Australian Department of Health and Ageing 2010 Report on Multiple Chemical Sensitivity

Due to recent comments on MCS/ IEI I am posting the following report by the Australian Dept. of Health and Ageing.  Please note that while it is open to the possibility that MCS is a definite disease entity with possible multifactorial etiology, at this time:

1. The underlying mode(s) of action of MCS, i.e. the biological mechanisms by which the chemical sensitivity occurs, remain uncertain.

2. Although non-specific neurological symptoms are common, overall there is no characteristic symptom profile that identifies MCS.

3. Presently, a diagnosis of MCS is based commonly on self-reported symptoms and chemical exposure histories. The symptom profile of MCS is indistinguishable from other multi-symptom disorders. No laboratory tests currently exist for diagnosing MCS.

4. There are no standardised treatments for MCS.

To read the Full Report, go to:

http://www.nicnas.gov.au/Current_Issues/MCS/MCS_Final_Report_Nov_2010_PDF.pdf

1
EXECUTIVE SUMMARY
1.1
OVERVIEW
Multiple Chemical Sensitivity (MCS) is the most common term used to describe a condition presenting as a complex array of symptoms linked to low level chemical exposures. The underlying mode(s) of action of MCS, i.e. the biological mechanisms by which the chemical sensitivity occurs, remain uncertain.
A common theme reported by individuals is experiences of heightened responsiveness to chemicals at extremely low exposure levels. The agents linked with MCS symptoms in susceptible individuals are numerous and chemically diverse. They include individual chemicals and chemical products encompassing air pollutants, workplace and domestic chemicals, agricultural chemicals, therapeutics and foods.
Similarly, the symptoms experienced by individuals from exposures are diverse and involve multiple organ systems. Although non-specific neurological symptoms are common, overall there is no characteristic symptom profile that identifies MCS. Nevertheless, reported symptoms can, in some cases, be debilitating.
Numerous modes of action have been postulated for MCS. These include immunological changes, respiratory/neurogenic inflammation, limbic sensitisation, elevated NMDA receptor activity, altered metabolism as well as behavioural conditioning and psychological disorders. Alternative names for MCS in part reflect views on particular modes of action.
Several attempts have been made to establish diagnostic criteria for this disorder. A set of ‘Consensus Criteria’ developed in 1999 describes MCS as a chronic condition involving multiple organ systems with reproducible symptoms following low-level exposure to multiple unrelated chemicals. These criteria have been used to a limited extent for research and survey purposes. Worldwide, a small number of available studies indicate the prevalence of medically diagnosed MCS at 0.2% – 4%. In Australia, only limited surveys of the prevalence of chemical sensitivities and MCS in the community have been conducted. South Australian state health surveys reported a prevalence of medically diagnosed MCS of 0.9%.
At this time, worldwide, MCS is not an internationally classified disorder, with only Germany and Austria (via adoption of German diseases documentation) listing MCS in their national disease classifications.
Presently, a diagnosis of MCS is based commonly on self-reported symptoms and chemical exposure histories. The symptom profile of MCS is indistinguishable from other multi-symptom disorders. No laboratory tests currently exist for diagnosing MCS. Different case definitions and the lack of a characteristic symptom profile and objective laboratory biomarkers for MCS have impeded recognition of the disorder as a distinct clinical entity.
There are no standardised treatments for MCS. Current treatments advocated for MCS include dietary changes, nutritional supplements, detoxification and desensitisation techniques, holistic or body therapies, as well as prescription medicines and behavioural therapies. The most common management regime for MCS is avoidance of agents that trigger symptoms.

A Review of Multiple Chemical Sensitivity
1.2
FINDINGS
1.2.1
Research into biological mechanisms underpinning MCS
There is considerable debate as to what biological mechanisms (modes of action) are responsible for the state of chemical sensitivity in MCS. The literature describes numerous potential causative modes of action, both physiological and psychological in nature, many of which are amenable to further testing. MCS may have a multifactorial origin.
An understanding of mode of action and how chemicals interact with organ systems would be assisted by more detailed identification of the chemical species and the exposure scenarios responsible for symptoms in MCS.
Finding 1: Targeted research into mode (s) of action
While there are a number of proposed mechanism(s) that warrant further research consideration, based on biological plausibility, testability and known research gaps, the following modes of action for MCS are highlighted for further scientific research and investigation as priorities:

Immunological variables;

Respiratory disorder/neurogenic inflammation;

Limbic kindling/neural sensitisation and psychological factors;

Elevated nitric oxide, peroxynitrite and NMDA receptor activity;

Altered xenobiotic metabolism.
1.2.2
Clinical research needs
An Australian clinical review has highlighted differences with criteria used for the diagnosis of MCS and methods to treat MCS.
Overall, a number of primary clinical research needs are evident:

