Allergy and Asthma Source

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

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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

I thought I’d get a jump on National Poison Prevention Week which is from March 18 to 24 this year. I had dinner recently with a neurotoxicologist friend who told me the sad story of a child who died from drinking silver cleaner which had been left out when his mom was interrupted while doing chores.

We are so paranoid about child seats and bike helmets, but sometimes we forget the dangers that are in our own closets.

Here are some important prevention tips from the National Capital Poison Center

Facts On Poison Exposures:
• On average, poison centers handle one poison exposure every 14 seconds.
• Over two million poison exposures were reported to local poison centers in
2000.
• Most poisonings involve everyday household items such as cleaning supplies,
medicines, cosmetics and personal care items.
• 89 percent of all poison exposures occur in the home.
• 92 percent of exposures involve only one poisonous substance.
• 86.7 percent of poison exposures are unintentional.
• 75 percent of poison exposures involve ingestion of a poisonous substance.
Other causes include breathing in poison gas, getting foreign substances in
the eyes or on the skin, and bites and stings.
• 77 percent of all exposures are treated on the site where they occurred,
generally the patient’s home with phone advice and assistance from local
poison control experts.

Children and Poison:
• 53 percent of poison exposures occur in children under the age of six.
• The most common forms of poison exposure for children under the age of six
are cosmetics and personal care products (13.3%), cleaning substances
(10.7%), analgesics (7.6%) and plants (6.9%).

The Most Dangerous Poisons for Children

The most dangerous poisons for children include the following. Be sure to check the poison prevention tips to protect your loved ones.

Medicines: these are OK in the right amount for the right person. They can be dangerous for children who take the wrong medicine or swallow too much.

Iron pills: adult-strength iron pills are very dangerous for children to swallow. Children can start throwing up blood or having bloody diarrhea in less than an hour.

Cleaning products that cause chemical burns: these can be just as bad as burns from fire. Products that cause chemical burns include include drain openers, toilet bowl cleaners, rust removers, and oven cleaners.

Nail glue remover and nail primer: some products used for artificial nails can be poisonous in surprising ways. Some nail glue removers have caused cyanide poisoning when swallowed by children. Some nail primers have caused burns to the skin and mouth of children who tried to drink them.

Hydrocarbons: this is a broad category that includes gasoline, kerosene, lamp oil, motor oil, lighter fluid, furniture polish, and paint thinner. These liquids are easy to choke on if someone tries to swallow them. If that happens, they can go down the wrong way, into the lungs instead of the stomach. If they get into someone’s lungs, they make it hard to breathe. They can also cause lung inflammation (like pneumonia). Hydrocarbons are among the leading causes of poisoning death in children.

Pesticides: chemicals to kill bugs and other pests must be used carefully to keep from harming humans. Many pesticides can be absorbed through skin. Many can also enter the body by breathing in the fumes. Some can affect the nervous system and can make it hard to breathe.

Windshield washer solution and antifreeze: Small amounts of these liquids are poisonous to humans and pets. Windshield washer solution can cause blindness and death if swallowed. Antifreeze can cause kidney failure and death if swallowed.

Wild mushrooms: many types of mushrooms grow in many areas of the country. Some are deadly to eat. Only experts in mushroom identification can tell the difference between poisonous mushrooms and safe mushrooms.

Alcohol: when children swallow alcohol, they can have seizures, go into a coma, or even die. This is true no matter where the alcohol comes from. Mouthwash, facial cleaners, and hair tonics can have as much alcohol in them as alcoholic beverages.

Household Poisons
The Yukkiest Poisons
These are especially hazardous household items. Buy small quantities. Discard unneeded extras. Make sure they are always out of a child’s reach.

antifreeze
windshield washer solutions
drain cleaners
toilet bowl cleaners
insecticides
artificial nail removers
topical anesthetics (i.e. Products that may be used for sunburn pain)
medicines, medicines, medicines.
Did you know that even these common household items can poison little children?
detergents
automatic dishwasher detergents
furniture polish
perfume & aftershave
mouthwash
gasoline, kerosene, and lamp oil
paint and paint thinner
mothballs
alcoholic beverages
miniature batteries
flaking paint
cigarettes, tobacco products
rat and mouse poison

Pet Poison Prevention Tips:
Your pets can be poisoned too. Follow the same poison prevention tips given for children to protect you animals. The following are some additional poison prevention tips specifically for your pet:

