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Flu Season Could Spell Double Trouble

September 2, 2010

If you or your child has asthma, you may worry about serious complications from the flu, such as asthma attacks, pneumonia and ear and sinus infections. Now a new study suggests some people with allergic asthma may be particularly susceptible to getting the flu in the first place.

When the body of someone with allergic asthma reacts to an indoor allergen such as dust mites, mold or pet dander, it may fail to mount a healthy immune response against the flu virus.

For the study, published in the American Journal of Immunology, researchers took blood samples from 56 people ranging in age from 3 to 35. Twenty-six of the participants suffered from allergic asthma and were sensitive to at least one indoor allergen; the rest formed the control group.

From the blood samples, the researchers isolated immune cells, called dendritic cells. These cells are normally found in blood and tissues along the skin, lung and nasal passages; and they influence immune response in many ways. When dendritic cells from allergic persons were exposed to the flu virus, the cells produced less of a protein involved in mounting a defense against the flu.

The study also highlighted the role immunoglobulin E (IgE), an antibody known to be elevated in people with allergic asthma. When IgE levels were high, less of the important protein was produced.

The bottom line: While many critical questions still need to be answered, this study provides further motivation to control allergic asthma in yourself or your child—particularly during flu season, which in the U.S., lasts from October to May.

Although no vaccine is 100 percent effective against preventing disease, vaccination is the best protection against influenza and can help prevent illness. The best time to get the vaccine is in early fall before flu viruses start to circulate.

Take the following steps to keep allergic asthma under control:

  • Get a flu shot as soon as it becomes available. People with asthma should not use vaccines that contain live attenuated virus, such as FluMist® nasal spray. Children older than 6 months to 8 years who have never received a flu shot will need two doses. (The 2010–2011 flu shot protects against both the seasonal and H1N1 flu viruses.)
  • Adults 19 to 64 should also get the pneumococcal polysaccharide vaccine (PPSV). These individuals may be more likely to develop secondary bacterial pneumonia after having the flu.
  • Reduce your exposure to your particular indoor allergen:
    • Dust mites: Cover your mattress and pillows with allergen-proof cases. Keep stuffed animals out of the bedroom. Vacuum carpets regularly, or remove them.
    • Pet dander: Keep pets out of the bedroom; and give pets a weekly bath.
    • Mold: Keep the humidity level in your home between 25 and 50 percent. Also, fix all water leaks. When showering, cooking or washing dishes, use exhaust fans or open a window. A dehumidifier and/or an air conditioner can also help.
  • Finally, ask your allergist/immunologist about the best ways to treat allergic asthma, including whether allergy shots or medications may help control your condition.

By taking due care, you can outsmart the flu this season.

Sources: Gill, et. al. Counterregulation between the Fc{varepsilon}RI Pathway and Antiviral Responses in Human Plasmacytoid Dendritic Cells. The Journal of Immunology, June 1, 2010.;
Centers for Disease Control and Prevention (CDC); and

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Acetaminophen Linked to Asthma in Teens

September 2, 2010

The common pain reliever acetaminophen may be contributing to the prevalence of asthma, a new study suggests. Teens who used acetaminophen as infrequently as once or a few times in the past year were 43 percent more likely to report asthma symptoms, such as wheezing, according to the study, published in the American Journal of Respiratory and Critical Care Medicine. Teenagers who took the medication more often (at least once a month) were more than twice as likely to report symptoms.

The global study, called The International Study of Asthma and Allergies in Childhood (ISAAC), was based on questionnaire responses from almost 323,000 adolescents ages 13 to 14 from 50 different countries.

A few previous studies have noted an association between acetaminophen use and asthma in young children and adults.

Whether acetaminophen actually contributes to the development or persistence of asthma remains unclear. The study was observational, so it could not determine causation. "Randomized controlled trials are urgently required to investigate this relationship further," according to the researchers.

If the medication does trigger asthma or worsen it, the scientists speculate acetaminophen may spur inflammation in the airways. Or, the drug could suppress a healthy immune response to rhinoviruses, such as the common cold, leading to worse breathing.

Bottom line: More research is needed to prove a cause and effect relationship between acetaminophen and risk of asthma. In the meantime, speak with your pediatrician and/or allergist about which pain relievers, fever reducers and cough and cold remedies to use.