Standardising diagnostic criteria that are acceptable to, and utilised by, clinical and scientific groups;

Determining the prevalence of MCS in the community, for both self-reported cases and those that are medically diagnosed;

Exploring initiating/triggering agents/events and modes of action in MCS through the use of well designed and conducted blinded challenge tests and longitudinal studies of illness course;

Determining and documenting effective treatment/management protocols for MCS based on long-term therapeutic alliances and individual self-management.
Finding 2. Longitudinal study
To get a better understanding of the clinical picture of MCS in Australia there is a need to look more closely at the natural history of people with MCS. A longitudinal clinical and sociological study should assist in identifying key elements of MCS such as how MCS is initiated and/or triggered and how sensitivities vary over time.
Such a study should examine eliciting agents/events, diagnostic experiences, clinical course and impacts of treatment/management strategies. To undertake such a longitudinal study it would be necessary to identify people with MCS who would be prepared to be involved. Findings in Appendix 1 provide some practical suggestions to address this issue.
- 6 -
A Review of Multiple Chemical Sensitivity
- 7 -
Finding 3: Education/training
A survey of clinical approaches to MCS of Australian medical practitioners identified a lack of coverage of MCS within the current Australian medical curriculum given the relatively small amount of time devoted to minor specialties. Other than hospital protocols containing practical measures to assist inpatients with chemical sensitivities, there are also currently no clinical guidelines available to inform medical practitioners as to how to provide appropriate care for MCS individuals.
The development of a clinical education program should be investigated. Such a program should be based on evidence currently available, utilise any findings from clinical research in Australia (such as a longitudinal investigation) and consider the practical guidance on approaches to MCS clinical management agreed by participants in the recent clinical review of MCS.

Laser/Biofeedback Treatment for Allergies = Snake Oil

from The Seattle Times

Miracle Machines | The 21st-century snake oil

 

ALAN BERNER / THE SEATTLE TIMES

The EPFX’s slick and sophisticated graphics may impress, but no scientific research shows that energy machines can diagnose or cure medical problems. Still, clients may pay hundreds or thousands of dollars for treatments with practitioners. This session was at the Puyallup Fair.

Related

• How one man’s invention is part of a growing worldwide scam that snares the desperately ill
• Special report | Miracle Machines

They can cure cancer, reduce cholesterol, end allergies, treat cavities, kill parasites and even eliminate AIDS.

“Energy medicine” devices can be as small as a television remote control, or as large as a steamer trunk.

Their operators say the devices work by transmitting radio frequencies or electromagnetic waves through the body, identifying problems, then “zapping” them.

Their claims are a fraud — the 21st-century version of snake oil. But a Seattle Times investigation has discovered that thousands of these unproven devices — many of them illegal or dangerous — are found in hundreds of venues nationwide, from the Puyallup Fair, to health-care clinics in Florida, to an 866-bed regional hospital in Missouri.

These are not the devices in wide use by medical doctors, such as electrical stimulators used for sports injuries. Nor are they the biofeedback devices used at respected alternative-medicine centers such as Seattle’s Bastyr University. Rather, these are boxes of wires purported to perform miracles. Their manufacturers and operators capitalize on weak government oversight and the nation’s hunger for alternative therapies to reap millions of dollars in profits while exploiting desperate people:

• In Tulsa, Okla., a woman suffering from unexplained joint pain was persuaded to avoid doctors and rely on an energy device for treatment. Seven months later, her son took her to a hospital. She died within hours from undiagnosed leukemia.

• In Los Angeles, a mother pulled her 5-month-old son out of chemotherapy for cancer and took him to a clinic where a 260-pound machine pulsed electromagnetic waves through his tiny body. The baby died within months.

• In Seattle, a retiree with cancer emptied her bank account to buy an energy machine. Shortly before she died, her husband, a retired Microsoft manager, examined its software, finding that it appeared to generate results randomly — “a complete fraud,” he said.

Over the past year, The Times investigated these machines and the people behind them.

The investigation took us to where the manufacturers of some of these machines are based, in Hungary and Greece. We found the operators — including a cross-dressing federal fugitive who moonlights as a cabaret singer — making outrageous claims as they peddled their wares. We discovered that the U.S. regulatory system has allowed them to flood this nation with an estimated 40,000 devices.

And we learned that many operators consider our state a safe haven for these “miracle machines.”

Can A Laser Cure Your Allergies?

