remains unclear if OIT is cost-effective compared with avoidance. “That sort of creates the ‘haves’ versus the ‘have nots,’” said Stacey Sturner, a Chicago food allergy mom whose son completed peanut OIT as a 5-year-old in 2017. Not surprisingly, the “haves” tend to be higher-income families. “OIT has ignored large segments of the patient population who have food allergy — particularly those who are poorer or ethnic minorities,” said Keet, who sees many low-income families.

Beyond cost, there’s also time and emotional burden. A treatment that requires strict compliance and many clinic visits is a significant undertaking, “especially with two working parents and multiple kids in the house,” said Edwin Kim, a father of two food-allergic children who works as an allergist-immunologist at the University of North Carolina School of Medicine. Such considerations can add to the frustration many families face when they hear about OIT. On the one hand, the treatment offers hope. But for some, it is inconvenient or even inaccessible. And it doesn’t work for everyone.

But on social media, these drawbacks are sometimes overlooked. Using the #OITWorks hashtag, some families post photos of smiling kids with OIT completion certificates and bags of peanuts, or eating birthday cake for the first time. Sturner, who started the Facebook group Food Allergy Treatment Talk, said that these voices have gotten louder over time. “That loudness really turned off a lot of people,” she said, “because it felt like shouting.”

Some parents say that doctors and journalists unwittingly fuel the shouting when they use terms like “graduation” and “failure” to describe OIT outcomes. Jaelithe Judy’s son started peanut OIT two years ago at age 13 but had to stop six months later after he was diagnosed with an OIT-triggered inflammatory disease called eosinophilic esophagitis. “I make a point myself never to say that my son ‘failed’ OIT,” said the St. Louis, Missouri, mother. Rather, she frames it as the treatment failing him. Judy said she is not alone on this point. Other families that have not benefitted from the treatment also “find this ‘failure’ language troubling and discouraging to their kids.”

Much rarer than OIT successes are food allergy deaths, which also get shared heavily on Facebook and Twitter. This creates “a false illusion of extreme circumstances,” said David Stukus, a pediatric allergist at Nationwide Children’s Hospital in Columbus, Ohio, who joined Twitter in 2013 to fight misconceptions by disseminating evidence-based information. “People read a headline and now they think that their risk has changed.”

If there were a true balance of stories, Stukus said, for each tragic death that occurs and every story shared, “we would literally have a million other stories demonstrating that someone who has peanut allergy went to school that day, went to a ballpark, or flew on an airline without any problems at all.”

Still, food allergy sufferers can find themselves in dangerous situations if needed medication isn’t available. Since last year, EpiPens have been in short supply and are not always carried by airlines — something advocates are now pushing to change.

With rising pharmaceutical interest in developing food allergy products — two of which are heading toward an FDA decision — Kim worries that a single catastrophe with off-label OIT could set back the field.

The number of providers in the United States who currently offer off-label oral immunotherapy is estimated to be around 2 percent of board-certified allergists. It’s not easy for clinics to offer a highly individualized treatment that requires considerable time, clinical space, and nursing support, Schroer said. An even bigger obstacle, he noted, is the need to produce food-based products “to essentially pharmaceutical-grade levels.” Most allergists are waiting for an FDA-approved food allergy treatment before offering the therapy in their clinics. And in the case of peanut OIT, years ago leading experts believed that securing FDA approval would require measuring peanut flour into standardized capsules so each holds precise amounts of peanut protein. Aimmune Therapeutics launched in 2011 with that mission.

“The allergists who offered OIT early on were the pioneers, who had to blaze their own trails. Aimmune is working to lay the railroad and make the journey much easier and more reliable for everyone involved,” said Alison Marquiss, a former spokesperson for the Bay Area company.

Last November the New England Journal of Medicine published results of a clinical trial of AR101, Aimmune’s investigational peanut-containing drug. According to a company press release, it is the largest phase 3 peanut allergy oral immunotherapy trial to date, with 551 participants at 66 sites in North America and Europe. (Outside of research, private practice allergists in the United States have treated more than 7,800 patients with commercial food products.)

At the end of the Aimmune study, about two-thirds of the treated group were able to tolerate peanut protein equivalent to a dose of about two peanuts. Based on those results, the company submitted a licensing application. The FDA has said it will review the application in September and make a decision by January 2020. France-based DBV Technologies is developing a different type of immunotherapy called Viaskin Peanut, which delivers peanut proteins through a skin patch, and is headed for FDA review.

Outside of clinical trials, OIT has generally only been offered by private practice allergists. But as more data have come out, academic centers have begun to explore the possibility of offering the therapy as a service to patients. Some are already doing so.

“Especially as a public institution, we have the responsibility to translate what we’ve learned from trials to best practices,” said allergist Rita Kachru of the University of California, Los Angeles, which has served as a site for DBV and Aimmune trials.

Her team still considers the treatment investigational. “We are just starting to understand the risks, the benefits, the efficacy,” Kachru said.

“If we’re writing a novel,” she added, “we’re maybe at chapter 2. But I think we’re getting a better understanding, definitely more than a few years ago.”

