Skip to main content

Posts

Showing posts from 2009

Daily Saline Nasal Irrigation May Increase Risk of Infection

Over the past few years, it has become increasingly common for physicians to recommend saline nasal lavage (or sinus rinsing) to patients. The concept that rinsing allergens and pollutants out of the sinonasal cavities will decrease inflammation is certainly an attractive one. Patients, especially those with chronic sinusitis, would report getting gobs of ugly mucous out with each rinse- so the exercise was cathartic, as well. So, it was an easy step to go from recommending "as needed" use to recommending daily preventative use.

Turns out, it may have been a step off a cliff.

A recent study from Georgetown University Hospital School of Medicine suggests that although as-needed use of saline irrigation is beneficial, daily long-term use of nasal saline irrigation (NSI) by patients with recurrent rhinosinusitis (RS) can increase the frequency of acute infection by as much as 60%.

Why is this? The researchers postulate that daily sinus irrigation depletes the sinonasal cavit…

My Croupy Wheezy Baby- Or Why I Should Follow My Own Advice

OK- both boys have a barky cough, Son #2 has been having some mild stridor (that whistling noise you hear after a croupy child is crying and takes a deep breath), and just yesterday, the daycare informed me that my musical little one need albuterol during the day, and felt "so much better" afterwards.

I think the respiratory goblins have arrived at my home. Serves me right.

Although I always tell my patients to resume their child's respiratory controller medicine around one month before their "bad season" is due to begin, I deliberately ignored my own advice and tried to hold out for as long as I could before resuming Baby's inhaled steroid this fall/winter. This I did despite knowing better than anyone that my child is probably destined to become asthmatic.

Why did I make such a ridiculous decision?

Am I concerned about medication side effects?
At the low doses of controller medication that my 16-month old requires, hardly.

Is the medication too expensive?
U…

BREAKING NEWS: CDC Phishing Scam

Thanks to the JCAAI for the following alert:
The CDC has received reports of fraudulent emails (phishing) referencing a CDC sponsored State Vaccination Program.

The messages request that users must create a personal H1N1 (swine flu) Vaccination Profile on the cdc.gov website. The message then states that anyone that has reached the age of 18 has to have his/her personal Vaccination Profile on the cdc.gov site.

The CDC has NOT implemented a state vaccination program requiring registration on www.cdc.gov. Users that click on the email are at risk of having malicious code installed on their system. CDC reminds users to take the following steps to reduce the risk of being a victim of a phishing attack:


•Do not follow unsolicited links and do not open or respond to unsolicited email messages.
•Use caution when visiting un-trusted websites.
•Use caution when entering personal information online.

Additional information can be foun…

Single Lot of H1N1 Vaccine Associated with Increased Allergic Reactions

GlaxoSmithKline has recalled a batch of H1N1 vaccine that appears to be associated with a higher than normal rate of allergic reactions. Six individuals in Canada experienced allergic reactions after receiving the vaccine from this batch, but no other countries have reported similar adverse events. This batch (lot number A80CA007A) was distributed in Canada, and consists of 170,000 doses (the majority of which have already been administered). It was shipped in late October.

Important points:

• This affected batch was not distributed in the United States. The affected Canadian batch has been recalled.
• Allergic reactions to a vaccine occur within 30 minutes to an hour after vaccination, so those who received the affected vaccine do not need to worry about the potential for a lingering reaction.
• People with asthma are at high risk of serious complications from influenza infection, including H1N1. Vaccination can significantly reduce this risk.
• Most individuals with egg allergy ca…

How My 4 Year Old Shows Me He's Maturing

Son #1 has been going through a phase where he insults my parenting skills whenever I make him do something he doesn't want to. I know he doesn't mean it, but it still smarts. Here are a few examples:

me: "Put your toys away, or I'll take them away."
him: "You're a bad mommy!"

me: "TV off, kiddo. You've watched enough."
him: "I'm not going to be your son anymore!"

me: "I know you don't want to leave, but we have to go home now."
him: "I don't want to go home with you. Just send me to outer space. I'll live with the friendly aliens."

Now, I know these statements make my kid sound like a spoiled brat, but to be honest, he's actually a very well-behaved little boy. I've come to recognize this phase as proof that my child understands that threatening to withdraw affection is the worst punishment you can inflict on someone who loves you. This is an important lesson, because it will…

Holiday Baking with Your Food-Allergic Kids- It's Possible!

There's something about cooking with your kids which makes the holidays feel more holidaylicious. And just like all kids, mine are enamoured of the kitchen (especially since Disney's "Ratatouille").

Used to be, if you wanted to bake an allergy-friendly holiday dessert, you had to pull out a cookbook, make substitutions, and hope for the best. Not my style. Although I love it when other people slave away all day in the kitchen, I'm not really a "from scratch" kind of gal.

