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

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.

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

No Evidence Supports Link Between Vaccines and Autism

No Evidence Supports Previously Held Link Between Vaccines and Autism

Laurie Barclay, MD
from Medscape
February 9, 2009 — There is no cause for parental concern that childhood immunization might cause autism, according to the results of a new review that shows no link between vaccines and autism. The review is published in the February 15 issue of Clinical Infectious Diseases.

“Vaccines don’t cause autism — 20 studies now show no link between vaccines and autism,” senior author Paul A. Offit, MD, chief of infectious diseases, The Children’s Hospital of Philadelphia in Pennsylvania, told Medscape Infectious Diseases. “I think that many people are reassured by these studies, although there are still a group of parents who hold that vaccines cause autism, much as some people hold a religious belief. To those people, it really doesn’t matter how many studies you do, it’s not going to change their minds.”

More education is needed to prevent further disease resurgence among children whose parents have refused vaccination based on this unfounded fear, he added.

Three Theoretical Links

Three specific hypotheses have been offered to suggest a theoretical link between vaccines and autism. The review describes how each of these theories originated and summarizes the pertinent epidemiological data, which refute the 3 hypotheses.

“The first theory concerned the Measles-Mumps-Rubella (MMR) vaccine; the second, that it wasn’t the MMR vaccine specifically but a mercury-containing preservative, thimerosal; and the third, that the simultaneous administration of many vaccines is just too much for a young child’s immune system,” Bryan H. King, MD, co-chair, American Academy of Child and Adolescent Psychiatry Autism and Intellectual Disabilities Committee, told Medscape Infectious Diseases when asked for independent comment.

The first hypothesis is that the combination MMR vaccine damages the gastrointestinal lining, thereby permitting the entrance of encephalopathic proteins and causing autism. After publication of a 1998 study in The Lancet suggesting an association between MMR vaccine and autism, 13 subsequent studies performed in 5 different countries showed no such link. The reviewers concluded that no data supported any causal connection between the MMR vaccine and autism, and that any apparent association was coincidental, because the MMR vaccine is typically administered at the age when symptoms of autism first emerge.

“While rates of immunization have been constant or declined, the incidence of autism has increased, and the rate of autism in vaccinated and unvaccinated children is the same,” said Dr. King, who is professor and vice chair of Psychiatry and Behavioral Sciences and director of Child and Adolescent Psychiatry at University of Washington and Seattle Children’s Hospital. “Neither the timing of onset, nor the severity of autism, differ whether or when a child gets immunized,”

The second hypothesis is that thimerosal, an ethyl mercury–containing preservative used for more than 50 years in some vaccines, causes central nervous system toxicity. However, the review describes 7 studies from 5 countries demonstrating that autism rates were not affected by the presence or absence of thimerosal in vaccines.

These 20 epidemiologic studies showing that neither thimerosal nor MMR vaccine causes autism were conducted by many different investigators, using a variety of epidemiologic and statistical methods.

“Even very rare associations, if they existed, would have been detectable given the large size of studied populations,” Dr. King said. “Studies on the causes of autism should focus on more promising leads.”

The third hypothesis is that giving multiple vaccines simultaneously overwhelms or weakens the immune system. In rebuttal, the review authors point out that the immune system in childhood routinely processes far more antigenic material than the relatively small amount contained in vaccines, and that it is biologically implausible that vaccines overwhelm a child’s immune system, even if the system is still immature.

“The challenge to the immune system from modern vaccines — even in multiple combinations — is actually significantly less than was given routinely to children back in 1980 (long before the autism epidemic),” Dr. King said.

Finally, the review authors note that autism is not triggered by an immune response, and they suggest that future research on the biological basis of autism should prove or refute alternative, more plausible hypotheses.

While the risks of vaccination concerning autism are theoretical and shown not to be valid, the risks of not being vaccinated are real and sometimes fatal.