In many countries, acetaminophen has been the preferred pain reliever for people with asthma because aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may worsen asthma and allergy symptoms in some individuals.

Acetaminophen is found in pain relievers and fever reducers, such as Tylenol®, and in many combination products, such as cough and cold remedies.

Source: Beasley, RW. Acetaminophen Use and Risk of Asthma, Rhinoconjunctivitis and Eczema in Adolescents: ISAAC Phase Three. The American Journal of Respiratory and Critical Care Medicine. August 13, 2010.

Stolen Inhalers Pose Risk

July 26, 2010

The U.S. Food and Drug Administration (FDA) is warning consumers not to use asthma inhalers stolen from a Virginia warehouse that may have turned up in some pharmacies. The inhaler is the Advair Diskus® (fluticasone propionate and salmeterol inhalation powder), lot numbers:

  • Lot 9ZP2255 - NDC -00, Advair Diskus 250/50, 60 Dose
  • Lot 9ZP3325 - NDC -00, Advair Diskus 500/50, 60 Dose

You can find the lot number for your inhaler imprinted on the inhaler's circular label, foil wrap, or box.

The stolen medicine may pose a health risk, according to FDA experts, if it has been stored at improper temperatures or humidity levels. It's also possible that the inhalers have lost potency or been contaminated.

More than 25,000 of the inhalers were stolen from the drug maker GlaxoSmithKline last summer. The inhalers are set to expire this September. Pharmacies have been notified to remove the inhalers from store shelves.

If you have purchased one of the stolen inhalers, call GlaxoSmithKline's Customer Response Center at .

Source: Adapted from FDA Consumer, Stolen Inhalers Pose Risk, July 16, 2010. GlaxoSmithKline

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On the Horizon: A Hypoallergenic Peanut

July 26, 2010

Researchers are working on many fronts to prevent and treat peanut allergy. Groups of scientists are studying vaccines and other preventative treatments. "On the food front, groups are trying to produce natural or genetically-engineered varieties of peanuts that are less allergenic," says Soheila J. Maleki, Ph.D., research chemist at the U.S. Department of Agriculture (USDA). Her team is leading the effort to breed a natural variety of peanut that contains a much lower dose of allergens than your average peanut. So far, they've managed to reduce some of the three major peanut allergens ARA h1, ARA h2, and ARA h3.

How will a hypoallergenic peanut help? "We hope it can be used in oral immunotherapy to increase allergic children's tolerance to peanuts. That means a child who is accidentally exposed to a stray peanut potentially could have no or a mild reaction," she says.

If the special peanut makes it to the commercial market, restaurants might use it instead of regular peanuts. Since it would contain few allergens, patrons accidentally exposed to it might have milder reactions, easing some of the fear peanut allergy sufferers have when dining out.

A hypoallergenic peanut is still several years away. In the meantime, Maleki says "stay vigilant" to minimize exposure to peanuts.

Allergy-Friendly Restaurants

A new web site is making it easier to find allergy-friendly restaurants. offers a directory of 600,000 restaurants in the U.S. and presents ratings from users (not doctors) on how well the establishments meet the needs of people with allergies. The rating is not designed to measure whether a restaurant's menu does or does not accommodate specific allergies, but rather whether any allergic patron feels that he or she can be served a safe meal on or off the menu.

You can search the directory by allergy (or intolerance) and by address to find suitable restaurants in your area. Users are invited to submit reviews of restaurants they've visited to grow the database.

Sources: Soheila J. Maleki, Ph.D., research chemist at the USDA;
Asthma and Allergy Foundation of America;

Keep Asthma Under Control

June 25, 2010

Pop quiz: What simple step can help you better manage asthma and avoid serious complications? Keeping up with your medication! While it's not the most exciting research finding, it certainly is among the most influential—and it may keep you out of the hospital emergency room.

A recent study published in The Journal of Allergy and Clinical Immunology found that those who adhered to their inhaled corticosteroid medication required fewer treatments with oral corticosteroids for worsening asthma and were less likely to experience an asthma-related emergency. Previous studies have reached the same conclusion.