So, you can imagine my delight when a patient's mother introduced me to Cherrybrook Kitchen (http://www.cherrybrookkitchen.com), which has created a line of dairy, egg, and peanut-free mixes for cookies, cakes, brownies, pancakes, and more. (Frostings, too!) They're now even offering wheat and gluten free items. Best of all, the result is something even someone without allergies would like to eat...

Thanks, Cherrybrook! Now I can make goodies for my son's class without…

What I'm Thankful For This Year (or What's Good About Healthcare in America)

As we approach Thanksgiving in the midst of a raging healthcare reform debate, I'd like to share what I think is good about healthcare in America these days...

I'm thankful that I practice medicine in a country where I have access to the most helpful and novel innovations with which to heal my patients.

I'm thankful for compassionate nurses and assistants who put the patient first.

I'm thankful for experienced and competent managers who keep small medical practices running during difficult economic times.

I'm thankful for front desk staff who are always friendly and helpful, even though they have numerous stressors.

I'm thankful for intelligent, thoughtful colleagues with whom I can discuss complex medical questions.

I'm thankful for sane, grounded colleagues with whom I can share my frustrations.

I'm thankful for the social media networks which allow physicians from all over the nation to interact as though we were neighbors.

I'm thankful for information t…

A Single H1N1 Vaccine Dose May Be Enough (even for kids!)

Image by Getty Images via DaylifeIn this season of influenza pandemics, our vaccine-naive little ones were scheduled to be subjected to not one, but 2 separate influenza vaccines, in a total of 4 doses! Ouch!

Well, here's some good news from GlaxoSmithKline, the makers of Pandemrix, one of the H1N1 vaccines currently being distributed and administered around the world. A single shot may be sufficient to confer protective immunity! The study is not yet complete, but preliminary results look promising... Son #2, who was none to happy with me when I gave him seasonal influenza vaccine 1 of 2 on Wednesday, would be pleased (if he had any idea what any of the fuss was about)!

http://www.medscape.com/viewarticle/711241_print


Halloween Tips for Allergic Kids

Halloween is an exciting time for children... costume parties, silly music, bags and bags of CANDY...

Yep. It's the candy part that gets our undies all in a knot.

Never mind the damage all that sugar does to those little teeth (Here's an idea-our dentist buys back candy at $1 per pound and sends it to our troops overseas!).

For the parent of an allergic child, the concern is more about the damage that the hidden food allergen might do to our kids. The zombie costumes are ghoulish enough- do we really need to amp up the freakishness with hives and giant swollen lips?

The American Academy of Allergy, Asthma & Immunology offers some Halloween tips here:
http://www.aaaai.org/patients/elements/1008/08halloween_checklist.stm

I think these ideas are a great start, but I do doubt the practicality of distributing your own safe snacks to neighbors in advance of trick-or-treating. (Not really fair to expect them to keep track- or even be able to recognize your kid if he or she is in cost…

New flu prevention and treatment recommendations for people with asthma

From the American Academy of Allergy, Asthma & Immunology:
MILWAUKEE – With the Centers for Disease Control and Prevention (CDC) reporting that an initial analysis of 1,400 adults hospitalized for H1N1 found that 26% had asthma, how can the more than 34 million Americans with asthma protect themselves from the virus and complications?An article set to appear in The Journal of Allergy and Clinical Immunology (JACI) recommends that people with asthma who have suspected or confirmed influenza should be strongly considered for antiviral medications because of their increased risk of developing a complication such as bacterial pneumonia.Additionally, most patients with asthma should be vaccinated with the seasonal and 2009 H1N1 inactivated vaccines.“People with asthma are at high risk of serious complications from influenza infection, including H1N1, but vaccination can significantly reduce this risk. If you have asthma, seasonal influenza and H1N1 vaccination is recommended. Be sure …

Generic Alternative to EpiPen and TwinJect? Not Exactly...

On Sept. 16, 2009, Adamis Pharmaceuticals Corporation announced that Walgreens will begin to offer its epinephrine pre-filled syringes (Epi PFS) as a generic alternative to epinephrine autoinjectors.

Certainly, it is wonderful to have a lower-cost alternative to EpiPen and TwinJect. (Tier 1 co-pay on Aetna and Cigna!) Many parents cough up $70 or more out of pocket for epinephrine autoinjectors that end up being thrown away. Now, don't get me wrong- I think it's much better to spend the money and throw it away than not spend it and be without life-saving medication if you should need it. But when you need one for home, one for school, one for grandma's house, etc... it adds up.

On top of that, I like to prescribe epinephrine for my immunotherapy patients, and they aren't thrilled about the co-pay either, especially when the prescription is only a precaution.