“We’ve already seen the outcomes of choosing not to comply — over the last 10 years or so, we’ve had outbreaks of pertussis among a relatively unvaccinated population of children,” Dr. Offit said. “We had a measles outbreak in this country that was bigger than anything we’ve had in a decade. Now we have a cluster of cases of Haemophilus Influenzae meningitis where 3 parents chose not to have their child vaccinated; all 3 children got meningitis, and all 3 of them died.”

Dr. Offit noted, “The question becomes, ultimately, when do we reach the tipping point? When do we say that exempting from vaccines is creating a problem not only for those children whose parents choose not to vaccinate but for those children in the community?”

Education of the lay public, as well as the healthcare community, is needed if unfounded fears of vaccination are to be dispelled.

The “Right to Catch and Transmit Potentially Fatal Infection”

“Public health officials and the academic community are really trying to communicate this science to the public, but it’s a real challenge,” Dr. Offit said. “Is it your right to catch and transmit a potentially fatal infection? Right now, the answer to that question is yes, but we’ll see how long it takes before the answer to that question is no.”

He added that it would be unethical to do a prospective study in which some children were not vaccinated, given the known harms of failure to vaccinate, and that retrospective studies would have methodological issues because the groups would differ in characteristics other than their vaccination status.

“Focusing our precious research time and talent on questions that have been asked and answered not only contributes to ongoing confusion — for example, about whether or not to be immunized — but also will delay us from finding real answers to this critical problem,” Dr. King concluded. “Parents and clinicians should have candid discussions about the risks and benefits of vaccination including the avoidance of potentially catastrophic diseases. It will be hard not to mention autism in this context, as it may give the impression that doctors are trying to hide something, and parents should feel empowered to ask these and any other questions of their clinicians, but on the other hand, constantly linking autism and vaccines in the same sentence may continue to suggest that a relationship exists when there is no evidence to support it.”

Telling Food Allergies From False Alarms

from The New York Times
By TARA PARKER-POPE
Published: February 2, 2009
For Ingelisa Keeling, a Houston mother of three children with multiple allergies, mealtime was a struggle. Nuts, eggs, wheat, beef, peas and rice were all off limits — banned by the children’s allergist.

But recently, Mrs. Keeling learned that her family’s diet need not be so restrictive. Although her children do have real allergies — to peanuts, milk and eggs, among other foods — extensive testing at a major allergy center showed that they were not in fact allergic to many of the foods they had been avoiding. Her 2-year-old son, who had been living on a diet primarily of potatoes, fruit and hypoallergenic formula, has resumed eating wheat, bananas, beef, peas, rice and corn.

“His diet had become so, so restricted that nutrition had become a real concern,” said Mrs. Keeling, who traveled to specialists at National Jewish Health in Denver last summer for answers about her children’s diet and eczema problems. Among other findings, she learned that neither of her younger children was really allergic to wheat.

“That’s the big one,” she said. “Wheat is in everything, so it makes life a whole lot easier.”

Doctors say that misdiagnosed food allergies appear to be on the rise, and countless families are needlessly avoiding certain foods and spending hundreds of dollars on costly nonallergenic supplements. In extreme cases, misdiagnosed allergies have put children at risk for malnutrition.

And avoiding food in the mistaken fear of allergy may be making the overall problem worse — by making children more sensitive to certain foods when they finally do eat them.

More than 11 million Americans, including 3 million children, are estimated to have food allergies, most commonly to milk, eggs, peanuts and soy. The prevalence among children has risen 18 percent in the past decade, according to the Centers for Disease Control and Prevention. While the increase appears to be real, so does the increase in misdiagnosis.

The culprit appears to be the widespread use of simple blood tests for antibodies that could signal a reaction to food. The tests have emerged as a quick, convenient alternative to uncomfortable skin testing and time-consuming “food challenge” tests, which measure a child’s reaction to eating certain foods under a doctor’s supervision.

While the blood tests can help doctors identify potentially risky foods, they aren’t always reliable. A 2007 issue of The Annals of Asthma, Allergy & Immunology reported on research at Johns Hopkins Children’s Center, finding that blood allergy tests could both under- and overestimate the body’s immune response. A 2003 report in Pediatrics said a positive result on a blood allergy test correlated with a real-world food allergy in fewer than half the cases.