Shiloh Woolman from LifeWhile

A device just coming to America from Australia claims to end allergy symptoms in as few as two treatments with the use of lasers. Can it stand up to rigorous scientific testing?There are a lot of potential patients. It’s estimated that one in five Americans suffers with allergies. Adult allergy sufferers spend more than $500 each per year on treatments, according to 2005 numbers from the U.S. Department of Health and Human Services.The report also showed that spending to fight allergies nearly doubled in the five years from 2000 to 2005 to $11.2 billion.David Tucker was among life-long sufferers looking for a cure.”It all stems back from when I was at Ohio State,” Tucker said. “On Saturday, everybody would wake up and go to football games. Because that’s when pollen season was, I’d spend time in the shower because I couldn’t breathe.”Later in life, he was selling electrodes to the chiropractic industry in Florida and suffering hay fever and allergies to cats and dust.Tucker said one chiropractor client turned him onto a device he’d seen in Australia.

Computer Diagnoses

“He’d been treated for his dairy allergy while on holiday. After 72 hours — he hadn’t drunk milk in 15 years — he had a full glass of milk and it had no effect,” Tucker said. “He set it up to have the equipment treat me for dust mites and, 48 hours later, I was fine. I’d always had to stay in a hotel at my mother-in-law’s because of cats. Now I can have cats on my lap.”Tucker said the device works based on biofeedback. The allergy sufferer wears a sensing clip on his finger for testing, and the computer simulates the bio-frequency for 10,000 known allergens. As the body responds to those stimuli, the computer lists which substances are irritants.”This digitized allergen actually matches the harmonic frequency of the actual allergen, making the body believe it is in contact with the real substance,” Tucker said. “The body will react if it is allergic to the particular substance.”The assessment takes about 20 minutes and can cost up to $250.

Curing Allergies

Once the allergens are identified, a laser stimulates biomeridian points on the body — the same points used in acupuncture and acupressure. Tucker said the idea is to strengthen organs to act properly the next time they encounter the allergen — that is, to treat them as harmless.Treatments are about $100, and Tucker said most people need two to 10 treatments to recondition the body’s response. After that, they’re done.Tucker said his own suffering, combined with his business experience, led him to bring the device to American chiropractors.He admits he doesn’t know all the science behind the device. But, he said, he thinks back on all the money he spent on shots and meds, and all the time getting jabbed, and he wonders why he didn’t have access to something so simple.

No Science Backs Device

So far, there is no science to prove the devices work, but Tucker claims a 70 percent positive response rate. He said he has patients filling out questionnaires so that researchers can begin scientific testing of the product.After opening his own AllergiCare Relief Center in Tampa, Tucker franchised the equipment to 11 more U.S. locations and two in Canada. More are planned.

PENN AND TELLER B@#$S&*#$ EPISODES ON ALTERNATIVE MEDICINE

Get Educated, don’t get ripped off! For further info on dubious medical devices go to www.quackwatch.org

Flu Shots OK for People With Egg Allergy

from Medscape:

Flu Shots OK for People With Egg Allergy

Denise Mann

October 18, 2010 — For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can — and should — get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.

About 1.5% of young children have an egg allergy, but most will outgrow it over time, according to the Food Allergy and Anaphylaxis Network in Fairfax, Va.

Why the change?

“We now know with confidence that most people with egg allergy can receive the flu shot without reaction,” says the report’s author, James T. Li, MD, PhD, an allergist at the Mayo Clinic in Rochester, Minn.

There is a “detectable, but very low” amount of egg protein in the H1N1 and seasonal flu vaccines, and studies have shown that the majority of people with egg allergy do not have an allergic reaction to the flu shot, he says.

“The number of reactions wasn’t zero, but it was low, and most reactions were not serious,” Li tells WebMD.

Skin testing is not necessary either unless the person with egg allergy has had a reaction to the flu vaccine in the past, Li says. The flu vaccine can be given in two doses or as a single dose if someone has an egg allergy.

Caution is still advised in certain scenarios. For example, there is still some question on whether people with severe egg allergy can receive the flu shot, he says.

See an Allergist for Proper Evaluation

“If you have egg allergy or suspected egg allergy, see your doctor, and there is a very high probability that you can receive the influenza vaccine without reaction and derive the benefits,” Li says.

Elizabeth Loewy, MD, an allergist in private practice in New York City, says that she feels very comfortable giving the flu vaccine to individuals with mild egg allergy.  “An egg allergy in a child is a huge predictor for asthma, and children and adults with asthma are at greater risk for complications from the flu,” she says.

The new report “makes it easier for pediatricians to give kids with egg allergy their annual flu shots because it eliminates some of their concerns about reactions,” she says.

Loewy currently uses a skin test, and if the person does not react, she will give the vaccine as one shot. If there is a reaction, she will break it up into two doses. She may decide to skip the skin tests in the future based on this new report, she says

SOURCES:

American Academy of Allergy, Asthma & Immunology.