You may have the best of intentions. But in the course of your busy life, you may forget to take your medication and refill your prescriptions. If the medication doesn't appear to be working, you may be tempted to stop taking it. Or, cost could be an issue. Then, you may neglect to bring it up with your doctor out of embarrassment or fear.

The truth is there's little a doctor can do if you don't take your medication. This study underscores that point. Even when physicians had access to a database of patients' prescription habits, few doctors had or took the time to review the information—missing a key opportunity to address a problem before it escalated into worsening asthma and asthma attacks.

When doctors did review patients' medication usage, it resulted in better medication compliance. Reviewing the asthma action plan and discussing the asthma prescription likely motivated patients to take their inhaled medication.

The bottom line: If your doctor doesn't raise the issue, bring it up! "Patients should see [the doctor visit] as an opportunity to share information about problems that they are experiencing with a medication so that they can work together with their physician to find a medication regime that works for them," suggests the lead study author L. Keoki Williams, M.D., of the Center for Health Services Research in Detroit.

The following medications reminders from the NIH may also help:

  • Take your asthma medicine right after you brush your teeth and keep it with your toothbrush as a reminder, or put it next to your cereal box and take it with breakfast.
  • Put "sticky" notes in visible places to remind yourself to take your asthma medicine, i.e., on the refrigerator, on the cabinet where you keep your favorite morning mug (you might even keep the medicine bottle inside the mug), on the bathroom mirror, on the front door.
  • If you have a personal computer, program a start-up reminder to take your asthma medicine or sign up with one of the free services that will send you a reminder e-mail every day.
  • If you have a watch or cell phone with an alarm, program it to beep and remind you to take your asthma medicine.
  • Keep your medicine on the nightstand next to your side of the bed.
  • Remember to refill your prescription. Each time you pick up a refill, make a note on your calendar to order and pick up the next refill one week before the medicine is due to run out.

Finally, if you can’t afford your asthma medication, talk to your doctor and visit the National Council on Patient Information and Education to learn about prescription assistance programs.

Sources: L. Keoki Williams, et al. A cluster-randomized trial to provide clinicians inhaled corticosteroid adherence information for their patients with asthma. Journal of Allergy and Clinical Immunology, 2010; DOI: 10.1016/j.jaci.2010.03.034;
So You Have Asthma, a publication of the National Heart, Lung and Blood Institute of the National Institutes of Health; and the
National Council on Patient Information and Education

Do Burgers Boost Asthma Risk?

June 21, 2010

What your child eats could influence his or her chances of developing asthma suggests a new international study published in Thorax. Researchers examined food frequency questionnaires for 50,000 children ages 8 to 12 from 20 different countries and calculated their risk of asthma and allergy symptoms.

None of the foods appeared to sensitize children to allergies. But among children living in more affluent countries, eating 3 or more burgers a week was associated with increased risks of wheezing (12%) and asthma (42%).

So should you halt the barbecues? Not quite. The researchers believe that burger overconsumption is a proxy for an unhealthy lifestyle. Many fast foods, including burgers, contain trans fats, and "there is some evidence that intake of these fats is associated with asthma," write the authors. It's also possible that an unknown factor could be at work. This study, for example, could not adjust for the effects of total calorie intake or body mass index (BMI).

You may want to grill up some vegetables and fruit, though; and include fresh fruits and veggies in your meals and side dishes. (Skip the fizzy drinks, such as soda.) What is becoming clear: a Mediterranean diet—full of fruits and vegetables and fish and low in meat and other animal products—may protect lung health. In this study, children who ate lots of produce and fish were less likely to experience wheezing and also enjoyed a lower lifetime risk of asthma.

"Fruit and vegetables contain antioxidants and other biologically active factors which may contribute to the favorable effect…in asthma," write the authors. Fish is rich in polyunsaturated fats and has anti-inflammatory properties.

A Mediterranean diet is widely recommended for the prevention of heart disease and cancer. Preventing asthma is one more reason to encourage your child to adopt this healthy diet, conclude the authors. Bon appétit!

Source: Nagel, G.; Weinmayr, G., Kleiner, A.; Garcia-Marcos, L. and Strachan, D. Thorax 2010;65:516-522 doi:10.1136/thx.2009.128256

FDA Approves New Device for Severe Asthma

June 21, 2010

Is your asthma poorly controlled by inhaled corticosteroids and long-acting beta agonist (LABA) medication? If so, you may have an additional therapy option. The FDA has approved a new medical device to help treat severe, persistent asthma in adults.