However, just because the medication inside the syringe is the same doesn't mean that device is equivalent …

Antibacterial Treatment Does Little to Reduce Staph Colonization, but Reduces Eczema Severity Nonetheless

I have a special interest in the treatment of severe eczema, and for years have been recommending to my patients treatments designed to reduce the burden of the bacteria known as staphylococcus aureus. Staph aureus, as it is commonly known, colonizes the skin and nose of up to 90% of patients with atopic dermatitis, or eczema. This not only can lead to infections in inflamed skin, but can also contribute to worsening of eczema when patients develop an allergy to the toxins produced by the bacteria.

The mainstays of antibacterial therapy for control of staph aureus colonization are: oral antibiotics, nasal antibiotics, and dilute bleach baths. The traditional thinking has been that implementing these measures would reduce the bacterial burden, thereby improving the condition of the skin.

Now, a fascinating study in the September issue of Pediatrics has turned the traditional wisdom on its head. Sure enough, patients treated with the anti-staph cocktail therapy had better outcomes tha…

How You Know Your Little Boy is Growing Up... (sniff, sniff)

This afternoon, Son #1 showed me an art project that he made at daycare- a conglomeration of sand and paint and glitter.

Son #1: Mommy, look I made a picture for-

Me (interrupting): It's beautiful, honey! Thank you!
Me (thinking to myself): Oh gosh, he's going to be so proud of this one... How am I going to recycle it without him noticing?

Son #1: Mommy, it's not for you. I made this picture for Selena Gomez (Disney teen queen).

Me: Oh! Okay... well, it's very nice. I'm sure she'll love it.
Me (thinking to myself again): Oh no. I have just been supplanted as my son's most loved woman. Selena Gomez, you better watch your back, little lady.

Can Athlete's Foot Increase Asthma Severity?

The evidence is mounting that the fungus responsible for athlete's foot and ringworm- trichophyton, may be playing a role in severe asthma...

A Japanese study published in the Journal Chest examined rates of allergic sensitivity to this fungus in asthmatics and non-asthmatics, as measured by presence of IgE antibody in the blood specific for trichophyton.

32.4% of patients with severe asthma were sensitized to trichophyton, 15.8% of patients with moderate asthma were allergic, and only 4.9% of patients with mild asthma were sensitized.

Interestingly, the rates for allergic sensitization to other common environmental allergens (cat, dog, mixed molds) did not differ significantly between the different groups of asthmatics.

Similar associations between trichophyton and asthma have been noted in Venezuela and Turkey as well. Antifungal treatment in these patients has been shown to improve asthma severity.

Bottom line? Although probably not a major issue for well-controlled asthmatics, se…

FDA Issues Nebulizer Medication Theft Alert: Patients Urged to Check Their Medication

The following post is courtesy of the American College of Allergy, Asthma & Immunology (ACAAI) and the Allergy & Asthma Network- Mothers of Asthmatics. Thank you!

The Food and Drug Administration (FDA) is warning healthcare professionals and the public about a shipment of a nebulizer medication that was recently stolen. The American College of Allergy, Asthma and Immunology (ACAAI) and Allergy & Asthma Network Mothers of Asthmatics (AANMA) urge patients using the nebulizer medication Albuterol Sulfate Inhalation Solution 0.083% to check the medication's lot numbers (see "What to look for," below).
Police reported that on approximately Aug. 5 a tractor-trailer containing a 35,760-carton shipment of Albuterol Sulfate Inhalation Solution 0.038% belonging to the RiteDose Corporation was stolen in McKinney, TX.

Anyone who comes across this product should notify the authorities immediately (see contact information below). The product is now illegal and may not be s…

Is the Needle Length on Epinephrine Auto-Injectors Too Short?

Image via WikipediaEpinephrine is the first-line medication for the immediate treatment of anaphylaxis (sometimes referred to as "killer allergy"). Intramuscular injection of epinephrine is superior to subcutaneous injection in terms of how fast peak plasma levels of the life-saving drug are achieved. Consequently, epinephrine auto-injectors are deigned to deliver the medication to the large muscle of the anterior thigh (called the vastus lateralis).

A recent study published in the July issue of the Journal of Pediatrics, however, suggests that intramuscular injection may not be achieved in a significant percentage of children with the current needle lengths of epinephrine auto-injectors (EpiPen and TwinJect). Ultrasound measurements of the thickness of subcutaneous tissue in children indicated that the needle lengths of the auto-injectors may be too short to penetrate into the muscle.

When the outcome that one is attempting to prevent is death, this is no small issue.