Elizabeth Loewy, MD, allergist, New York City.

James T. Li, MD, PhD, allergist, Mayo Clinic, Rochester, Minn.

Food Allergy and Anaphylaxis Network.

Poison Ivy Rash

from MayoClinic.com

A poison ivy rash is a type of skin irritation called allergic contact dermatitis. Poison ivy rash is caused by a sensitivity to an irritant found in poison ivy and similar toxic plants, such as poison oak and poison sumac. Each of these plants contains an oily resin called urushiol (u-ROO-she-ol) that can irritate the skin and cause a rash.

Although the itching from a poison ivy rash can be quite bothersome, the good news is that a poison ivy rash or one caused by poison oak or poison sumac generally isn’t serious. Poison ivy rash treatment consists of self-care methods to relieve itching until the reaction disappears.

Signs and symptoms of a poison ivy rash include:

• Redness
• Itching
• Swelling
• Blisters

Often, the rash looks like a straight line because of the way the plant brushes against the skin. But if you come into contact with a piece of clothing or pet fur that has urushiol on it, the rash may be more spread out.

The reaction usually develops 12 to 48 hours after exposure and can last up to eight weeks. The severity of the rash is dependent on the amount of urushiol that gets on your skin.

In severe cases, new areas of rash may break out several days or more after initial exposure. This may seem like the rash is spreading. But it’s more likely due to the rate at which your skin absorbed the urushiol.

Your skin must come in direct contact with the plant’s oil to be affected. Blister fluid from scratching doesn’t spread the rash, but germs under your fingernails can cause a secondary bacterial infection.

When to see a doctor
See your doctor if any of the following occur:

• The reaction is severe or widespread.
• The rash affects sensitive areas of your body, such as your eyes, mouth or genitals.
• Blisters are oozing pus.
• You develop a fever greater than 100 F (37.8 C).
• The rash doesn’t get better within a few weeks.

Poison ivy, poison oak and poison sumac can all cause contact dermatitis and the resulting itchy rash.

• Poison ivy is an extremely common weed-like plant that may grow as a bush, plant or thick, tree-climbing vine. The leaves typically grow three leaflets to a stem. Some leaves have smooth edges, while others have a jagged, tooth-like appearance. In the fall, the leaves may turn yellow, orange or red. Poison ivy can produce small, greenish flowers and green or off-white berries.
• Poison oak can grow as a low plant or bush, and its leaves resemble oak leaves. Like poison ivy, poison oak typically grows three leaflets to a stem. Poison oak may have yellow-white berries.
• Poison sumac may be a bush or a small tree. It has two rows of leaflets on each stem and a leaflet at the tip.

The irritating substance is the same for each plant, an oily resin called urushiol. When your skin touches the leaves of the plant, it may absorb some of the urushiol made by the plant. Even a small amount of urushiol can cause a reaction. Urushiol is very sticky and doesn’t dry, so it easily attaches to your skin, clothing, tools, equipment or pet’s fur.

You can get a poison ivy reaction from:

• Direct touch. If you directly touch the leaves, stem, roots or berries of the plant, shrub or vine, you may have a reaction.
• Urushiol remaining on your skin. You may develop a poison ivy rash after unknowingly rubbing the urushiol onto other areas of your skin. For example, if you walk through some poison ivy then later touch your shoes, you may get some urushiol on your hands, which you may then transfer to your face by touching or rubbing.
• Urushiol on objects. If you touch urushiol left on an item, such as clothing or firewood, you may have a reaction. Although animals usually aren’t affected by urushiol, if it’s on your pet’s fur and you touch your pet, you may develop a poison ivy rash. Urushiol can remain allergenic for years, especially if kept in a dry environment. So if you put away a contaminated jacket without washing it and take it out a year later, the oil on the jacket may still cause a reaction.
• Inhaling smoke from burning poison ivy, oak or sumac plants. Even the smoke from burned poison ivy, poison oak and poison sumac contains the oil and can irritate or injure your eyes or nasal passages.

A poison ivy rash itself isn’t contagious. Blister fluid doesn’t contain urushiol and won’t spread the rash. In addition, you can’t get poison ivy from another person unless you’ve had contact with urushiol that’s still on that person or on his or her clothing.

Scratching a poison ivy rash with dirty fingernails may cause a secondary bacterial infection. This might cause pus to start oozing from the blisters. See your doctor if this happens. Treatment for a secondary infection generally includes antibiotics.

Surviving Spring Allergies

If it seems like you get a “cold that won’t quit” at the same time every year, chances are it’s a seasonal allergy. Seasonal allergies, commonly referred to as “hay or rose fever”, can seem like a stubborn cold. The symptoms — including stuffy, runny nose, sneezing and wheezing – certainly match the misery of a cold. But hay or rose fever carries some telltale signs, the seasonal nature of symptoms being the major one.

