Allergy & Asthma Center of the Tri-State Inc. - Allergist Cincinnati

513-451-6006 (Western Hills)

513-791-6006 (Montgomery)

Adult and Pediatric Allergist

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By Dr. Mark Michael, Jan 24 2017 05:29PM
















By Dr. Mark Michael, Oct 26 2016 05:28PM

The first physician most people see for allergies is their primary care provider. But when your itchy, drippy nose or eyes continue to get you down despite over-the-counter and prescription medications, it's time to see a specialist. If you are experiencing symptoms of coughing, wheezing, shortness of breath and serious sinus infections, or if you suspect food allergies, see an allergist as soon as possible.

A board-certified allergist is trained to look at the whole picture: your family history, your overall health, your history of symptoms – and put it together with specialized diagnostic tests to reach a diagnosis and set up an individualized treatment plan.

Don't let allergies rule your life! See an allergist. Here's what to expect:

The allergist will first ask about personal and family medical history and allergy symptoms:

When did you first notice symptoms, how long did they last, what made them better or worse?

Do you have a history of runny, sneezy, itchy or congested nose or eyes?

What time of year?

What were you doing when they arose?

What did you do to treat them?

Was the treatment successful?

Have you had episodes of wheezing or difficulty breathing?

What did you do to treat it, and did it help?

Do you have skin rashes or itchy skin?

Have you noticed symptoms such as skin rash, runny nose, itchy mouth, stomach discomfort or difficulty breathing after eating particular foods?

Does anyone in your close family have allergy, asthma, eczema or colds that linger for months instead of days?

Allergy Testing

If signs point to allergy, the doctor will likely perform an allergy test – perhaps on a follow-up visit. Based on your history and your home and work environment, the doctor will choose which allergens to test for.

Allergists do not usually test for a full spectrum of allergens, as the results can be misleading. False positives are common – meaning that the test result may be positive, but you do not experience symptoms when actually exposed to the allergen. When testing for food allergy, too many false positives can prompt you to limit your diet unnecessarily, possibly affecting your nutrition. An accurate allergy diagnosis combines your personal history of symptoms along with test results.

The most common allergy test is the skin prick test. When a small amount of liquid allergen is pricked onto your arm or back, a small raised bump will appear if you are sensitized to it. The test is quick (the whole thing takes about 30 minutes), accurate and can be done in one visit.

Sometimes the doctor will recommend a blood test. This is usually done if there are specific reasons you're unable to undergo the skin tests – sensitive skin, perhaps, or a medication regimen that would affect the skin reaction. Blood tests must be sent away and processed in a laboratory, and results can vary from one lab to another.

Allergy Treatment Plans

After the diagnosis, the allergist will work with you to set up a treatment plan, which is likely to combine the following:

Allergen avoidance. What can be done to reduce exposure to your allergens? This may involve taking steps to reduce dust or other allergens inside the home, changing family habits to reduce exposure to pets, or discussing ways to reduce exposure to outdoor pollens and mold.

Non-medical therapies. Are there ways to ease symptoms without medication, such as nasal washes or eye drops? What about using HEPA vacuum filters when cleaning or face masks when working outdoors?

Medications. A wide variety of preventive and as-needed allergy medications are available to fit your lifestyle.

Immunotherapy. The decision to add allergy shots to treatment is not usually part of the first appointment, unless you have a life-threatening allergy such as insect venom. It will be considered later, based on the frequency and severity of symptoms, your response to medications and allergen avoidance, and the degree of unavoidable allergen exposure you face.

By Dr. Mark Michael, Jul 6 2016 04:43PM

Zika virus is a disease primarily transmitted by mosquitoes. The disease has historically occurred in Africa,

Southeast Asia and islands in the Pacific Ocean. In May 2015, Zika virus was found for the first time in the

Western Hemisphere in northeastern Brazil. The virus has since spread through much of the Caribbean,

Central America and South America. There have been no reported cases of Zika virus disease transmission

through mosquito bites in Ohio or anywhere else in the continental United States at this time. However,

cases have been reported in travelers returning to the United States from Zika virus-affected countries.

The Centers for Disease Control and Prevention (CDC) maintains an updated list of affected countries and

territories as well as associated travel advisories on its website at

What are the symptoms of Zika virus infection?