The Alair Bronchial Thermoplasty System is composed of a heat generator and a catheter with an electrode tip. Using the device, a trained doctor delivers controlled radiofrequency energy directly to areas of lung tissue (through a bronchoscope) to reduce the muscle and thereby prevent excessive constriction of the airways during an asthma attack. The goal: To reduce the number of severe asthma attacks over the long-term. View an animation of the procedure at the manufacturer's website.

Treatments are given over 3 outpatient visits, scheduled approximately three weeks apart. Moderate sedation or light anesthesia is administered.

This asthma treatment carries certain risks. Possible side effects include asthma attacks, wheezing, chest tightness or pain, partial collapse of a lung, coughing up blood, anxiety, headaches and nausea.

People with sensitivity to certain medications or who have an implanted device, such as a pacemaker, should not have the procedure. Talk to your doctor to learn more about the pros and cons of treatment.

The FDA based its approval on data from a clinical trial of 297 patients with severe and persistent asthma, according to the news release. The trial showed a reduction of severe asthma attacks with use of the Alair system. The long-term safety and effectiveness of the device has not yet been established beyond one year. However, an unpublished study, recently presented at a medical conference did find that radiofrequency energy devices reduced certain asthma symptoms for up to five years after treatment, according to a news report.

Sources: FDA Press release; Alair Bronchial Thermoplasty System Label; the Manufacturer's website; and MedPage Today

Top 10 Spring Allergy Capitals

May 14, 2010

Is the itching, sneezing and sniffling worse this season? You're probably living in one of the cities identified as a spring allergy capital. Each year, the Asthma & Allergy Foundation of America (AAFA) ranks U.S. cities by their pollen scores (based on counts of airborne grass, tree and weed pollen and mold spores), allergy prescriptions and allergy specialists. So which metro areas topped the list this year? The eastern half of the country appears to have been the hardest hit:

  1. Knoxville, Tennessee
  2. Louisville, Kentucky
  3. Chattanooga, Tennessee
  4. Dayton, Ohio
  5. Charlotte, North Carolina
  6. Philadelphia, Pennsylvania
  7. Greensboro, North Carolina
  8. Jackson, Mississippi
  9. St. Louis, Missouri
  10. Wichita, Kansas

For the full list of spring allergy capitals, visit

You may be wondering what allergens are triggering your symptoms. Seeing an allergy specialist for testing is the only way to know for sure. But here is a short list from the AAFA of trees and grasses that pollinate in spring:

  • Trees: Ash, beech, birch, cedar, cottonwood, box, elder, elm, hickory, maple and oak pollen
  • Grasses: Kentucky bluegrass, timothy, Johnson, Bermuda, redtop, orchard, rye and sweet vernal

To get the daily pollen count in your area, visit the American Academy of Allergy, Asthma & Immunology's National Allergy Bureau.

Traffic-related Pollution Near School May Increase Childhood Asthma

May 14, 2010

Traffic conditions near where kids live—and go to school—may affect their chances of developing asthma, according to a new study published in Environmental Health Perspectives. Previous research has linked living near major highways with childhood asthma, but this study found that the risk of asthma is similarly high at school—45% compared to 51%. Combined exposure at home and at school had a slightly larger effect.

The study, based on Southern California's Children’s Health Study, looked at new cases of asthma among 2,500 children in kindergarten or first grade. To determine exposure to air pollution, researchers used a model that took into account local traffic volume, distance to major roadways as well as local weather conditions. During the three-year follow-up, 120 kids developed asthma.

Children spend only about a third of their day at school; So why would the effect of air pollution at school be similar to the effect at home? Exercising during gym class, playing in the schoolyard and other physical activities increase breathing rates and possibly the dose of pollutants to the lungs, suggest the study authors. Traffic-related pollution also may be higher during the morning hours when children are being driven and dropped off at school.

The effect is probably not limited to California, conclude the study authors. Almost 10% of public schools in California are located within 150 meters of roadways with high traffic. But students living in cities on the East coast are more likely to attend schools near major roadways.