Howe…

My Letter to the President After Listening to his Press Conference

Mr. President,I am writing to you today as a physician, a patient, a mother, and as an American voter.It is difficult for me to put into words how deeply hurtful your characterization of physicians during your most recent press conference was, both professionally and personally.Your portrayal of the American physician as self-serving was both inaccurate and counter-productive.The vast majority of physicians in this nation hold themselves to the highest standards of ethical behavior- I believe I speak for my colleagues when I state that I care not only for the physical health of my patients, but also care deeply about how my medical recommendations impact their financial health. To imply that I, or any of my colleagues, would routinely consult a fee schedule before making a medical decision implies that we value our pocketbooks over our patients’ welfare.I sincerely hope that this is not the opinion you want the American public to have of the individuals who have sacrificed their youth…

Can Eating More Butter Prevent Allergies?

Here's some food for thought: Researchers in New Zealand are studying whether eating butter instead of margarine can help to reduce the risk of allergies and asthma. They are currently recruiting children to take part in a study examining the effects of butter and an enriched butter made from cows fed fish oil on eczema.

Read about the study here: http://www.nzherald.co.nz/health/news/article.cfm?c_id=204&objectid=10585257

Apparently, you don't need to eat a stick of the stuff to obtain benefit- 10grams (just a few pats) may do the trick!

Just wait until this gets out- my dad (who refuses to even touch anything that's not "real butter" because it "just doesn't taste right") and father-in-law (who forwards me emails about how margarine is "one molecule away from plastic") are going to be thrilled.

The Teeth Are In- And My Kid's Still Smiling!

Well, after a few weeks of procrastination and second opinions, I ultimately deferred to the dentist's sound judgment and scheduled the appointments for Son #1 to get his stainless steel crowns.

Turns out all my worries about "metal-mouth" were largely unwarranted. For the most part, you can't see the shiny new molars, unless my kiddo's laughing hysterically or screaming his brains out. (Which means that we do see them at least a few times each day... as life with a 4 year old is equal parts giggle-fit and hissy-fit.)

Although I'm glad it's done and that my child doesn't hate me, I'm still disappointed that I wasn't able to ward away the caries despite excellent dental hygeine. Brushing, flossing, fluoride rinsing... why did this still happen to my baby?

The dentist blames genetics. But I think that secretly, he blames me.

Or is it that, not-so-secretly, I still blame me? Such is the perpetual angst of motherhood.

Sometimes, our best may no…

Children's Memorial Hospital Food Allergy Study- Your Chance to Participate!

If you have a child or children with food allergies, consider participating in the Children's Memorial Hospital Food Allergy Study.

"The Children’s Memorial Food Allergy Study is a large, family-based food allergy study and holds great potential for scientific discovery and clinical translation. It is gaining momentum with the support of the National Institutes of Health (NIH), the Chicago Community Trust, Food Allergy Initiative, and generous donors."

Your participation will advance knowledge regarding the genetic basis of food allergy, environmental contributors to food allergy, the possibility of predicting and/or preventing food allergy, and the optimal treatments for this condition. Participation will not alter your child's current medical treatment.

This is an excellent opportunity to contribute to the knowledge about a condition that affects so many of our children.

For more information, visit http://www.childrensmrc.org/allergy/, call 1-888-573-1833 or email a…

Ringleader of Allergy Scam Sentenced- Good Riddance!

On June 29, 2009, the ringleader of an allergy scam which fraudulently billed for allergy blood tests which were not properly stored, and then gave over 800 patients allergy injections which were prepared by unlicensed individuals in unsanitary conditions, was sentenced to 9 years in prison and a $2.6 million fine. The ringleader was a nurse, but some doctors (also included n the indictment) allowed this man's company to bill insurance under their names, even though they never examined the patients or supervised the selection or preparation of the allergen extracts.

Read the Department of Justice press release here: http://www.usdoj.gov/usao/iln/pr/chicago/2009/pr0629_01.pdf

For shame! This type of malpractice is unconscionable, unethical, and DANGEROUS! However, suboptimal allergy testing and treatments are offered by all manner of self-proclaimed "experts", many of whom aren't even M.D.'s or D.O's. It's easy to be swindled the the title "Dr."…

FDA Recommends Removal of Zicam from Market- Proof that Just Because It's Labeled as Homeopathic, Doesn't Mean It's Safe

Just received the following update from the American Academy of Allergy, Asthma & Immunology:

This morning, The Food and Drug Administration (FDA) held a news conference warning physicians and consumers about Zicam Cold Remedy intranasal products, indicating “these products may pose a serious risk to consumers who use them.” Specifically, the FDA has received more than 130 reports of anosmia (loss of sense of smell, which in some cases can be long-lasting or permanent), associated with use of these products. Some individuals also report loss of sense of taste.