About 1 in 5 people infected with Zika virus will develop symptoms. Illness from Zika virus is usually

mild, and most people feel better within a week. Symptoms of Zika virus include fever, rash, joint pain,

conjunctivitis (red eyes), muscle pain and headache. Severe disease requiring hospitalization is uncommon,

and deaths are rare. Rare complications may include Guillain-Barré syndrome (neurologic abnormalities)

following a Zika virus infection.

What are the concerns about Zika virus and pregnancy?

Zika virus can be spread from a pregnant woman to her fetus. There have been reports of a

serious birth defect of the brain called microcephaly in babies of mothers who had Zika

virus while pregnant. Knowledge of the link between Zika and birth defects is evolving, but

until more is known, CDC recommends special precautions for pregnant women. Pregnant

women in any trimester should consider postponing travel to any area where Zika virus is

spreading. If you must travel to one of these areas, talk to your healthcare provider first and

strictly follow steps to prevent mosquito bites during your trip.

Until more is known, CDC recommends that women trying to get pregnant and their

male partners talk to their healthcare providers before traveling to areas with Zika virus

transmission. Because sexual transmission is possible, both men and women should

strictly follow steps to prevent mosquito bites during the trip. More information about

Zika virus and pregnancy is available on CDC’s website at

How do people get Zika virus, and is it contagious?

There is no indication that Zika virus can spread from person to person through

casual contact.

Department of Health

Facts About Zika Virus

1 Updated February 2016

The most common way people get Zika virus is through the bite of an

infected mosquito. The primary mosquito that transmits Zika virus is

Aedes aegypti, the yellow fever mosquito. This mosquito is found in the

tropics and southern United States. It is not established in Ohio. Aedes

albopictus, the Asian tiger mosquito which is established in parts of

Ohio, may potentially transmit Zika virus in the United States, although

it has not yet been implicated in the transmission of human cases.

Zika virus also can be transmitted from a man to a woman through

sexual contact. In known cases of likely sexual transmission, the men

had Zika virus symptoms, although in one case the virus was spread a

few days before symptoms developed. At this time, there is no evidence

that a woman can transmit Zika virus to a man through sexual contact.

However, more research is needed to understand this issue. More information about Zika virus sexual

transmission is available on CDC’s website at

A mother can pass Zika virus to her fetus during pregnancy. A mother already infected with Zika virus

near the time of delivery can pass on the virus to her newborn around the time of birth, but this is rare.

To date, there are no reports of infants getting Zika virus through breast milk. Because of the benefits of

breastfeeding, mothers are encouraged to breastfeed even in areas where Zika virus is found.

There have not been any confirmed blood transfusion transmission cases in the United States at this time.

There have been reports of blood transfusion transmission cases in Brazil, and these reports are currently

being investigated.

How is a Zika virus infection treated?

There is no specific treatment for a Zika virus infection. Treat the symptoms by getting plenty of rest, drinking

fluids to stay hydrated and taking medications to reduce fever and pain such as acetaminophen. Avoid

taking aspirin and other non-steroidal anti-inflammatory medications. If you are pregnant, contact your

obstetrician or prenatal care provider for additional follow-up.

How can I prevent becoming infected with Zika virus or spreading it to others?

There is no vaccine to prevent Zika virus infections at this time. Preventing mosquito bites is the best defense

against Zika virus infections and other mosquito-borne viruses.

Yellow fever mosquito, Aedes aegypti, which can carry

dengue chilkungunya or Zika viruses. Photo by the

Centers for Disease Control and Prevention.

2 Updated February 2016


Warning: Zika might be linked to birth defects

There is no vaccine to prevent Zika virus infection

Protect yourself from mosquito bites

Daytime is most dangerous

Mosquitoes that spread

chikungunya, dengue, and Zika

are aggressive daytime biters.

They can also bite at night.

Use insect repellent

It works!

Look for the following

active ingredients:


Wear protective clothes

Wear long-sleeved shirts and

long pants and use insect

repellent. For extra protection,

treat clothing with permethrin.

Mosquito-proof your home

Use screens on windows and

doors. Use air conditioning

when available. Keep

mosquitoes from laying eggs in

and near standing water.

For more information: • •


Protect Yourself From Mosquito Bites

CDC has recommended that pregnant women consider postponing travel to areas with active Zika virus


To prevent potential Zika virus sexual transmission, CDC recommends that men who reside in or have

traveled to an area with active Zika virus transmission should use condoms every time during sexual contact

or abstain from sexual activity with a pregnant sex partner for the duration of the pregnancy. CDC also

recommends that pregnant women without symptoms of Zika virus be offered testing two to 12 weeks after

returning from areas with ongoing Zika virus transmission.