"It's important to understand how these micro-environments where children spend a lot of their time outside of the home are impacting their health," said Rob McConnell, the lead study author, according to a press release. "Policies that reduce exposure to high-traffic environments may help prevent this disease."

7 Asthma Inhalers That Use CFCs Being Phased Out

April 26, 2010

The FDA has announced that seven metered dose asthma inhalers (MDI) that contain chlorofluorocarbons (CFCs) are being phased out due to the risk to the environment. CFCs were used as propellants in certain asthma inhalers, but research shows the chemicals decrease the ozone layer above the earth, which protects us from harmful ultraviolet light.

Here is a list of the MDI inhalers and the last date they will be sold in the United States.

  • Tilade Inhaler (nedocromil), made by King Pharmaceuticals, last date for sale: June 14, 2010
  • Alupent Inhalation Aerosol (metaproterenol), made by Boehringer Ingelheim Pharmaceuticals, last date for sale: June 14, 2010
  • Azmacort Inhalation Aerosol (triamcinolone), made by Abbott Laboratories, last date for sale: Dec. 31, 2010
  • Intal Inhaler (cromolyn), made by King Pharmaceuticals, last date for sale: Dec. 31, 2010
  • Aerobid Inhaler System (flunisolide), made by Forest Laboratories, last date for sale: June 30, 2011
  • Combivent Inhalation Aerosol (albuterol and ipratropium in combination), made by Boehringer Ingelheim Pharmaceuticals, last date for sale: Dec. 31, 2013
  • Maxair Autohaler (pirbuterol), made by Graceway Pharmaceuticals, last date for sale: Dec. 31, 2013

From FDA Consumer, April 13, 2010

If you use one of these inhalers, talk to your doctor about switching to another product. There are many options, including inhalers that use hydrofluoroalkane (HFA), dry powder inhalers that don't use propellants and liquids that work with a nebulizer machine. The FDA offers a helpful list of treatments for asthma and COPD that don't use CFCs.

These asthma and COPD medicines may look, feel, or taste different, and may be used differently than your CFC inhaler. Ask your doctor to show you how to use your new medication.

Allergies & Mouth Breathing

April 26, 2010

Many adults and children with allergic rhinitis (hay fever) suffer from nasal congestion and mouth breathing. And, according to the author of a recent article in General Dentistry, mouth breathing may lead to serious health problems, such as sleep problems and low oxygen in the blood, which is associated with high blood pressure and heart failure.

In children, mouth breathing also may lead to abnormal growth of the face and teeth. "Children who mouth breathe typically do not sleep well, causing them to be tired during the day and possibly unable to concentrate on academics," says Yosh Jefferson, DMD, author of the article, according to a press release. "If the child becomes frustrated in school, he or she may exhibit behavioral problems."

The good news is early treatment of mouth breathing may help. A dentist and doctor can check for mouth breathing symptoms and swollen tonsils. If the tonsils and/or adenoids (germ-trapping tissues at the back of the throat) are swollen, blocking the airways, they can be surgically removed by an ear-nose-throat (ENT) specialist. If the face and mouth are narrow, dentists can use expansion appliances to help widen the sinuses and open nasal airway passages.

"After surgery and/or orthodontic intervention, many patients show improvement in behavior, energy level, academic performance, peer acceptance and growth," says Leslie Grant, DDS, spokesperson for the Academy of General Dentistry, according to the release. "Seeking treatment for mouth breathing can significantly improve quality of life."

So if you or your child is a mouth breather, see your dentist and doctor for an assessment.

2010 Asthma Capitals

April 13, 2010

The Asthma and Allergy Foundation of America has revealed the top 100 most challenging places in the U.S. to live with asthma in 2010. The ranking is based on a number of factors, including outdoor air quality, the prevalence of asthma, the number of asthma prescriptions per person, the number of asthma specialists, smoking laws, and mortality.

This year, the top five asthma capitals are:

  1. Richmond, Virginia
  2. St. Louis, Missouri
  3. Chattanooga, Tennessee
  4. Knoxville, Tennessee
  5. Milwaukee, Wisconsin

Did your city make the list? Visit to download the complete ranking.

Managing Asthma
Short of moving, what can you do to manage asthma symptoms? Work closely with your asthma specialist to identify your asthma triggers and to get the right mix of medication to control your symptoms.