“The only true test of whether you’re allergic to a food or not is whether you can eat it and not react to it,” said Dr. David Fleischer, an assistant professor of pediatrics at National Jewish Health. In one recent case there, doctors treated a young boy who had been given a feeding tube because blood tests indicated he was allergic to virtually every food. Food challenge testing allowed doctors to quickly reintroduce 20 foods into his diet, and they expect more to be added.

Blood tests may be unreliable because they fail to distinguish between similar proteins in different foods. A child who is allergic to peanuts, for instance, might test positive for allergies to soy, green beans, peas and kidney beans. Children with milk allergies may test positive for beef allergy.

The most important question in diagnosing food allergy is whether the child has tolerated the food in the past, Dr. Fleischer says. While some severe allergies are obvious, parents given a positive blood test result should seek advice from an experienced allergist who performs medically supervised food challenge testing.

Even when a food allergy has been confirmed, parents should have children retested, because many allergies are outgrown, particularly in the cases of milk, eggs, soy and wheat.

Doctors’ groups are also starting to acknowledge that some of their own policies may have contributed to overtesting and misdiagnoses. A committee for the American Academy of Asthma Allergy and Immunology is considering revised guidelines recommending earlier introduction of foods like eggs, peanuts and shellfish, which in the past have been delayed until age 2 or 3. A 2008 study of 10,000 British children, reported in The Journal of Allergy and Clinical Immunology, found that early exposure to peanuts lowered allergy risk.

Just as an allergy indicates oversensitivity to certain foods, it may be that doctors and parents have become oversensitive to food allergies. In an essay in The British Medical Journal in December, Dr. Nicholas A. Christakis, a professor at Harvard Medical School, argues that an “overreaction” to allergy is leading to unnecessary testing and false positives.

“If the kid has been doing fine, I would advise parents not to get allergy testing, because the results are more likely to be false positives than true positives,” Dr. Christakis said in an interview. “If they do think they need allergy testing, be extremely measured and go to reputable people.”

Q&A:Transition from CFC Propelled Albuterol Inhalers to

from the FDA Albuterol info page:
Albuterol inhalers that contain chlorofluorocarbons (CFCs) will not be sold in the U.S. after December 31, 2008. Albuterol inhalers that contain hydrofluoroalkanes (HFAs) will take the place of albuterol CFC inhalers. Here are some questions and answers to help you understand the change.
Why are albuterol CFC inhalers being phased out?
The phase out of albuterol CFC inhalers is due to an international agreement called the “Montreal
Protocol on Substances that Deplete the Ozone Layer” at www.fda.gov/cder/mdi/albuterol.htm. CFCs are harmful to the environment because they decrease the protective ozone layer above the Earth.
When will albuterol CFC inhalers be gone?
Albuterol CFC inhalers will not be sold in the United States after December 31, 2008. The company
that makes albuterol CFC inhalers is expected to stop making albuterol CFC inhalers before then. People who are using albuterol CFC inhalers should talk with their health care professional now about switching to an albuterol HFA inhaler. There are enough albuterol HFA inhalers for everyone who needs them.
What hydrofluoroalkane inhalers (HFA) (non-CFC albuterol inhalers) are available?
There are three albuterol HFA inhalers that FDA has approved as safe and effective:
ProAir (albuterol sulfate) HFA Inhalation Aerosol•
Proventil HFA (albuterol sulfate) Inhalation Aerosol •
Ventolin (albuterol sulfate) HFA Inhalation Aerosol•
Also available is Xopenex HFA (levalbuterol tartrate) Inhalation Aerosol that contains the active form
of albuterol and does the same thing as albuterol.
Patients in the United States have been using HFA inhalers safely and effectively since 1998.
How are albuterol HFA inhalers the same as albuterol CFC inhalers?
Albuterol HFA inhalers are used in the same way as albuterol CFC inhalers and give the same dose of albuterol as the CFC inhalers. Albuterol HFA inhalers are safe and effective for the same FDA approved uses: treatment or prevention of bronchospasm in patients with reversible obstructive airway disease, including asthma and chronic obstructive pulmonary disease (COPD).
How are albuterol HFA inhalers different from albuterol CFC inhalers?
CFCs are used as propellants (spray) to move the albuterol medicine out of the inhaler so patients
can breathe the medicine into their lungs. HFAs are a different type of propellant (spray). The albuterol and levalbuterol HFA inhalers have a different propellant called hydrofluoroalkane (HFA). Albuterol
HFA and albuterol CFC inhalers may taste and feel different. The force of the spray may feel softer
from albuterol HFA than from albuterol CFC inhalers. Each of the HFA inhalers is different (see table).
Albuterol HFA inhalers have to be cleaned and primed to work in the right way and give the right dose
of medicine. Each HFA inhaler has different instructions for cleaning and priming. The patient
information that comes with each inhaler tells you how to clean and prime your inhaler.