While there have not been any reports of cases transmitted through blood transfusions in the United States

at this time, the Food and Drug Administration recommends as a precaution that certain people defer

donating blood. This includes people who traveled to or resided in areas with active Zika virus transmission

in the past four weeks, people with symptoms consistent with Zika virus infection in the past four weeks, and

those who have had sexual contact with people living in or traveling to areas with active transmission in the

previous three months.

As a precaution, it is recommend that people suspected to have Zika virus avoid mosquito exposure for

the week after symptom onset when mosquitoes are active (usually from May to October in Ohio) in order

to prevent the possibility that mosquitoes might become infected by biting an infected person and then

transmit the virus to other people.

For more information, please visit these websites:

• ODH Zika Virus Information:

• CDC Zika Virus Information:

• CDC Areas with Active Zika Virus Transmission:

• CDC Insect Repellent Use & Safety:

• World Health Organization:

• Pan-American Health Organization:

Adapted from materials developed by the Ohio Department of Health, the Centers for Disease Control and Prevention

and the Food and Drug Administration

By Dr. Mark Michael, May 24 2016 01:28PM

While only a few tick species infect people with diseases, the rising popularity of many outdoor activities and the spread of residential developments has upped the odds that one of those creepy parasites might latch on to you.

"Luckily, ticks don't fly, jump or fall from the sky," vector-borne disease expert Stephen Wikel said. He's a professor emeritus of medical sciences at Quinnipiac University's Frank H. Netter M.D. School of Medicine, in North Haven, Conn.

"They generally move from grass to a living host, and crawl upwards, looking for a warm, moist area to feed. Ticks also have incredible anti-detection defenses. For example, their saliva is loaded with antihistamines, anticoagulants and other inhibitors that prevent wound healing, and dampen pain and itch responses; unfed nymphs are so small, they can be mistaken for freckles," he said.

So, how can you avoid becoming a tick's next meal? Wikel recommends the following preventive steps:

Protect your ankles. Wear long pants tucked into high socks when doing yard work. Wrap duct tape -- sticky-side out -- around where the pants and socks meet so that crawling ticks get stuck on the tape.

Dress properly. Use clothing, tents and other gear treated with repellent, such as permethrin. This repellent kills ticks, mosquitoes, chiggers and mites. These products are available online or at sporting goods stores.

Wear repellent. Apply topical insect repellent that contains less than 40 percent DEET. Children should use repellent that contains no more than 30 percent DEET, Wikel said.

Conduct tick checks. "Tick bites are painless, so if you are in an area with ticks, perform a thorough tick check and remove ticks immediately," he advised.

Don't forget pets."The neurotransmitter blockers in anti-tick treatments and flea collars are very effective in keeping ticks from biting pets," said Wikel. "When pets come indoors, check for crawling ticks to prevent them from getting off your pet and on to you."

Create a tick-free zone. You can make your yard less attractive to rodent, deer and other tick-carriers. Keeping lawns trimmed and creating barriers between your yard and the woods with wood chips, mulch or gravel can eliminate tall grasses where ticks crawl. Remove wood piles and stones where mice, chipmunks and squirrels may hide. These little critters keep tick larva and nymphs circulating in nature.

Hike carefully. Stay in the center of hiking trails to avoid contact with vegetation.

If despite your best prevention efforts, a tick still attaches to you, there's a right and a wrong way to remove ticks, Wikel cautioned.

Don't use matches or the tip of a cigarette to burn off ticks. This could cause them to transmit bacteria more quickly.

The correct way to remove a tick is to lift it gently with thin forceps or tweezers. It's also a good idea to use a magnifying glass while removing a tick, Wikel advised.

If you can remove the tick intact, you can bring it to your doctor's office or local health department for identification.

If you develop symptoms within a few weeks after a tick bite, make an appointment with your doctor, advises the U.S. Centers for Disease Control and Prevention.

Warning signs of tick-borne diseases may vary from person to person, said Wikel. Symptoms, which can range from mild to severe, may include: fever and chills, headaches, fatigue and muscle aches.

People with Lyme disease may also develop joint pain, he said.

"Many people think a sign of Lyme disease is a bull's-eye rash, but rashes don't always occur," said Wikel.

If left untreated, Lyme disease can affect the joints, the heart or the nervous system. When diagnosed early, on the other hand, Lyme disease can be cured with antibiotics. This is the case for most tick-borne disease,

By Dr. Mark Michael, May 12 2016 07:38PM

Allergic reactions to latex may be serious and can very rarely be fatal. If you have latex allergy you should limit or avoid future exposure to latex products.