About 20% of the US population or 35 million people suffer from allergic rhinitis. In the spring, tree pollen is the primary culprit in triggering allergic rhinitis, although in more humid areas outdoor mold can also spawn similar symptoms. Tree pollen can start to be a problem as early as February.

Even though symptoms and their timing can indicate a springtime allergy, allergy testing is the only way to confirm it and weed out which substances are causing the misery. It’s true that tree pollen is the main culprit behind allergies that take their leave once spring has passed. But many people with allergies are sensitive to a number of other substances; hanging out with the neighbor’s cat could also be contributing to those springtime sniffles.

In addition, people tend to seek treatment only when symptoms get severe. So even though you might be bothered enough to see a doctor only in the spring, it’s possible that other allergens — perhaps the grass pollen predominant in summer or the weed pollen that abounds in autumn — are producing milder reactions.

Treatment approach for seasonal allergies include:

1. Environmental control or Allergen avoidance:

Pollens are difficult to avoid. Individuals who suffer from allergies should avoid outdoor activity during peak pollen times. Trees and grasses pollinate mainly during early morning hours (5-10 AM). You should keep windows closed in the house and car and operate your air conditioner.

2. Medication treatment

Several types of oral and nasal medications are known to control hay fever. Devising the right combination depends on the severity of patients’ symptoms and whether they suffer any medication side effects. Antihistamines, which block the action of symptom-spurring histamine, are a mainstay of hay fever therapy. One of the drugs’ drawbacks is drowsiness, but newer prescription and over-the-counter antihistamines are made to be non-sedating. Other potential side effects include dry mouth, constipation and, in some children, irritability and restlessness.
Antihistamines are also available as nose sprays and eye drops, which act directly on the nose and/ or eyes affected.

Oral antihistamines can quash sneezing, itching and eye symptoms, but offer little relief from congestion, so some products have an added decongestant. Decongestants work by acting on blood vessels, but side effects include increased blood pressure and sleeplessness and are problematic for people with glaucoma, hypertension, and large prostates.

Prescription nasal corticosteroids, which include medications, are another cornerstone of treatment. Corticosteroid drugs are similar to a hormone, cortisol, that the body produces naturally. Nasal corticosteroids ease a range of hay fever woes by blocking the release of inflammatory chemicals in the nasal passages. They are intended to be taken daily to prevent symptoms, starting shortly before the onset of pollen season.

Inhaled steroids can cause nasal irritation, including nose bleeds, and there have been concerns over their possible effects on children’s growth. But studies show the drugs are safe when used appropriately for allergies and asthma.

Nasal-spray decongestants offer a temporary reprieve from a stuffy nose, but should not be used for more than a few days because they can actually make congestion worse if used longer.

An “often overlooked” part of hay fever treatment is the nasal wash, a salt-water solution that can help remove mucus and pollen from the nose — and clear a path for inhaled medications to do their job.

3. Allergen vaccination/ Immunotherapy or “Allergy shots”:

For hay fever that is particularly severe or that persists beyond spring due to sensitivity to several allergens, allergy shots may be an option. This treatment, also called immunotherapy, involves injecting small amounts of the offending substance, over time, in order to normalize the immune response.Immunotherapy can quell hay fever, and may even prevent seasonal allergies from progressing to asthma.

Allergy shots are used for those with moderate to severe allergies who are not easily controlled on medications or who cannot tolerate medications. Shots can also be offered for those who desire permanent relief after 3-5 years of treatment. Allergy shots reduce the need for medications and provide the possibility of long-term benefit after 3-5 years of treatment. Related research has also shown that allergy shots prevent the development of persistent asthma and also reduce the development of new allergies. Research has also shown that allergy shots prevent the development of persistent asthma in individuals with hay fever and reduce the development of new allergies.

LINK:

Allergy Medications

FDA WARNS AGAINST SOLE USE OF LONG-ACTING BETA AGONISTS IN ASTHMA

 

 

 

FDA Warns Against Sole Use of Long-Acting Beta Agonists in Asthma

from Medscape

Long-acting beta agonists should not be used alone in asthma, the FDA warns. The drugs at issue include the single-agent LABAs Serevent and Foradil.

Because LABAs have been associated with severe worsening of symptoms, the agency is requiring that labels carry the following guidance:

• LABAs are contraindicated without the use of a controller medication, such as an inhaled corticosteroid.
• Long-term use is only indicated for patients whose disease doesn’t respond to controller medications.
• LABAs should be used for the shortest period possible.
• To ensure compliance, children and adolescents should only use LABAs that contain an inhaled corticosteroid.