Albuterol and Levalbuterol HFA Inhalers
ProAir HFA
Proventil HFA
Ventolin HFA
Xopenex HFA
Active ingredient
Albuterol sulfate
Albuterol sulfate
Albuterol sulfate
Levalbuterol tartrate
Inactive ingredients
HFA propellant
alcohol
HFA propellant
alcohol
oleic acid
HFA propellant
HFA propellant
alcohol
oleic acid
Dose Counter
No
No
Yes
No
Priming required
Yes
Yes
Yes
Yes
Cleaning required
Yes
Yes
Yes
Yes
Why is cleaning and priming my albuterol HFA inhaler important?
Cleaning the inhaler to prevent clogging and properly priming the albuterol HFA inhaler are very important to make sure that the medicine sprays from the inhaler so you can breathe it into your lungs. Each albuterol HFA inhaler comes with directions for washing, drying the mouthpiece (part that goes in your mouth) and priming. There are some differences between brands of inhalers, so you will need to follow the directions that come with each inhaler.
What should I do if I have problems with my albuterol HFA inhaler?
First, remember that the force of the spray from the albuterol HFA may feel different. Make sure you wash, dry, and prime the inhaler as described in the directions that come in each package. If you have problems using your albuterol HFA inhaler, talk to your health care professional as a different product may be right for you.
If the spray feels different, how will I know if my HFA inhaler is working in the right way?
It is important to remember that it is the deep breath that you take with each puff that gets the medication into your lungs, not the force of the spray. The spray from an albuterol HFA inhaler may feel softer than the spray from an albuterol CFC inhaler but this will not affect the amount of drug that
you breathe into your lungs. The spray from an albuterol CFC inhaler often hits the back of the mouth. The spray from an HFA inhaler is a fine mist that may actually be easier to breathe into your lungs
compared to a CFC inhaler.
The HFA inhalers cost more than the CFC inhalers. What can I do if it’s hard for me to pay for my HFA inhaler?
Talk to your health care professional about programs to help patients get medicines they need. •
Some drug companies have patient assistance programs that make medicines available to
• patients at no cost, or at a lower cost.
Some patients may be able to get help paying for medicines from the Centers for Medicare & • Medicaid Services.
Is it safe to buy HFA inhalers over the internet?
Buying your medicine online can be easy, just make sure you do it safely. The Internet makes it possible to compare prices and buy products without leaving home. But when it comes to buying medicine online, it is important to be very careful. Some websites sell medicine that may not be safe to use and could put your health at risk. For more information please see our guide: “Buying Prescription Medicines Online: A Consumer Safety Guide” at www.fda.gov/buyonlineguide.DEPARTMENT OF HEALTH & HUMAN SERVICES • USA
U.S. Department of Health and Human Services
Food and Drug Administration – www.fda.gov
Questions? Email: druginfo@fda.hhs.gov,
or call 1-888-INFOFDA

FAQ: Winter Itch/ Eczema

The chill air of winter is more than just a harbinger of the holidays and snowy days. It can also precipitate the dry, itchy skin some people get during the cold weather and often leads to flare- ups for people with concurrent skin problems like allergic eczema or psoriasis.

