Steven Machtinger MD & Associates, Inc

08/14/2025

We are in the Age of Biologics. Monoclonal antibodies are transforming the treatment of many chronic diseases. In the field of allergy and immunology there are effective biological agents for the treatment of asthma, eczema, chronic hives, eosinophilic esophagitis, chronic sinusitis, nasal polyps, and food allergies. There are even biologic treatments for uncommon disorders like eosinophilic granulomatosis with polyangiitis (EGPA - Churg Strauss syndrome) and prurigo nodularis. These agents are not only effective but remarkably safe to use. Unfortunately, they are expensive.

08/29/2021

To help manage food allergies there are some great websites and apps to be found. Here's a good place to start:

The power of food allergy apps promises to transform weekly grocery shopping from a soul-sucking chore to a semi-manageable task.

05/28/2021

Because over 10,000 people have died from the COVID-19 vaccine, said my octogenarian patient, she won't be receiving the injection. An Internet search revealed that Tucker Carlson and Senator Ron Johnson share her concerns. Not to mention the folks at Epoch Times. So let's put their concerns to rest.

US Population 2021: 331,449,281 persons
50% have at least one COVID vaccine: 165,724,640.5 persons
US Death rate/1000 persons 2021: 8.977/1000
Expected deaths in vaccinated/year 1,487,710
Expected deaths in vaccinated/day 4075.918
Expected deaths in vaccinated/30 days 122,250

When 165,000,000 people get a vaccine 122,250 of them are expected to die in the following month FROM ANY CAUSE.

When 165,000,000 people eat their vegetables, or walk the dog, or read the failing New York Times, or even watch FOX News, 122,250 of them are expected to die in the following month.

The Vaccine Adverse Event Reporting System (VAERS), https://vaers.hhs.gov/, is designed as the first step in recording events coincidentally occurring after vaccination. Further analysis is required to establish causation. The CDC has analyzed these reports and found no pattern of vaccine-associated death after receiving the Pfizer or Moderna vaccines. There have been three deaths due to brain hemorrhage attributed to the Johnson & Johnson vaccine.

Three as opposed to 10,000. Tucker, we know that you're only asking questions. I'm only giving answers.

Important: If you are experiencing a medical emergency, seek immediate assistance from a healthcare provider or call 9-1-1. CDC and FDA do not provide individual medical treatment, advice, or diagnosis. If you need individual medical or health care advice, consult a qualified healthcare provider.

07/18/2020

Mask unto others as you would have them mask unto you. It's a simple courtesy like covering your mouth when you cough. Should be pretty simple to understand.

05/29/2020

CAN DIET PREVENT ASTHMA?
In a study of vitamin D supplementation during pregnancy, Lee-Sarver & colleagues observed a lower rate of asthma and wheezing in three-year-old children who at birth had higher levels of vitamin D in their blood. Higher newborn vitamin D levels were also associated with higher blood levels of the polyunsaturated acids (PUFA) omega-3 and omega-6. These findings suggest a beneficial role for augmenting maternal and infant diet with PUFA and vitamin D to decrease episodes of wheezing and perhaps asthma in young children. Read more at: https://www.aaaai.org/global/latest-research-summaries/New-Research-from-JACI-In-Practice/fatty-acid.

The Journal of Allergy and Clinical Immunology: In Practice talks about how low polyunsaturated fatty acid intake is linked to childhood allergy.

05/29/2020

PREVENTION OF FOOD ALLERGY
While American parents report an adverse reaction to food in about 1/3 infants and young children, the rate of true food allergy is only around 10%. But don't say "only". For incompletely understood reasons the frequency of food allergies in infants, children and adults is increasing in the developed world. Maternal diet during pregnancy and while breast-feeding as well as the diet of infants may each play a role. Caesarean section - regardless of reason - appears to elevate the risk of the infant developing a food allergy. Earlier introduction of highly allergenic foods like peanut, cow's milk and hen's egg reduces, although does not eliminate, the risk of developing a food allergy to one or more of these foods. Especially if either parent or a sibling has food allergies, eczema or asthma your next child may benefit from a discussion of these issues with your pediatrician, pediatric nurse practitioner, or allergist.

05/29/2020

THE OFFICE IS OPEN. We have been open on a part time basis since San Mateo County began sheltering in place. We are now open Monday through Thursday for allergen immunotherapy and biologic injections. Our physicians are available for tele-medicine and in-person office visits. In-office skin testing and oral allergen challenges have resumed. To maintain the safety of social distancing all visits, including visits for injections, are by appointment only. Call 650-696-8230 for information and to make an appointment.

04/16/2020

Is the “Flu” Worse than COVID-19?