Included in the warning are: Zicam Cold Remedy Nasal Gel, Zicam Cold Remedy Gel Swabs, and Zicam Cold Remedy Swabs, Kids Size. All are administered by direct application to the nasal cavity, and as described in the labeling, are intended for use in “adults and children 3 years of age and older (with adult supervision). These products are available without a prescription, and they contain zinc gluconate (identified as zincum…

My Advice to Our President- Get Some Professional Help in Your Quest to Quit Smoking

President Obama addressed the American Medical Association in Chicago on Monday June 15th, aggressively pushing his plan for health care reform. During his speech, he stated, "That starts with each of us taking more responsibility for our health and the health of our children. It means quitting smoking, going in for that mammogram or colon cancer screening." OK, I can agree with that.

However, on Friday, June 12, an exchange between reporters and White House press secretary Robert Gibbs made it clear that the President has not yet kicked the habit. http://blogs.suntimes.com/sweet/2009/06/obama_may_still_be_smoking_war.html

C'mon now, Mr. President! Your daughter is asthmatic- and you're still puffing away?

From the sounds of it, it seems that his sole aid in the fight to quit is Nicorette gum. Really? The leader of the free world, and all he can come up with is Nicorette? OK, maybe mood-altering medications like Zyban and Chantix are not the most appropriate for …

The Great American Peanut Butter Challenge- Bring It On!

With much cajoling, I was able to convince Son #1 to submit to an open peanut butter challenge. This is a task much easier said than done.

After the tolerated accidental ingestion and negative skin test, I knew the risk of a reaction was low, but I still wanted to follow the protocol and do it right. So I spent a little over 2 hours feeding him incrementally larger amounts of creamy peanut butter. (Disclaimer- in all seriousness, please do not do this at home. Food challenges can be dangerous, and should be performed by a medical professional trained to immediately recognize, and equipped to treat, the symptoms of a life-threatening allergic reaction. Luckily for me, I just so happened to fit the bill.)

So, picture me chasing a 4 year old around every 30 minutes with a measuring spoon.

Me: "Come on, honey. One more bite, okay?"
Son #1: "You can't catch me, Mommy! I'm fast!"
Me: (out of breath) "Slow...down...or... I'm calling...your...father.&quo…

If You Think This Is a Good Invention, You Really Need to See an Allergist

This photo has been circulating on the internet for quite some time, but it is so ridiculous that I felt it deserved another moment in the sun...

Against All Odds, Son #1 May Have Outgrown His Peanut Allergy

Traditionally, peanut allergy has always been thought of as persistent, with only ~30% of kids outgrowing the hypersensitivity. This is in contrast to allergies to milk, egg, soy, and wheat, which are often outgrown by 6-7 years of age.

So, when we discovered that Son #1 was allergic to peanuts, cashews, and pecans (luckily limited to a mild reaction- hives), I figured that we were due for a lifetime of avoidance. And we have been really good about strict avoidance, for the most part...

A few weeks ago, however, he was able to tolerate some accidental peanut exposure, so I decided to retest him last week.

Imagine my delight when skin tests to peanut and pecan were negative, as well as a subsequent prick-prick test with peanut butter-- my kid is possibly in the lucky 30% of children who outgrow peanut allergy!

An open food challenge is yet to be done- mainly because my son refused to eat any peanut butter ("Mommy, I can't eat peanut butter- I'm ALLERGIC!"). I may have …

"Poop in My Eye"- A Novel Cause of Conjunctivitis

It's that time of year. The intersection of tree and grass seasons. Beautiful to look at, miserable to inhale.

Naturally, my 4 year old's allergic conjunctivitis is starting to rear its ugly head. This morning, I found him rubbing his watery little eyes as we were getting ready for a visit to the pediatrician.

As I went to grab a Kleenex for him, I passed by my 9 month old and caught a whiff of his unusually pungent diaper. Aah, the sensory joys of motherhood...

Upon hearing me call his brother a "stinky butt", my son decided to embellish his story, as 4 year olds are wont to do:

"Mommy, I think he pooped in my eye."

The visual had me cracking up all the way to the pediatrician's office... I secretly prayed that he wouldn't share his theory about the cause of his conjunctivitis symptoms, lest she believe I am allowing my baby to use his brother as a potty.

The Case for Good Nutrition and Playing Outside... low Folic Acid and Vitamin D Levels Associated with Allergies, Asthma

Two recent studies find interesting associations between lower levels of folic acid and vitamin D and increased allergy/asthma symptoms...

#1) A retrospective study performed at Johns Hopkins and recently published in the Journal of Allergy and Clinical Immunology tracked the effect of folate levels on respiratory and allergic symptoms, as well as levels of the allergic antibody IgE. They reviewed the medical records of over 8000 patients ranging from toddlers to octogenarians. The researchers found that patients with serum folate levels at the higher range of normal had lower rates of high IgE, atopy, and wheeze than those patients with lower levels, even though some of the patients with lower levels were technically within the normal range for serum folate. Bottom line? Folate levels on the high side of normal may be protective against some allergic disease, but blinded prospective studies are needed before we begin recommending supplementation for this purpose alone.

