Thursday, December 17, 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 cavities of a protective layer of mucous which has infection-fighting properties (both due to a barrier function and immunologically active cells and molecules). Washing this "good mucous" away regularly exposes the mucosa (the wet skin lining the inside of your nose and sinuses) to bacteria and other irritants, increasing the likelihood of infection.

When you have an active infection, the short-term (1-2 weeks) use of sinus irrigation helps to wash away the infection-laden mucous. However, once you are well again, it makes sense to leave your protective mucous layer undisturbed.

In the researchers study, the rate of infection decreased significantly in patients who discontinued daily use of saline irrigation.

This elegant study highlights the dangers of assuming that just because a therapy is "natural", it's 100% safe.

My recommendations for patients?

Use saline sinus irrigation 1-2 times daily at the first sign of an upper respiratory infection, and continue until you feel well again. However, if you're still feeling sick 10-14 days into your illness, stop rinsing and see your doctor- you may need an antibiotic.
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Wednesday, December 9, 2009

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?
Umm, I'm an asthma expert with a closetfull of samples and (thanks to my husband's job) excellent insurance coverage. Access to medication, luckily for me, is not an issue.

Am I lazy?
DING DING DING! I hate struggling with a squirmy child (with very strong leg muscles, mind you) who would rather do anything than have a silicone mask pressed up against his face. I hate arguing with my mother who thinks that just because I'm a physician, I think drugs are the answer to everything and am therefore over-medicating my children. In other words, there is really no excusable explanation.

And, because inhaled steroids take around 2 weeks to start working and 6 weeks to reach maximal effect, my poor little guy will have to suffer with inflamed airways for approximately one more month. Bad allergistmommy!

I am what Son #1 would refer to as a "dumb-dumb".

Don't be like me and wait it out. Start controller meds early enough to avoid a bad winter. Your children will thank you for biting the bullet and taking your physician's advice.

Thursday, December 3, 2009


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 website. The message then states that anyone that has reached the age of 18 has to have his/her personal Vaccination Profile on the site.

The CDC has NOT implemented a state vaccination program requiring registration on 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 found at

An example of the Phishing email follows:

Subject: State Vaccination Program

You have received this e-mail because of the launching of the
State Vaccination H1N1 Program.

You need to create your personal H1N1 (swine flue) Vaccination Profile on the website. The vaccination is not obligatory, but every person that has reached the age of 18 has to have his personal Vaccination Profile on the site. This profile has to be created both for the vaccinated people and the not-vaccinated ones. This profile is used for the registering system of vaccinated and not-vaccinated people. Create your Personal H1N1 Profile using the link:

Create Personal Profile

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