At any given moment, OIT conversation on Food Allergy Treatment Talk, the Facebook group Sturner started, might highlight successes, discuss challenges, or raise questions. “It’s complicated. Because the human immune system is complicated. So are our emotions,” wrote Sturner on a Friday in March when a discussion about the risks and benefits of OIT became heated. “Read the threads. Absorb the info. Do your research. Most importantly, don’t panic.”

The post Why parents are turning to a controversial treatment for food allergies appeared first on HviRAL.

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jarangomd · 5 months ago

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Ear Infection Treatment: Expertise from Your Throat Specialist in El Paso, Texas

Ear infections are a common ailment, particularly in children, but they can affect individuals of all ages. If you are experiencing persistent ear pain, discomfort, or hearing issues, it might be time to consult a throat specialist in El Paso, Texas. Dr. Jorge Arango and his team at the Ear Sinus & Allergy Center are dedicated to diagnosing and treating ear infections with a high level of expertise and care.

Understanding Ear Infections

An ear infection, medically known as otitis media, occurs when the middle ear becomes inflamed, often due to bacteria or viruses. This condition can cause fluid buildup behind the eardrum, leading to pain and potential hearing difficulties.

Symptoms of Ear Infections

Common symptoms of ear infections include:

Ear pain or discomfort

Difficulty hearing

Fluid drainage from the ear

Fever

Headache

Loss of balance

If you or your child are experiencing these symptoms, it's essential to seek medical attention from a throat doctor in El Paso, Texas, who can provide accurate diagnosis and effective treatment.

Diagnosis by a Throat Specialist in El Paso, Texas

At the Ear Sinus & Allergy Center, Dr. Jorge Arango employs state-of-the-art diagnostic tools to assess the severity and type of ear infection. The diagnosis process typically includes:

Otoscopy: Using an otoscope, Dr. Arango examines the ear canal and eardrum for signs of infection.

Tympanometry: This test measures the movement of the eardrum to determine the presence of fluid in the middle ear.

Hearing Tests: These may be conducted to evaluate any hearing loss associated with the infection.

Treatment Options

Once a diagnosis is made, Dr. Arango and his team will recommend the most appropriate treatment based on the severity of the infection and the patient's medical history.

1. Medications

For bacterial infections, antibiotics are often prescribed to eliminate the infection. Pain relievers and anti-inflammatory medications may also be recommended to alleviate symptoms.

2. Ear Tubes

In cases of recurrent ear infections or persistent fluid buildup, Dr. Arango might suggest the insertion of ear tubes. These small tubes help drain fluid from the middle ear and prevent future infections.

3. Surgical Intervention

For severe or chronic cases, surgery may be necessary. Dr. Arango, a highly skilled vocal cords doctor near me, performs various surgical procedures to address complex ear issues, ensuring patients receive the best possible care.

Preventing Ear Infections

Prevention is an essential aspect of managing ear health. Here are some tips to reduce the risk of ear infections:

Maintain Good Hygiene: Regular handwashing can prevent the spread of bacteria and viruses.

Avoid Smoke Exposure: Secondhand smoke can increase the risk of ear infections, particularly in children.

Stay Up-to-Date with Vaccinations: Vaccines, such as the flu shot and pneumococcal vaccine, can help prevent infections that may lead to ear problems.

Manage Allergies: Controlling allergies can reduce the likelihood of developing ear infections.

Why Choose Dr. Jorge Arango?

Dr. Jorge Arango, an esteemed throat doctor in El Paso, Texas, brings extensive experience and a compassionate approach to treating ear infections. Here are a few reasons why patients trust Dr. Arango and his team:

Expertise in ENT Care: With a background in ear, nose, and throat treatments, Dr. Arango offers comprehensive care for all ENT-related issues.

State-of-the-Art Facility: The Ear Sinus & Allergy Center is equipped with advanced diagnostic and treatment tools to provide the highest quality care.

Patient-Centered Approach: Dr. Arango and his team prioritize patient comfort and satisfaction, ensuring personalized treatment plans tailored to each patient's needs.

Commitment to Education: Dr. Arango believes in educating his patients about their conditions and treatment options, empowering them to make informed decisions about their health.

Contacting Your Throat Specialist in El Paso, Texas

If you are suffering from ear infections or other ENT-related issues, don’t hesitate to reach out to Dr. Jorge Arango at the Ear Sinus & Allergy Center. With his extensive experience and commitment to patient care, Dr. Arango is the trusted throat specialist and vocal cords doctor near me who can provide the effective treatment you need.

Business Hours:

Monday to Thursday: 8:30 a.m. – 4:30 p.m.

For more information on Dr. Jorge Arango’s achievements, specialization, and treatment methods, visit his website.

Conclusion

Ear infections can be painful and disruptive, but with the right care from a qualified throat doctor in El Paso, Texas, relief is within reach. Dr. Jorge Arango and his team at the Ear Sinus & Allergy Center are dedicated to providing top-notch treatment for ear infections, ensuring patients receive the best possible care. By understanding the symptoms, seeking prompt diagnosis, and following the recommended treatment plan, you can effectively manage ear infections and maintain optimal ear health.

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