If you don't already have an asthma action plan, download this blank asthma action form and bring it to your next doctor's appointment. Your doctor may also recommend a peak flow meter, a device you can use at home to track your breathing.

It's important to follow your personal asthma action plan. It tells you what medications to take when you’re experiencing asthma symptoms, such as wheezing, coughing, chest tightness or shortness of breath. When you're in the green zone, you're doing well; if you're in the yellow zone, your asthma is getting worse; if you reach the red zone, you need to seek medical attention immediately. If you have questions about how to follow the plan, talk to your doctor.

Gardening Tips for Allergy Sufferers

April 13, 2010

Spring is in full swing, and many plants are pollinating. But that doesn't mean people with pollen allergies have to stay out of the garden. Follow these tips from the American Academy of Allergy, Asthma & Immunology (AAAAI) to minimize your allergy symptoms.

  • Before you start planting, see your allergist/immunologist to determine which plants will trigger your allergic reactions, so you can avoid them.
  • Windy, dry, sunny and clear days may have greater pollen counts. You may experience fewer allergy symptoms if you garden on rainy, cloudy and windless days. You can also visit the National Allergy Bureau, a division of AAAAI, to monitor pollen counts in your area.
  • Be selective with your plants. Some plants tend to minimize allergy symptoms, such as azalea, daisy, geranium, gladiola, iris, marigold, orchid, roses, sunflowers and tulips.
  • Wear a pollen mask (or goggles) and gloves while gardening.
  • After yard work, brush off shoes, rinse glasses and leave clothing outside to keep pollen out of your living space.
  • Shower and shampoo after spending time outdoors.

Food-Allergic Children Should Carry Two Epinephrine Doses

March 29, 2010

If your child is at risk for life-threatening anaphylaxis from food allergies, it's a good idea for him or her to carry backup epinephrine (adrenaline), suggest the authors of a recent study published in Pediatrics. Anaphylaxis is a severe allergic reaction that can quickly get worse. Epinephrine is the best emergency treatment to temporarily improve breathing and stimulate the heartbeat in time to get emergency care. In the study, 12% of children and teenagers being treated for food-related anaphylactic reactions in Boston-area emergency rooms between 2001 and 2006 needed two shots of epinephrine.

Although these results may not reflect the frequency of anaphylactic reactions among children and adolescents in the U.S., "until these risk factors are better understood, it may be advisable to prescribe multiple doses of self-injectable to all patients at risk of food-related anaphylaxis," write the researchers. As parents of allergic children know too well, regular doctor visits, an emergency action plan, and vigilance are key to managing food allergies. But less than half the children and teens (43%) in the study were prescribed self-injectable epinephrine following emergency care, and even fewer were referred to an allergist or instructed on avoidance of trigger foods. A variety of foods provoked the allergic reactions in the study, including peanuts, tree nuts and milk.

Here's what concerned parents and allergic children can do:
Talk to an allergist to

  • Review the food allergy emergency action plan.
  • Discuss the need to carry a second dose of epinephrine.
  • Receive training on administering epinephrine injections properly; this is crucial. Accidentally injecting epinephrine in the hands or feet can be dangerous. You also need to know when giving a second dose of epinephrine is advisable.

In addition, make sure your child, family members, caregivers and school personnel are educated about food allergies and, if allowable, receive training in giving injectable epinephrine (such as EpiPen, EpiPen Jr. and Twinject).

Epinephrine auto-injectors come in an adult dose (0.3 mg) or a pediatric dose (0.15 mg). Generally the adult dose is for individuals who weigh 66 pounds or more and the pediatric dose is for children who weigh 33 to 66 pounds. Talk to your child's allergist about which auto-injector is most appropriate to carry and use.