#2) A cross-s…

How My Inability to do the Laundry Embarrassed My 4 Year Old

So it's been a while since I've done the boys' laundry... I've been busy! And they have so many clothes, I didn't really think they'd run out.

I was wrong.

Yesterday morning, it was time to go to school, and I couldn't find clean pants for Son #1. So, I decided that it was warm enough to break out his summer wardrobe. Last year's summer wardrobe.

Kids grow fast.

I hurriedly squeezed him into an oversized pair of blue shorts. They didn't look oversized on him, though. Maybe that's because they were made for an 18 month old. I convinced myself that as long as no one looked at the label, it would be okay.

However, when we pulled into the parking lot, Son #1 refused to get out of the car. His explanation? "I don't want anyone to see me like this. I look like I'm going to the beach." Poor kid kept pulling the shorts down to his knees and sheepishly found a place on the floor during "circle time".

This is the first tim…

Our Trip to the Dentist- Or, How I'm a Flossing Failure...

So, returned from a trip to Son #1's dentist this morning...

At our last visit ~6 months ago, he was found to have areas of decalcification ("almost-cavities") between his molars. At that point, he was still not the best at cooperating with tooth-brushing and used to swallow the toothpaste, which meant that we couldn't use fluoride-based toothpaste. We were instructed to optimize the brushing, start flossing, and switch to fluoride toothpaste.

We did great! Well, the flossing could have been a little better, but otherwise, we did great! Twice a day, without fail, spending plenty of time focusing on the molars. Very limited juice, candy only on Halloween and birthdays... our only weakness was ice cream, but he always drank water afterwards.

Despite our best efforts, half of the areas of decalcification have progressed to cavities, and now we're facing having the teeth fixed with a pulpotomy and the placement of ugly stainless steel crowns, which will remain unti…

Prebiotic Supplementation May Decrease Allergic Antibodies in At-Risk Infants

Researchers from the Netherlands have reported in the March issue of Allergy that supplementation with a mixture of short-chain galacto-oligosaccharides (GOS) and long-chain fructo-oligosaccharides (FOS) appears to decrease total levels of the allergic antibody IgE, as well as IgG subclasses 1, 2 & 3, while increase levels of the "blocking" antibody IgG4.

These oligosaccharides are known as "prebiotics", and they supply a nutrition source for the "good bacteria" (probiotics) that colonize our gastrointestinal tracts shortly after birth.

The microbial environment in the gut may be an important factor in the risk of developing allergic disease, such as atopic dermatitis (eczema).

The interesting thing about this study is that it demonstrated that despite the overall decrease in antibody levels, the immune response to vaccinations was preserved. This is important, because antibodies are essential to protecting us from infection, and a decrease in allergic …

Insider Tips on Surviving a Hospital Stay

Just visited my husband's grandmother in the hospital today... being a physician gives me a slightly different perspective when I am on the "patient-side".

Being hospitalized is always stressful, even when for a joyous occasion such as for the birth of a child. You're out of familiar surroundings, usually not in the best of health, sometimes in pain, and certainly NOT in control of what happens to you, at least not in the way that you are accustomed to being. You and your family are eager to get home as soon as possible. Under these circumstances, the inefficiencies and "unique" communication issues in our healthcare system can be frustrating at best.

So, here are my insider tips for optimizing communication in the hospital setting.

1) Please be patient. I know, not what you want to hear. But it's important to realize that the physicians and nurses caring for you and your loved ones are also responsible for the medical care of many other patients as w…

Anxiety During Pregnancy Increases Asthma Risk

A study in the April issue of the Journal of Allergy and Clinical Immunology reveals that prenatal maternal anxiety, especially late in pregnancy, is associated with higher rates of asthma in children at approximately 7 years of age.

Why might this be the case? Maternal stress hormones, such as cortisol, may have a negative-feedback effect on the developing fetal adrenal glands, leading to relatively low levels of anti-inflammatory hormone production in the child.

Makes one wonder... knowing that women tend to display higher levels of anxiety than men during times of economic downturns... will the current economic crisis result in increased pediatric asthma rates a few years down the road? One can only speculate, but it certainly makes the case for prenatal yoga!

Does "the Pill" Increase Asthma Risk- a New Study Says Yes!

Further evidence that hormonal influences really do affect allergic disease...

A European study published in the Journal of Allergy & Clinical Immunology has shown an increased risk of asthma in normal weight (odds ratio 1.45) and overweight (odds ratio 1.91)women using oral contraceptives.