-Never give your pet any medications unless specifically instructed to do so by a veterinarian. Many human medications can have dire consequences to animals, even in small amounts.
-Never give your dog chocolate. Dogs are particularly sensitive to chocolate, and it is considered extremely poisonous for dogs.
-Be aware of you houseplants. Many common household plants can cause kidney damage to your pets if ingested.
Keep all medications out of an animals reach, even they can get into a closed medicine bottle.
-Keep hydrogen peroxide available in case you need to make your animal vomit due to a poisoning. Do not give the peroxide unless instructed to do so by a veterinarian or a Poison Center.
-When treating you animal for ticks and fleas, read all product labels before you begin. Follow the safety recommendations given for you and for the animal.
-Hose-down areas in your driveway or garage in which chemicals have been drained or leaked. A small amount of many chemicals can be fatal to an animal.
-Be aware of neighborhood poisons that may be lurking for your pet.
slug or snail baits put out in gardens
yards and gardens recently treated with insecticides
mushrooms and outdoor plants
rat and mouse poisons
snakes and frogs (frogs may be very poisonous if eaten by a pet)

Finally, Act Fast
What to do if a poisoning occurs:

1. Remain calm
2. Call 911 if you have a poison emergency and the victim has collapsed or is not breathing. If the victim is awake and alert, dial 1-800-222-1222. Try to have this information ready:
-the victim’s age and weight
-the container or bottle of the poison if available
the time of the poison exposure
-the address where the poisoning occurred
3.Stay on the phone and follow the instructions from the emergency operator or poison control center.

P.S.DON’T FORGET TO VISIT BLOG MD FOR PEDIATRIC GRAND ROUNDS 1:24

Who can refuse a puppy?
Okay, okay, I’m playing the “cute” card, but cuteness will not be a factor in choosing the posts.
You can comment on this page telling me how to get in touch with you or send a link to deasis80@yahoo.com. Deadline is Feb. 23, 2007 (ET) 12 midnight ET
and check out PGR 1:22 at Adventures of an Awesome Mom

Inhaled Steroid Monotherapy Seen Best for Mild-Moderate Pediatric Asthma

The following abstract reiterates what is already known and considered the standard of care, which is the use of inhaled corticosteroids for mild- moderate asthma. I was not surprised by the superiority of the inhaled steroid alone and inhaled steroid/ salmeterol arms over the montelukast arm, but what I found interesting is the finding that double dose inhaled steroid was superior to inhaled steroid/ salmeterol combo in terms of FEV1/FVC and other markers such as exhaled nitric oxide and maximum bronchodilator response. But what does this mean clinically? If these children are followed longitudinally, which I’m sure they will be, it would give us important information on the long-term relevance of these markers and give us further guidance on the use of higher dose ICS vs. ICS plus long acting beta-agonists.

Sorkness CA, Lemanske RF Jr, Mauger DT, Boehmer SJ, Chinchilli VM, Martinez FD, Strunk RC, Szefler SJ, Zeiger RS, Bacharier LB, Bloomberg GR, Covar RA, Guilbert TW, Heldt G, Larsen G, Mellon MH, Morgan WJ, Moss MH, Spahn JD, Taussig LM; for the Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Clinical Science Center, University of Wisconsin, Madison.

BACKGROUND: More evidence is needed on which to base recommendations for treatment of mild-moderate persistent asthma in school-aged children.

OBJECTIVE: The Pediatric Asthma Controller Trial (PACT) compared the effectiveness of 3 regimens in achieving asthma control.

METHODS: A total of 285 children (ages 6-14 years) with mild-moderate persistent asthma on the basis of symptoms, and with FEV(1) >/= 80% predicted and methacholine FEV(1) PC(20) RESULTS: Fluticasone monotherapy and PACT combination were comparable in many patient-measured outcomes, including percent of asthma control days, but fluticasone monotherapy was superior for clinic-measured FEV(1)/forced vital capacity (P = .015), maximum bronchodilator response (P = .009), exhaled nitric oxide

CONCLUSION:Both fluticasone monotherapy and PACT combination achieved greater improvements in asthma control days than montelukast. However, fluticasone monotherapy was superior to PACT combination in achieving other dimensions of asthma control. Growth was similar in all groups.

CLINICAL IMPLICATIONS: Therefore, of the regimens tested, the PACT study findings favor fluticasone monotherapy in treating children with mild-moderate persistent asthma with FEV(1) >/= 80% predicted, confirming current guideline recommendations.

J Allergy Clin Immunol. 2007 Jan;119(1):64-72. Epub 2006 Nov 30

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