Recognizing the Signs of an Anaphylactic Reaction

The Food Allergy & Anaphylaxis Network offers these pointers on identifying anaphylaxis:
Anaphylaxis is highly likely to be occurring when any ONE of the following happens within minutes to hours after ingestion of the food allergen:

  1. A child has skin symptoms or swollen lips and either:
    • Difficulty breathing
    • OR
    • Reduced blood pressure (e.g., pale, weak pulse, confusion, dizziness, loss of consciousness)
  2. A child was exposed to a suspected allergen, and two or more of the following occur:
    • Skin symptoms or swollen lips
    • Difficulty breathing
    • Reduced blood pressure
    • Gastrointestinal symptoms (i.e., vomiting, diarrhea, or cramping)
  3. A child was exposed to a known allergen, and experiences:
    • reduced blood pressure

If a child or teen has any of these symptoms, administer epinephrine immediately and call 911 for emergency medical care. Don't wait to see if the symptoms go away or get better on their own.

Pregnancy & Asthma Symptoms

March 29, 2010

Asthma symptoms were more likely to remain stable during pregnancy when women continued to use their prescribed asthma medication, according to a recent study published in Obstetrics & Gynecology. If women discontinue medication, even mild asthma is likely to become significantly more severe, suggest the study authors. In fact, they point out that recent research indicates that developing fetuses may experience significant risks, such as lack of oxygen, from worsening asthma.

These findings generally support recommendations from the National Asthma Education and Prevention Program, which state, "It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations." The American College of Obstetricians and Gynecologists offer similar recommendations.

For the study, information on symptoms and medication use was collected from 641 pregnant women treated in doctors' offices and clinics in Connecticut and Massachusetts. A majority (58%) had intermittent asthma, 20% had mild persistent asthma and 23% had moderate or severe persistent asthma.

Women with milder asthma benefitted the most from appropriate asthma treatment. Notably, month or trimester did not appear to affect asthma severity.

If you are pregnant or planning to become pregnant and you have asthma, talk to your doctor about the best ways to prevent and manage an asthma flare-up during pregnancy. Don't stop taking your asthma medication without talking to your doctor, since this can lead to loss of asthma control.

Quick Tip
It may be difficult to distinguish labored breathing due to pregnancy from asthma symptoms, such as cough, shortness of breath, tightness in the chest or wheezing. A peak flow meter, which measures airflow out of your lungs, may help.

Choosing an Asthma Step-Up Treatment

March 15, 2010

Uncontrolled asthma occurs in many children who use a low-dose inhaled corticosteroid. Additional medication, called step-up treatment, is often recommended. But up to this point there's been little research to guide doctors toward which step-up treatment will work best for a particular child. So scientists conducted a study that tested three step-up treatments. Despite a "valiant effort," according to an accompanying editorial, the study published in the New England Journal of Medicine suggests there's "no compelling way" of predicting which step-up therapy will work best for a child with asthma.

Nearly all of the 165 children who completed the study responded better to one therapy than another. Of the three step-up treatments—2.5 times the original dose of the inhaled fluticasone (a corticosteroid); the original dose of fluticasone (100 micrograms) plus inhaled salmeterol (a long-acting beta agonist); and fluticasone plus oral montelukast (a leukotriene modifier)—the fluticasone plus salmeterol combination had the best response at about 45%. The other two therapies had a response just under 30%.

The study did garner a few insights. The study authors conclude that the findings highlight "the need to regularly monitor and appropriately adjust each child's asthma therapy within this level of care before further step-up."

An accompanying editorial agrees that the findings are somewhat helpful. But the editorialists point out that doubts linger about the safety of using long-acting beta agonists (such as salmeterol) for asthma treatment. The best course of action remains discussing the options with your child's doctor.

March 15, 2010

Many people with penicillin allergy can safely tolerate antibiotics related to penicillin called cephalosporins, according to a study presented at the 2010 annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI).

For the study, Mayo Clinic researchers reviewed data on 15,298 patients with a history of penicillin allergy who were evaluated by an allergist. 193 reported a history of anaphylactic reaction (a life-threatening allergic reaction) to penicillin. Twelve of those individuals had positive skin test results to penicillin, but 156 had negative results. Eighty of the 156 later went on to receive cephalosporin for surgery. Almost all of those 80 patients safely tolerated the medication. Only one had a "possible mild adverse drug reaction."

The bottom line: "Even patients with a history of a serious reaction to penicillin can receive cephalosporins safely if the allergy tests are negative," says lead author James T. Li, M.D., FAAAAI in a press release. "The main message here is that patients with a history of penicillin allergy who need surgery can benefit from consultation with an allergist. They can get the best antibiotic with the lowest risk of drug reaction."