What Causes It?
Indoor heating dries the air. In winter people often take hotter baths and showers and stay in them longer to warm up.Many don’t drink enough fluids. When the air surrounding the skin is drier, water evaporates out more easily, drying the skin. Natural protective skin oil is dissolved and washed away by the use of strong soaps, such as antibacterial or deodorant soaps. Dry skin is more sensitive and easily irritated; it gets itchy, then scratching that itch can actually cause a rash.

What Do I Do?
It is better to wash only once every day or two in winter, and showering is preferred, as it is less drying than a tub bath. Use lukewarm, not hot water, and stay in for no longer than 10-15 minutes. After rinsing, apply a dye and fragrance free moisturizer such as Aquaphor or Vaseline all over your body while it’s still wet. Avoid moisturizers that contain alcohol, as they can actually dry the skin more. Recent studies have shown that people with eczema have less amounts of a lipid called Ceramide in their skin and replacing it in the correct proportion with a ceramide containing moisturizer helps relieve this condition.

How Can I Prevent It?
Re-apply your moisturizer repeatedly through the day to keep your skin from getting dry.Don’t overheat your environment. Use a humidifier or set out pans of water to moisten your air. Also drink extra water to humidify from the inside out. Avoid dehydration caused by drinking alcohol and by neglecting to replace fluids lost through sweating. Use a sunscreen cream on exposed areas if going out in the sun, even in winter. If your dry skin or rash isn’t better in a week or so, see your doctor.

What Else Could It Be?
What can be worse than winter itch? Having a severe skin disease. Eczema and psoriasis are severe skin conditions that get worse in the winter. Although eczema is more prevalent in children, it also affects 10 percent of the adult population. Eczema can be described as skin that is itchy, dry, scaly, red, crusty, inflamed and sometimes oozing.

There are three main forms of eczema:

1. Irritant Contact Dermatitis. People who fail to moisturize or wash their skin too frequently can easily irritate it. Skin becomes red and dry and anything including water and baby shampoo can distress it.

2. Atopic Dermatitis. This is an internal chronic inclination towards eczema and it tends to flare in the winter. This form usually starts in infancy and affects those who have a family history of allergies, asthma, or dry, sensitive skin. Many children grow out of it as they get older but it tends to flare up again when they are adults.

3. Allergic Contact Dermatitis. This form is less common and occurs after an allergic reaction to a substance such as rubber, nickel, lanolin or a fragrance. This type of allergy develops over time and your skin could develop an allergy to something that did not irritate it in the past.

Other less common forms of eczema include seborrhoeic eczema, which affects the scalp and eye-lashes as a severe form of dandruff; and discoid eczema, which causes circular patches of eczema over the body.

Allergy tests such as skin/ blood tests and/ or patch testing is available to identify possible triggers for various forms of eczema and to direct appropriate treatment.

LINK:
Atopic Dermatitis/ Eczema

Pediatric Guidelines Updated for Influenza Vaccination in 2008-2009 Season

From Medscape
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD

October 14, 2008 — The American Academy of Pediatrics (AAP) has issued updated guidelines for routine use of influenza vaccine in children and adolescents in the 2008 to 2009 influenza season, according to a statement reported in the October 1 Early Release issue of Pediatrics. This update revises guidelines originally published in a comprehensive format in Pediatrics in April 2008.

The AAP recommends annual influenza immunization for all children aged 6 months through 18 years, including those who are healthy and those who have high-risk conditions; for household contacts and out-of-home care providers of children with high-risk conditions or of healthy children younger than 5 years; for any woman who will be pregnant during influenza season; and for healthcare professionals.

Since the April 2008 guidelines, the recommended age range of children for annual influenza immunization has been expanded in these updated guidelines to include all children aged 6 months through 18 years.

