Category: Blog

Palforzia: First FDA approved treatment for Peanut Allergy (part 3)

COVID-19 in Colorado

As of 3/5/2020 there have been 2 confirmed cases of COVID-19 in Colorado.

COVID-19 is a novel form of a coronavirus that started in China.  There are many common forms of coronavirus that can cause the common cold, but SARS and MERS are also forms of corona virus.  One of the major differences between COVID-19 and SARS and MERS, is that COVID-19 seems to be transmitted from person to person very easily.  At this time, we believe that COVID-19 is spread only through respiratory droplets, this means from a cough or sneeze.

Symptoms of COVID-19 vary in each infected person and may be as mild as a common cold (runny nose, sneezing, fatigue) or as serious as respiratory failure.  Currently, the CDC is recommending testing in individuals with a combination of fever and lower respiratory symptoms (cough, shortness of breath) AND a history of recent travel to a high risk region or contact with another person who had recent travel to a high risk region AND without another explanation for their symptoms (such as influenza).  Our office is NOT equipped for testing of COVID-19 at this time.

There is no specific treatment for COVID-19.  The treatment is supportive which means that treatment is directed at the symptoms and not at the virus.  Many hospitalized patients with COVID-19 have required oxygen or assisted breathing as well as medication to treat fever and fluids to combat dehydration.  There is not an antibiotic or antiviral medication known to treat COVID-19.

If you are concerned that you may be infected with COVID-19, you should contact your primary care physician or our office by PHONE.  If your symptoms are very concerning or progressive, you may be directed to a local emergency department for treatment and testing.  YOU SHOULD STAY HOME IF YOUR SYMPTOMS ARE MILD and avoid contact with other people.  You should especially avoid contact with the elderly population and with individuals that have underlying medical problems such as lung disease, heart disease or a compromised immune system.

Because an individual may be able to spread COVID-19 for days or even a week before they have any symptoms, it is important that everyone is washing their hands often.  This is the most effective way to decrease the risk of transmission and infection.

At this time, our office will be managing patients with fever and lower respiratory symptoms by phone only.  If a patient arrives with fever and lower respiratory symptoms, they will be asked to be seen in the emergency department rather than our office.  This is an effort to minimize risk to our other patients and our staff.  Finally, we are certainly concerned about the increasing number of cases of COVID-19 in the US, but we are also still very much concerned about seasonal influenza infections.

Thank you for reading and for your patience and understanding as we all work together.  We will update this post as new information becomes available.

– Dr. Stewart and Dr. Garcia

Palforzia: First FDA approved treatment for Peanut Allergy (part 2)

Palforzia: First FDA approved treatment for Peanut Allergy (part 1)

Lora Stewart MD and Meghan Garcia MD

Run the Rocks 5k

New Physician has joined our practice


We are thrilled to have Dr. Meghan F Garcia joining our team in October 2019!

Dr. Garcia attended medical school and her combined Internal Medicine/Pediatrics residency at the University of California in San Diego.

She is a Colorado native and in 2017 returned to her roots and relocated to Denver for her fellowship at National Jewish. She takes great pleasure in the opportunity to care for both adult and pediatric patients.  Her other special interests include chronic hives, treating asthma and allergies in pregnant women, asthma control in athletes, allergic skin conditions, chronic nose and sinus problems, and allergies to foods and medications.

Dr. Garcia enjoys spending time with her husband, son, and mini goldendoodle. She also delights in spending time in the beautiful Colorado mountains, trying new restaurants, attending concerts, and going to the theater.

She has immediate availability to care for you and your family!

FDA warns of Ranitidine/Zantac Contamination

The Safety of Peanut Oral Immunotherapy in Question

by Dr. Lora Stewart

Can A-fib worsen if asthma is poorly controlled?

Atrial fibrillation (AF) is an increasingly common diagnosis for patients >40 years of age.  Treatment options vary from medications to surgical options.  For most patients, it is simply too late for lifestyle changes such as weight loss and diet changes to be effective as the damage is already done.
A recent study out of Norway examined the relationship between asthma and AF.  The study looked at a group of 54,000 adults that did NOT have AF initially.  The authors then looked at a sub-group of patients that also had asthma.  Over the following 15 years, 3.8% of the group developed AF.  The authors found that patients with poorly controlled asthma were more likely to develop AF, compared to those without asthma.  They also found that well controlled asthma was NOT a risk factor for developing AF.
It has been proposed that poorly controlled asthma increases inflammation in the body which leads to an increased heart rate and an increased risk of arrhythmias.  The study did NOT show any link between asthma MEDICATIONS and the risk of AF.
TAKE HOME MESSAGE: Well controlled asthma which in turn means less inflammation in the body has potential benefits beyond improved asthma symptoms and quality of life.
Cepelis et al. Associations of asthma and asthma control with atrial fibrillation risk: results from the Nord-Trondelage Health study. JAMA Cardiol. 2018;3:721-728.

Early Life Medications May Increase Allergy Risk

We all recognize that infants are especially fragile when it comes to health concerns.  A recent article published in JAMA Pediatrics last year, suggests that infants exposed to antibiotics and acid-suppression medications in the first 6 months of life were significantly more likely to develop allergic disease.  The article highlighted the risk for food allergies and asthma as the greatest risks, respectively.
This study included more than 790,000 children in the US born between 2001 and 2013.  The study then evaluated the number of infants that received antibiotics or any type of acid-suppressing medication before 6 months of life.  Infants who received antibiotics during the first 6 months of life were at increased risk of developing asthma, hay-fever, and food allergies (specifically cow’s milk and egg allergy).  Receiving any type of acid-suppression medication was associated with an increased risk of food allergies.
The explanation is possibly that these medications change the gut bacteria or the microbiome.  There have been many recent medical studies that strongly support the idea that the bacteria in our gut are crucial for our immune system education.  These same studies show that it matters which bacteria you have in your gut.  The “wrong” type of bacteria may result in a poor education of the immune system which can then lead to the development of allergic disease.  Whereas, having the “right” kind of bacteria can lessen the risk of allergies.  Unfortunately, there is still much debate about which bacteria are “right” and which ones are “wrong”.
THINGS TO KEEP IN MIND:  Firstly this study was a retrospective study – that means that the data was collected afterward – the decision to treat these infants was based on their individual situations and symptoms not on any study recommendations.  Secondly, the study is merely reporting an association.  This type of research can NOT determine the cause of the increased risk of allergic disease.   A prospective study will be the best next step to better understand the risk of these medications when used during infancy.
TAKE HOME MESSAGE:  Any medication used, especially in our youngest patients, may have unanticipated side effects.  The benefits and the potential risks of each medication must be considered.  There will be situations when antibiotics and acid-suppression medications must be used despite the possibility of increasing the risk of allergic disease, because the risk of not treating is far greater.
Mitre E et al. Association between use of acid-suppressive medications and antibiotics during infancy and allergic diseases in early childhood.  JAMA Pediatrics. 2018;172e180315