The recommendations do not apply to use of LABAs in chronic obstructive pulmonary disease.

LINK:

FDA Announces New Safety Controls for LABAS

AAAAI: What do you do now? Use of LABAS in light of the recent FDA decision

Contact Dermatitis

from Healthline.com
Definition:

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating substance.
Alternative Names

Dermatitis – contact; Allergic dermatitis; Dermatitis – allergic; Poison ivy; Poison oak; Poison sumac
Causes, incidence, and risk factors

Contact dermatitis is an inflammation of the skin caused by direct contact with an irritating or allergy-causing substance (irritant or allergen). Reactions may vary in the same person over time. A history of any type of allergies increases the risk for this condition.

Irritant dermatitis, the most common type of contact dermatitis, involves inflammation resulting from contact with acids, alkaline materials such assoaps and detergents, solvents, or other chemicals. The reaction usually resembles a burn.

Allergic contact dermatitis, the second most common type of contact dermatitis, is caused by exposure to a substance or material to which you have become extra sensitive or allergic. The allergic reaction is often delayed, with the rash appearing 24 – 48 hours after exposure. The skin inflammation varies from mild irritation and redness to open sores, depending on the type of irritant, the body part affected, and your sensitivity.

Overtreatment dermatitis is a form of contact dermatitis that occurs when treatment for another skin disorder causes irritation.

Common allergens associated with contact dermatitis include:

* Poison ivy, poison oak, poison sumac
* Other plants
* Nickel or other metals
* Medications
o Antibiotics, especially those applied to the surface of the skin (topical)
o Topical anesthetics
o Other medications
* Rubber or latex
* Cosmetics
* Fabrics and clothing
* Detergents
* Solvents
* Adhesives
* Fragrances, perfumes
* Other chemicals and substances

Contact dermatitis may involve a reaction to a substance that you are exposed to, or use repeatedly. Although there may be no initial reaction, regular use (for example,nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) can eventually cause cause sensitivity and reaction to the product.

Some products cause a reaction only when they contact the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as ragweed or insecticide spray, can cause contact dermatitis.

Symptoms

* Itching (pruritus) of the skin in exposed areas
* Skin redness or inflammation in the exposed area
* Tenderness of the skin in the exposed area
* Localized swelling of the skin
* Warmth of the exposed area (may occur)
* Skin lesion or rash at the site of exposure
o Lesions of any type: redness, rash, papules (pimple-like), vesicles, and bullae (blisters)
o May involve oozing, draining, or crusting
o May become scaly, raw, or thickened

Signs and tests

The diagnosis is primarily based on the skin appearance and a history of exposure to an irritant or an allergen.

According to the American Academy of Allergy, Asthma, and Immunology, “patch testing is the gold standard for contact allergen identification.” Allergy testing with skin patches may isolate the suspected allergen that is causing the reaction.

Patch testing is used for patients who have chronic, recurring contact dermatitis. It requires three office visits and must be done by a clinician with detailed experience in the procedures and interpretation of results. On the first visit, small patches of potential allergens are applied to the skin. These patches are removed 48 hours later to see if a reaction has occurred. A third visit approximately 2 days later is to evaluate for any delayed reaction. You should bring suspected materials with you, especially if you have already tested those materials on a small area of your skin and noticed a reaction.

Other tests may be used to rule out other possible causes, including skin lesion biopsy or culture of the skin lesion (see skin or mucosal biopsy culture).

How can I help my doctor diagnose my skin condition?

Keep a “diary” of when your symptoms appear, get worse or improve. It also helps to write down where your symptoms occur on your body, and how long they last. If you notice that your skin gets worse after certain activities, record the reaction and the activity in as much detail as possible.

Workers in some occupations are more likely to develop allergic contact dermatitis, so it’s important to describe your work to your doctor. If you handle chemicals during the day, make a list of these or find their Material Safety Data Sheets (MSDS).

Treatment

Successful treatment of dermatitis symptoms depends on getting an accurate diagnosis from your physician. Depending on the type of dermatitis and the severity of skin reactions, a physician may prescribe corticosteroids, antifungal agents, antihistamines, barrier creams, and moisturizers for your skin, shampoos with salicylic acid, selenium, zinc, or coal tar, and oral medications. These treatments are intended to treat your symptoms and improve your skin’s condition.

Because there is often no cure for dermatitis, your physician should discuss ways to avoid allergen and/or irritant contact, and how to take better care of your skin. In addition, reducing stress can improve your immune system response and help restore your skin’s normal integrity

Initial treatment includes thorough washing with lots of water to remove any trace of the irritant that may remain on the skin. You should avoid further exposure to known irritants or allergens.

In some cases, the best treatment is to do nothing to the area.