People who are at higher risk for developing latex allergy include:

Health care workers and others who frequently wear latex gloves

People who have had multiple surgeries (for example, 10 or more), such as children with spina bifida

People who are often exposed to natural rubber latex, including rubber industry workers

People with other allergies, such as hay fever (allergic rhinitis) or allergy to certain foods

An allergist has specialized training and expertise in managing allergies, allergic rhinitis and asthma. They can develop a plan for rhinitis treatment. The goal will be to enable you to lead a life that is as normal and symptom-free as possible.

What is natural rubber latex?

Natural rubber latex comes from the sap of the rubber tree, Hevea brasiliensis, found in Africa and Southeast Asia. Allergic reactions to products made with latex develop in persons who become allergic (or sensitized) to proteins contained in natural rubber latex. Natural rubber latex should not be confused with synthetic rubber made from chemicals. Synthetic rubber products, including “latex” house paints, are not made with natural latex and do not trigger allergic reactions in people who are allergic to products made with natural rubber latex.

What products contain natural rubber latex?

Latex is a common component of many medical and dental supplies. These include disposable gloves, dental dams, airway and intravenous tubing, syringes, stethoscopes, catheters, dressings and bandages. Latex also is found in many consumer products. These include condoms, handbags, balloons, athletic shoes, tires, tools, underwear leg and waistbands, rubber toys, baby bottles, nipples and pacifiers.

Triggers and Symptoms

What triggers the allergic reaction to latex?

When people with latex allergy come into direct contact with latex, an allergic reaction may follow. Common examples include:

A medical or dental procedure conducted by health care workers wearing natural rubber latex gloves

Blowing up a rubber balloon

What are latex allergy symptoms?

In most cases, latex allergy develops after many previous exposures to latex. Latex allergy symptoms may include hives, itching, stuffy or runny nose. It can cause asthma symptoms of wheezing, chest tightness and difficulty breathing. Symptoms begin within minutes after exposure to latex containing products. The most severe latex allergy can result in anaphylaxis, a serious allergic reaction involving severe breathing difficulty and/or fall in blood pressure (shock).

Allergic skin problems can occur following direct contact with allergic latex proteins in latex glove products. Symptoms may include immediate itching, redness and swelling of skin that touched the item containing latex. These and other latex allergic reactions are less common now. Many hospitals or doctors’ offices have switched to non-latex gloves or low protein latex gloves.

A second type of skin allergy called “allergic contact dermatitis” may be caused by chemicals used to manufacture rubber gloves. This dermatitis is recognized by the eczema and blisters on the back of the hands. It resembles a poison ivy rash, and begins 1 to 3 days after wearing rubber gloves.

Direct physical contact with latex products is not needed to trigger an allergic reaction. Anaphylaxis and severe asthmatic reactions have been caused by inhaling latex proteins in the air resulting from the powder in the latex glove.

What foods are potential problems for people with latex allergy?

If you have latex allergy you also can have food allergies. The foods most likely to cause this problem include: apple, avocado, banana, carrot, celery, chestnut, kiwi, melons, papaya, raw potato and tomato.

Management and Treatment

How is latex allergy diagnosed?

Latex allergy is diagnosed by an allergy blood test.

How is latex allergy treated?

The best treatment for latex allergy is avoidance. If you have severe latex allergy reaction you should:

Wear medical alert identification

Carry an epinephrine (adrenaline) auto-injector for emergency treatment

Health care workers with a history of latex sensitivity who must wear gloves should stop wearing latex gloves. Their co-workers should also not use latex gloves, but rather switch to synthetic gloves.

Patients with latex allergy are at risk of asthma on exposure to latex-containing aerosols. They should try to avoid areas where powdered latex gloves or other latex products are used.

How can latex allergy be prevented?

If you have latex allergy you should avoid direct contact with all products and devices that contain latex. Also avoid food that causes an allergic reaction. Latex allergy problems during dental, medical or surgical procedures can be prevented by warning health care providers about latex allergy before any test or treatment. Latex allergic people can receive medical or dental care in a latex-safe area. Hospitals and clinics that use only low protein latex gloves and non-latex gloves have experienced dramatic declines in new cases of latex allergy.

Allergists can provide latex-allergic people with information and assistance to help them avoid products which may contain latex.

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