Lean women (with a body mass index of >20 kg/m2) taking OCPs, however, were less likely than their non-OCP-taking counterparts to have asthma.

These findings support the theory that metabolic status may influence how susceptible a woman is to the effect of sex hormones on the airways.

However, the study authors take care to note that women should not abruptly discontinue OCPs without first discussing their concerns with their physician, as the health risk of an unexpected pregnancy may be greater than the small increase in asthma risk associated with oral contraceptives.

I agree. But although I won't be recommending blanket discontinuation of OCPs, I'll definitely consider that possibili…

Hay Fever Robots Make Theur Debut in Japan- Why Do the Japanese get all the Fun Stuff First?

It's a bird, it's a plane... it's an allergy-bot!

Weather News, a Japanese weather information company, has installed hundreds of globe-shaped light-emitting "robots" throughout the country, which estimate pollen levels and glow a different color based on the concentration of pollen in the air. Allergy sufferers can tell with a quick glance how miserable their day is likely to be, and can also sign up for pollen counts to be text-messaged to their cell phones each morning...



Although not nearly as George Jetson-like in its appeal, allergic folks state-side can also access up to date pollen conditions from the National Allergy Bureau. We don't use robots, though. Pollen counts in the U.S. are done manually, by volunteers!

To access airborne allergen information for your area, visit the National Allergy Bureau website.

Oral Immunotherapy for Peanut Allergy- On the Horizon, but Not Ready for Prime-Time

Since the recent American Academy of Allergy, Asthma & Immunology conference in Washington D.C., much has been made of studies describing oral immunotherapy for peanut, egg and milk. These studies have demonstrated that some food allergic children can eventually tolerate ingestion of significant amounts of their trigger food after a protocol or gradually increasing oral doses of that food.

You may have seen this story on the morning/evening news programs, or read about it in your local paper or online. Certainly, parents of my patients have been coming in asking if I can provide this therapy for their food-allergic children in my office.

They are invariably somewhat disappointed when my answer is: "Sorry, not yet."

Let me explain why.

Although the prospect of inducing some measure of tolerance to a food allergen is exciting, there are a number of things to keep in mind:

1) To date, the peanut immunotherapy studies have evaluated relatively small numbers of children (<40)…

Don't Use Hand Lotion Before Going through Airport Security- Or, Why Mommy's Milk is "Da Bomb"

Guess whose breastmilk tested positive for explosives?

As my family, friends, and patients know, I am a huge proponent of breastfeeding. Nursed Son #1 for a little over a year, and going on 8 moths with Son #2. Benefits definitely outweigh the occasional inconveniences. But yesterday, my dedication to "La Leche" was certainly tested.

Any nursing mother who works outside the home is intimately familiar with "The Pump". At work, in a restaurant, in the car (preferably not while driving, although I've been known to attempt such multitasking madness in the past) - you name it, we've pumped there.

Planning a trip away from baby is never easy, but when you're nursing, it complicates matters. Rather than pump and dump, I elected to store the milk and bring it back home for baby. I did a good deal of planning: arranged for a large fridge in the hotel room, packed plenty of bottles, bottle brush, a zillion little plastic storage bags, coolers, ice packs... ev…

Your Kiddo Won't Eat?- It May Be More than Pickiness...

Yesterday, I attended an excellent lecture series on eosinophilic esophagitis, a relatively newly recognized disease in adults and children which results in difficult to control heartburn symptoms and difficulty eating.

Eosinophilic esophagitis results from abnormal accumulation of inflammatory cells in the lining of the esophagus (food pipe), and has a strong relationship to food allergy.

If you or your child have heartburn symptoms which have not improved with a proton pump inhibitor (examples include Prilosec, Prevacid, or Protonix, among others), you may be experiencing more than reflux. Ask your primary care physician if you might benefit from a referral to a gastroenterologist for an endoscopy (a video evaluation of the inside of your esophagus, stomach, and/or intestines).

If a biopsy reveals high numbers if eosinophils (specialized white blood cells which are highly involved in allergic inflammation), you may benefit from further evaluation and dietary management. Approximately…

Allergy Meeting News...

I am writing today from our nation's capital, where I have spent the last few days attending the annual meeting of the American Academy of Allergy, Asthma & Immunology.

The amount of research and clinical information presented at this meeting is enormous, and is already starting to show up on Good Morning America, the New York Times, etc...

Some highlights:

* Avoidance of milk, egg, and peanut for the first few years of life may not be protective against the development of food allergies in at-risk children.

* Oral immunotherapy to milk, egg and peanut is showing promise in children.

* Atopic dermatitis (eczema) benefits from proactive treatment with an antiinflammatory ointment twice weekly, even when the skin is clear.