“This expansion targets all school-aged children, the population that bears the greatest disease burden and is at significantly higher risk of needing influenza-related medical care compared with healthy adults,” write AAP chairperson Joseph A. Bocchini, Jr, MD, and colleagues. “In addition, reducing influenza transmission among school-aged children will, in turn, reduce transmission of influenza to household contacts and community members.”

This expanded indication now means that the following groups should be vaccinated:

All children who are at greater risk for influenza complications, such as those who are immunosuppressed or who have chronic medical conditions.</li

All healthy children aged 6 through 59 months.</li

If feasible, all children aged 5 through 18 years should be vaccinated in the 2008 to 2009 influenza season. If not, these children should be routinely vaccinated no later than the 2009 to 2010 season.

Household members and out-of-home care providers of all children at high risk and adolescents and all healthy children younger than 5 years should also receive influenza vaccine annually to lower the risk for exposure to influenza for these young children, who are at serious risk for influenza infection, hospitalization, and sequelae. In healthy children younger than 24 months, the risk for influenza-associated hospitalization is at least as great as the risk in previously recognized high-risk groups. Furthermore, children aged 24 through 59 months have greater morbidity and higher rates of outpatient visits and antibiotic use related to influenza illness.

Influenza vaccine has not been approved for use in infants younger than 6 months. Clinicians should identify all children aged 6 months through 18 years, especially those at increased risk for complications related to influenza, and should inform their parents when annual influenza immunization is due.

All 3 strains in the 2008 to 2009 influenza vaccines are different from the 2007 to 2008 vaccine strains on the basis of global surveillance of circulating influenza strains.

Healthy children aged 2 through 18 years can receive either trivalent inactivated influenza vaccine (TIV) or live-attenuated influenza vaccine (LAIV).

Age determines the number of influenza vaccine dose(s) to be administered, as follows:

Children aged at least 9 years who have not previously received the influenza vaccine require only 1 dose in their first season of immunization.

Any child younger than 9 years who is vaccinated against influenza for the first time should receive a second dose at least 4 weeks after the first.

Children younger than 9 years who received only 1 dose of influenza vaccine in the first season they were vaccinated should receive 2 doses of influenza vaccine the following season. This recommendation applies only to the influenza season after the first year that a child younger than 9 years is vaccinated against influenza.

For the 2008 to 2009 influenza season, oseltamivir or zanamivir are still the antiviral medications recommended for chemoprophylaxis or treatment. Because of widespread resistance among some circulating influenza A virus strains, and lack of efficacy against influenza B strains, amantadine or rimantadine should not be prescribed for treatment or chemoprophylaxis of influenza. Oseltamivir resistance has been reported but it is still very limited, so current antiviral treatment recommendations have not changed.

As soon as the influenza vaccine is available, it should be offered to all children, and immunization efforts should continue throughout the entire influenza season, even after influenza activity has been documented in a community. There may be more than 1 peak of activity during the same influenza season, which often extends into March and beyond. Immunization through May 1 can still protect vaccinees during that season and facilitates administration of a second dose of vaccine to children who require 2 doses during that season.

“Health care professionals, influenza campaign organizers, and public health agencies should cooperate to develop plans for expanding outreach and infrastructure to achieve the target immunization of all children 6 months through 18 years of age, beginning no later than the 2009-2010 influenza season,” the guidelines authors conclude. “Concerted effort among the aforementioned groups, plus vaccine manufacturers, distributors, and payers, also is necessary to appropriately prioritize administration of influenza vaccine whenever vaccine supplies are delayed or limited.”

Pediatrics. Published online October 1, 2008.

CDC reports food allergies increasing in US Kids

from the Associated Press
ATLANTA, Georgia (AP) — Food allergies in American children seem to be on the rise, now affecting about 3 million kids, according to the first federal study of the problem.

According to research, nearly 1 in 100 Americans react to peanuts, an allergy that generally persist for a lifetime.

But experts said that might be because parents are more aware and quicker to have their kids checked out by a doctor.