In the U.S as of April 15, 2020 there have been 634,975 reported cases of COVID-19. 27,940 people have died of this viral respiratory disease. Worldwide there are over 2 million cases, an increase of 79,000 from the previous day, and 133,000 people have died. The first person to die of this infection was a resident of Wuhan, China. That death occurred late in December, 2019.
By comparison:
• The 1918 H1N1 influenza pandemic caused 500,000-700,000 deaths in the United States. 30-40 million people died worldwide. About the same number of people died in World War 1.
• The 1957 H2N2 influenza pandemic caused an estimated 70,000 deaths in the US while an estimated 34,000 Americans died from the 1968 H3N2 influenza pandemic.
• The World Health Organization estimates annual influenza epidemics result in about 3-5 million cases of severe illness and about 250,000 to 500,000 deaths worldwide.
• The CDC estimates that between 1976 and 2006 annual flu-associated deaths in the US ranged from about 3000 to 49,000.

Is COVID-19 less severe than the flu (influenza)? Consider these points.
• Quarantine was only employed for the 1918 H1N1 pandemic.
• Sheltering in Place has a clear impact on decreasing the number of people infected.
• The US epidemic is only two months old. Influenza reports are for an entire year.
• We haven’t hit the “peak” of new infections yet.
• Corona virus infection may not follow the flu pattern of abating in warmer months.
• As a killer COVID-19 is likely to be second only to the 1918 H1N1 Pandemic.

04/12/2020

GETTING THE MOST FROM YOUR NASAL SPRAY

Anyone can swallow a pill but is there a better way to use a nasal spray? Those who stop using nasal sprays do so for two major reasons: the medication goes down their throat or they get nosebleeds. You may like this technique that we’ve recommended in our practice for 23 years.
1. Hold the tip of the container about ¼” below your nostril. That’s right; don’t stick it in your nose.
2. Point the tip straight up; don’t point it towards one ear or the other.
3. Hold your head erect and spray.
4. Sniff gently, not hard, and only if the medication feels like it’s going to drip out.
I find this method nearly eliminates nosebleeds (you’re not sticking hard plastic up your nose). Holding the tip back allows medication to spread out in your nose staying there rather than going down your throat. No one has complained of getting medication in their eyes. Try

04/11/2020

Thanks to all my readers for liking my page. Let me know what topics in allergy, asthma and immunology you would like to see discussed on this FB page.

04/10/2020

Hay Fever During the Pandemic

What to do about your symptoms of seasonal allergic rhinitis & conjunctivitis without seeing your health care provider:

Hay Fever During the Pandemic
What to do about your symptoms of seasonal allergic rhinitis & conjunctivitis without seeing your health care provider:

1. Itchy, sneezy, runny nose? Take a long-acting, non-sedating antihistamine like fexofenadine (Allegra) or loratidine (Claritin). Take one a day, and in a pinch, two a day. Cetirizine (Zyrtec) and levocetirizine (Xyzal) are effective but cause drowsiness in about 1 user in 10.
2. All of the above AND STUFFY NOSE? Add or switch to a topical corticosteroid nasal spray like budesonide (Rhinocort), fluticasone diproprionate (Flonase), triamcinolone (Nasacort) or fluticasone furoate (Flonase Sensimist). To work nasal sprays need to be used daily for several days. Watch for occasional headache or nosebleed.
3. Itchy, watery eyes? Use ketotifen (Zaditor), bepotastine (Bepreve), or olopatadine (Patanol & Pataday). Eye drops may cause eye irritation & headache when initially used but these reactions usually resolve with continued use.
4. There’s nothing wrong with generics. Find them right next to the branded products.
5. Benadryl (diphenhydramine) also works BUT must be taken several times a day for sustained relief. Drowsiness occurs in 50% of users. How drowsy? Diphenhydramine is also marketed as Sominex, a product that helps you fall asleep. The dose is the same as for symptoms of allergy.
6. If these solutions don’t relieve your apparent symptoms of hay fever (allergic rhinoconjunctivitis) in a week or two contact your health care practitioner for advice. They may even be able to evaluate your complaint using telemedicine.

04/09/2020

Asthma, COVID-19 and Steroids

• Asthma is not a single disease. It's the clinical expression (coughing, wheezing, shortness of breath that responds to bronchodilators like albuterol) of a wide range of conditions with various levels of severity, risk, and control.
• Asthma has been listed as a risk factor for severe COVID-19 outcomes by the CDC and WHO. Data from China and Seattle, however, indicate that asthma is not a risk factor for patients with severe COVID-19 infections.
• Early reports of systemic corticosteroids (CS) being associated with death from COVID-19 have been extrapolated to include ALL steroids as being dangerous.
• Our bodies produce their own CS. In times of stress, like that of the pneumonia caused by corona virus, the adrenal glands release extra CS to help regulate the body’s inflammatory response. This release may dampen or even prevent cytokine storm.
• Frequent use of CS to control diseases like asthma, lupus, rheumatoid arthritis or inflammatory bowel disease may temporarily reduce the ability of the adrenal glands to release more CS in response to stress.
• To compensate for this decreased release of our own CS physicians treating COVID-19 infections often add high doses of CS.
• Inhaled corticosteroids like Flovent, Qvar, Symbicort & Advair have virtually no effect on the adrenal glands. Inhaled CS are safe to use to control asthma and to prevent exacerbations.
• Systemic (swallowed, injected, intravenous) CS should be used to treat an asthma exacerbation, even asthma symptoms caused by COVID-19.