Corticosteroid skin creams or ointments may reduce inflammation. Carefully follow the instructions when using these creams, because overuse, even of low-strength over-the-counter products, may cause a troublesome skin condition. In severe cases,systemic corticosteroids may be needed to reduce inflammation. These are usually tapered gradually over about 12 days to prevent recurrence of the rash.

Contact dermatitis usually clears up without complications within 2 or 3 weeks, but may return if the substance or material that caused it cannot be identified or avoided. A change of occupation or occupational habits may be necessary if the disorder is caused by occupational exposure.
Complications

Secondary bacterial skin infections may occur.

Call your health care provider if symptoms indicate contact dermatitis and it is severe or there is no improvement after treatment.
Prevention

Avoid contact with known allergens. Use protective gloves or other barriers if contact with substances is likely or unavoidable. Wash skin surfaces thoroughly after contact with substances. Avoid overtreating skin disorders.
References

Gober MD, DeCapite TJ, Gaspari AA. Contact dermatitis. In: Adkinson NF Jr, ed. Middleton’s Allergy: Principles and Practice. 7th ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 63.

Habif TP. Contact dermatitis and patch testing. In: Habif TP, ed. Clinical Dermatology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2009:chap 4.

Lancet Retracts Study Linking Autism to MMR Vaccine

from Medscape
Daniel J. DeNoon

Perspective by Dr. Dennis Niewoehner February 2, 2010 — The venerable British medical journal The Lancet has retracted a 1998 study suggesting a link between autism and childhood vaccination with the measles-mumps-rubella MMR vaccine.

The Lancet tells WebMD that it has retracted “10 or 15″ studies in its 186-year history. The retraction follows the finding of the U.K. General Medical Council (GMC) that says study leader Andrew Wakefield, MD, and two colleagues acted “dishonestly” and “irresponsibly” in conducing their research.

The Lancet specifically refers to claims made in the paper that the 12 children in the study were consecutive patients that appeared for treatment, when the GMC found that several had been selected especially for the study. The paper also claimed that the study was approved by the appropriate ethics committee, when the GMC found it had not been.

“We fully retract this paper from the published record,” The Lancet editors say in a news release.

The retraction means the study will no longer be considered an official part of the scientific literature.

BMJ, formerly known as the British Medical Journal, has competed with The Lancet since 1840. BMJ editor Fiona Godlee says she welcomes the Lancet retraction.

“This will help to restore faith in this globally important vaccine and in the integrity of the scientific literature,” Godlee says in a news release.

In 2004, 10 of Wakefield’s 13 co-authors disavowed the findings of the 1998 study. Although the study never claimed to have definitively proven a link between the MMR vaccine and autism, sensational media reports ignited a public panic. MMR vaccinations fell dramatically.

More rigorous studies have found no link between autism and the MMR vaccine. Last year, the U.S. “vaccine court” rejected U.S. lawsuits claiming that there was a plausible link between the vaccine and autism.

Wakefield continues to proclaim his innocence and defends his earlier work. He now resides in Texas, where he is executive director of an alternative medicine center for autism treatment and research.

SOURCES:

The Lancet, published online Feb. 2, 2010.

SWINE FLU AND YOU

Questions & Answers: Swine Influenza Info from the Centers for Disease Control

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in pigs. People do not normally get swine flu, but human infections can and do happen. Swine flu viruses have been reported to spread from person-to-person, but in the past, this transmission was limited and not sustained beyond three people.
How serious is swine flu infection?
Like seasonal flu, swine flu in humans can vary in severity from mild to severe. Between 2005 until January 2009, 12 human cases of swine flu were detected in the U.S. with no deaths occurring. However, swine flu infection can be serious. In September 1988, a previously healthy 32-year-old pregnant woman in Wisconsin was hospitalized for pneumonia after being infected with swine flu and died 8 days later. A swine flu outbreak in Fort Dix, New Jersey occurred in 1976 that caused more than 200 cases with serious illness in several people and one death.

Can I get swine influenza from eating or preparing pork?
No. Swine influenza viruses are not spread by food. You cannot get swine influenza from eating pork or pork products. Eating properly handled and cooked pork products is safe.

Is this swine flu virus contagious?
CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

How does swine flu spread?
Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

How can someone with the flu infect someone else?
Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.

Are there medicines to treat swine flu?
Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with these swine influenza viruses. Antiviral drugs are prescription medicines (pills, liquid or an inhaler) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. For treatment, antiviral drugs work best if started soon after getting sick (within 2 days of symptoms).

How long can an infected person spread swine flu to others?
People with swine influenza virus infection should be considered potentially contagious as long as they are symptomatic and possible for up to 7 days following illness onset. Children, especially younger children, might potentially be contagious for longer periods.