About 1 in 26 children had food allergies last year, the Centers for Disease Control and Prevention reported Wednesday. That’s up from 1 in 29 kids in 1997.

The 18 percent increase is significant enough to be considered more than a statistical blip, said Amy Branum of the CDC, the study’s lead author.

Nobody knows for sure what’s driving the increase. A doubling in peanut allergies — noted in earlier studies — is one factor, some experts said. Also, children seems to be taking longer to outgrow milk and egg allergies than they did in decades past.

But also figuring into the equation are parents and doctors who are more likely to consider food as the trigger for symptoms like vomiting, skin rashes and breathing problems. More on living with food allergies »

“A couple of decades ago, it was not uncommon to have kids sick all the time and we just said ‘They have a weak stomach’ or ‘They’re sickly,”‘ said Anne Munoz-Furlong, chief executive of the Food Allergy & Anaphylaxis Network, a Virginia-based advocacy organization.

Parents today are quicker to take their kids to specialists to check out the possibility of food allergies, said Munoz-Furlong, who founded the nonprofit in 1991.

The CDC results came from an in-person, door-to-door survey in 2007 of the households of 9,500 U.S. children under age 18.

When asked if a child in the house had any kind of food allergy in the previous 12 months, about 4 percent said yes. The parents were not asked if a doctor had made the diagnosis, and no medical records were checked. Some parents may not know the difference between immune system-based food allergies and digestive disorders like lactose intolerance, so it’s possible the study’s findings are a bit off, Branum said.

However, the study’s results mirror older national estimates that were extrapolated from smaller, more intensive studies, said Dr. Hugh Sampson, a food allergy researcher at the Mount Sinai School of medicine.

“This tells us those earlier extrapolations were fairly close,” Sampson said.

The CDC study did not give a breakdown of which foods were to blame for the allergies. Other research suggests that about 1 in 40 Americans will have a milk allergy at some point in their lives, and 1 in 50 percent will be allergic to eggs. Most people outgrow these allergies in childhood.

About 1 in 50 are allergic to shellfish and nearly 1 in 100 react to peanuts, allergies that generally persist for a lifetime, according to Sampson.

Some people have more than one food allergy, he said, explaining why the overall food allergy prevalence is about 4 percent.

Children with food allergies also were more likely to have asthma, eczema and respiratory problems than kids without food allergies, the CDC study found, confirming previous research.

The study also found that the number of children hospitalized for food allergies was up. The number of hospital discharges jumped from about 2,600 a year in the late 1990s to more than 9,500 annually in recent years, the CDC results showed.

Also, Hispanic children had lower rates of food allergies than white or black children — the first such racial/ethnic breakdown in a national study.

The reason for that last finding may not be genetics, said Munoz-Furlong. She is Hispanic and said people in her own family have been unwilling to consider food allergies as the reason for children’s illnesses. “It’s a question of awareness,” she said.

LINKS:
CDC Report: Food Allergy Among US Children

PASCACK VALLEY, NJ FOOD ALLERGY SUPPORT GROUP MEETING

PASCACK VALLEY FOOD ALLERGY SUPPORT GROUP MEETING/ ALLERGY-FREE CHILDREN’S HALLOWEEN PARTY

Food Allergy is the leading cause of severe allergic reactions or anaphylaxis, and up to 8% of children and 2% of adults are estimated to have food allergies in the U.S. Caring for a child with a food allergy can be overwhelming and difficult for many families. Children with food allergies often encounter problems at school and have trouble socializing with others.

Food Allergy Support Groups provide educational, emotional, and practical resources and support for these patients and their families, as well as raising community awareness. An organizational meeting of a local Pascack Valley Food Allergy Support Group combined with an Allergy Free Children’s Halloween Party will be held on October 25, 2008 (Saturday) from 2-5 PM. For further information, please call Dr. de Asis or Dr. Pistiner at Allergy and Asthma Consultants of Rockland and Bergen at (201) 666-8500.

LINKS:
Halloween: Celebrate with Food Allergies and Have Fun, Too!
Halloween, Kids, and Food Allergies