And so much more! I will discuss these issues in more depth in upcoming posts- as always, nothing is ever as simple as it seems on the news or in the paper. Each patient's case is unique, so do not act on anything you hear or read before discussing it with you…

New Albuterol HFA Inhalers May Increase Breath Alcohol

In an effort to save the ozone layer, the government has ridiculously mandated the phase out of standard chlorofluorocarbon (CFC) albuterol inhalers, and replaced them with hydrofluoroalkane (HFA).

Yep, in all their wisdom, the feds decided that all those asthmatics puffing away on their albuterol inhalers were creating a larger hole in the ozone layer than a gazillion automobiles or horrendously outdated factories. Don't get me started.

Well, don't puff on that new HFA inhaler within 5 minutes of getting pulled by the police over while you're speeding down the highway in your SUV... turns out that some of the HFA inhalers include ethanol, and it just might transiently raise your breath alcohol (less so than a drink of wine, though). Or so report researchers from Australia in a recent issue of the journal Respirology.

To be honest, if you need to urgently take albuterol, maybe you should just pull over for a while.

So... how long before the Hollywood lawyers start using t…

Show Someone You Love Them- Share Your Spitoon!

So, it's been a little while since my last post. The Bajowala household is dealing with a mini gastroenteritis epidemic right now. Lots of tummy aches, throwing up, and laundry.

My husband is out of town for work nearly every week, and it certainly makes parenting two young boys an adventure, especially when we're dealing with illness. But this time, dear hubby is sick as well, and all alone on the road. So, he called Son #1 from his hotel room to commiserate this evening. Here's a rough transcript of the telephone conversation.

Dad: How are you, buddy?
Son #1: Daddy, I throwed up. A lot.
Dad: Yeah, I'm throwing up too.
Son #1: Come home, Daddy. I will take care of you, and then you will feel better. You can puke in my bucket, okay?
Dad: What?!?
Son #1: I throwed up in my bucket that Dadi (grandma) gave me. You can do it too. We can puke in it together. Then we will feel so much better.
Dad: Okay, buddy. Thanks! Feel better- I love you.
Son #1: I love you too, Dad…

Prenatal Exposure to Traffic Pollution May Increase Asthma Risk

We are learning more and more about how life in Mommy's womb affects our health later on in life.

A recently published study in PLoS One has supported an association between maternal exposure to airborne byproducts of burning fuel (polycyclic aromatic hydrocarbons) and a parental report of asthma symptoms before age 5.

Turns out that prenatal exposure to this type of air pollution is associated with an alteration of certain DNA sequences- which are, in turn, associated with higher odds of reported asthma symptoms.

Although this study only shows an association, and does not confirm causality, it is very interesting. We already knew that air pollution is a key contributor to asthma exacerbations, but now we have evidence that traffic-related pollution may be contributing to the development of the disease itself. This may help explain why inner-city children have such high rates of asthma.

In any case, we now have yet another reason to contact our state and federal representatives and …

Son #2 Shows the Dust Mite Who's Boss

Only an allergist would give her kid a stuffed dust mite to play with.

Acetaminophen May Increase Risk of Wheezing, Asthma, Allergies

As a parent and pediatrician, I have considered acetaminophen (Tylenol) to be one of the medications I could pretty much always safely use for my children and patients.

However, a new study published in the Annals of Allergy, Asthma & Immunology has raised some important concerns. 345 women were followed from early pregnancy through their child's first birthday. Associations between acetaminophen use during pregnancy and the development of wheezing during the first year of life were investigated.

What was found is the following:

Acetaminophen use during early pregnancy was unrelated to respiratory events during the first year of life. However, acetaminophen exposure during mid to late pregnancy was associated with nearly double the risk of wheezing (odds ratio 1.8) and slightly more than double the risk of wheezing that caused sleep disturbance (odds ratio 2.1) during the first year of life.

Why might his be the case?

Acetaminophen depletes an imprtant antioxidant (glutathione) …

The Importance of a Detailed Food Diary...

Son #2 did not sleep well last night- lots of whining and refusing to sleep anywhere but my lap... :(

I initially couldn't figure out what the problem was, but it became clear when I switched on the light during a diaper change- little munchkin was covered in an itchy red bumpy rash! He's had eczema and hives before, but it resolved completely with the elimination of strawberries from my diet almost 3 months ago (I'm still nursing, and he is allergic).

This morning, after giving him a bath, lubing him up with hydrocortisone and petroleum jelly, and forcing some Zyrtec into his mouth, the detective work began. Hopefully, writing down my process here will help you understand how your allergist determines which exposures are most likely to be triggering allergic symptoms in you or your kids.

Rash is generalized (on face and body)- so it could be either something ingested (food sensitivity) or something applied to the skin topically (lotion, detergent, etc...)

Let's start wi…

How to Ensure that Your Child Gets Made Fun of at School