What surfaces are most likely to be sources of contamination?
Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk and then touches their own eyes, mouth or nose before washing their hands.

How long can viruses live outside the body?
We know that some viruses and bacteria can live 2 hours or longer on surfaces like cafeteria tables, doorknobs, and desks. Frequent handwashing will help you reduce the chance of getting contamination from these common surfaces.

What is the best way to keep from spreading the virus through coughing or sneezing?
If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands, and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?
Washing your hands often will help protect you from germs. Wash with soap and water. or clean with alcohol-based hand cleaner. we recommend that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?
If you live in areas where swine influenza cases have been identified and become ill with influenza-like symptoms, including fever, body aches, runny nose, sore throat, nausea, or vomiting or diarrhea, you may want to contact their health care provider, particularly if you are worried about your symptoms. Your health care provider will determine whether influenza testing or treatment is needed.

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others. If you become ill and experience any of the following warning signs, seek emergency medical care.

In children emergency warning signs that need urgent medical attention include:

* Fast breathing or trouble breathing
* Bluish skin color
* Not drinking enough fluids
* Not waking up or not interacting
* Being so irritable that the child does not want to be held
* Flu-like symptoms improve but then return with fever and worse cough
* Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:
* Sudden dizziness
* Confusion
* Severe or persistent vomiting
* Pain or pressure in the chest or abdomen
* Difficulty breathing or shortness of breath

Time for Spring Allergies

Pollen Grains

From the AAAI Rhinitis Tips:
Do you have bouts of sneezing and itching, or a runny or stuffy nose that do not seem to go away? If so, you may have rhinitis.

Rhinitis is one of the most common illnesses in the United States , affecting more than 50 million people. It often coexists with other respiratory disorders, such as asthma. Rhinitis has a significant impact on the quality of life of those who suffer from it. In addition, it can contribute to other conditions such as sinus problems, ear problems, sleep problems, and learning problems. In patients with asthma, uncontrolled rhinitis seems to make asthma worse.

Allergic rhinitis
Allergic rhinitis is caused by substances that we breathe called allergens. Allergens are usually harmless substances that can cause problems only in some people. These problems are caused because the immune system of people with allergic rhinitis mistakenly identifies these substances as intruders and generates a reaction against them. During this reaction, the immune system cells release substances such as histamine and leukotrienes that cause the symptoms of allergic rhinitis; these and other substances also cause inflammation in the nasal lining that makes the nose very sensitive to irritants such as smoke and strong odors or to changes in the temperature and humidity of the air.

Causes:

1. When allergic rhinitis is caused by common outdoor allergens, such as airborne tree, grass and weed pollens or mold, it is called seasonal allergic rhinitis, or “hay fever.”
2. Allergic rhinitis is also triggered by common indoor allergens, such as animal dander (dried skin flakes and saliva), indoor mold, droppings from dust mites and cockroach particles. This is called perennial allergic rhinitis.

Symptoms

Sneezing
Stuffy nose (congestion)
Runny nose
Itching in the nose, roof of the mouth, throat, eyes and ears
Diagnosis
If you have symptoms of allergic rhinitis, an allergist/immunologist can help determine which specific allergens are triggering your illness. He or she will take a thorough health history, and then test use to determine if you have allergies. Skin tests or blood tests are the most common methods for determining your allergic rhinitis triggers.

What to Do During Pollen Season:
When outdoor pollens are high, remain indoors, particularly in the late morning. Pollen grains can cause significant allergic symptoms like asthma and allergic rhinitis, particularly during the spring and the fall. It is difficult to avoid pollen because it is windborne and can cover wide distances. Short of moving to a different location, here are some tips for avoiding pollen during the season.

1. The pollen count is usually highest in the late morning and early afternoon particularly during sunny, windy days. The pollen count measures the concentration of a specific pollen like birch tree pollen, in the area in a specific area and time. A pollen count is a useful guide for when it is advisable to stay indoors and avoid contact with pollen.
2. Keep the windows and doors closed during the allergy season.
3. Install a room air conditioner with a special filter.The special filter (High Efficiency Particulate Air or HEPA filter) traps airborne allergens. If the house does not have central air, the best spot to put the air conditioner and filter would be the bedroom. Change the filters frequently. An allergic person should also use the car air conditioner to decrease pollen exposure when commuting. Pollen allergic persons should not have a window fan blowing into their bedroom as this will maintain outdoor pollen exposure all night.
4. Avoid working outdoors, if you must wear a special face mask. The face mask is designed to filter pollen out of the air and keep it from reaching the nasal passages.
5. Consider taking a vacation at the height of the pollen season. Preferably at a location where the pollen exposure is minimal, like the seashore.

Links: Allergy Medications
Info on Allergy Shots