FDA Issues New Recommendations for An Asthma Med

March 2, 2010

Due to safety concerns, the Food and Drug Administration (FDA) is requiring changes to how long-acting beta agonists (LABAs) are used to treat asthma. Previously published studies show an increased risk with these medications of severe worsening of asthma symptoms leading to hospitalizations and some deaths.

LABAs relax bronchial muscles, helping to keep airways open for up to 12 hours. They are available as single ingredient medications—such as salmeterol (Serevent®) and formoterol (Foradil®)—and in combination with corticosteroids in medications such as Advair® and Symbicort®.

According to the FDA's new recommendations,

  • LABAs should not be used alone. Single-ingredient LABAs should only be used in combination with an asthma controller medication.
  • LABAs should only be used long-term in people whose asthma cannot be adequately controlled on asthma controller medications.
  • LABAs should be used for the shortest duration of time to achieve control of asthma symptoms, and then discontinued—if possible. Patients should then be maintained on an asthma controller medication.
  • To ensure safe use, children and teens who require the addition of a LABA to an inhaled corticosteroid should use a combination product containing both medications.

By limiting use, the FDA hopes to limit risk. The agency is asking manufacturers to update LABA medication guides and to implement a plan to educate healthcare professionals about the appropriate use of LABAs. They are also requesting additional studies.

An expert panel from the American Academy of Allergy, Asthma & Immunology agrees that LABAs should not be used exclusively to treat asthma. But the panel raises concerns about a few of the FDA's recommendations, asking for more scientific evidence. What's clear: you shouldn't simply stop taking your LABA-containing medication. Consult your doctor first. Your doctor can best explain the pros and cons of using LABA medication in your individual asthma treatment.

Will Peanut Allergy Soon Be Treatable?

March 2, 2010

Oral immunotherapy holds promise as a treatment for peanut allergy, according to two new studies presented at the 2010 Annual Meeting of the American Academy of Allergy, Asthma & Immunology. In the first study, children allergic to peanuts consumed tiny incremental amounts of peanut flour to a threshold amount over a number of months. Peanut tolerance was then assessed during an oral food challenge. The results: Kids in the oral immunotherapy group were able to tolerate 5,000 mg—roughly the equivalent of 15 peanuts—compared to only 315 mg or one peanut for the placebo group, according to a press release.

In the second small study, children who completed oral immunotherapy participated in a final oral food challenge one month following treatment. The goal: to see if peanut tolerance continued past treatment. Nine of the 12 children passed the food challenge and were able to have peanut in their diets.

These findings are encouraging, researchers say. But they caution that there is still a lot more to learn about using immunotherapy for peanut allergy. In the meantime, the research findings will help guide future studies.

Experts strongly warn that no one should attempt to perform peanut tolerance tests at home. Peanut allergies can cause serious reactions, including life-threatening anaphylactic shock.

Massachusetts Restaurants To Be Safer for People With Food Allergies

February 16, 2010

Massachusetts is poised to become the first state to require restaurants to educate staff about food allergies. It's a move applauded by some advocates—and no doubt everyone with food allergies—who hope that other states will follow suit.

Under the Massachusetts regulations, restaurant managers would be required to obtain a food allergy certification by viewing a training video on safe food preparation and avoiding cross-contamination. In the kitchen where meals are prepared, a poster that lists common food allergies—such as shellfish, peanuts, soy, wheat, egg, milk—would be prominently displayed. Finally, menus would carry a statement reminding allergic patrons to notify staff of their food allergies.

Critics of the measure say that the responsibility of avoiding dangerous food allergy reactions lies with customers. But people with food allergies know all too well that, when communicating an allergy, a lot can get lost in translation. A case in point: according to a 2007 study, 54% of restaurant staffers considered a buffet "safe" if kept clean, and 25% thought that removing an allergen from a finished meal—by, say, taking off the nuts—was adequate. The study concluded, "The [100] restaurant personnel surveyed expressed a relatively high comfort level in providing safe meals to allergic consumers, but there are deficits in their knowledge base, indicating the need for more training and consumer caution."

Low Vitamin D May Worsen Asthma

February 16, 2010

People with asthma who have low blood levels of vitamin D have worse lung function than those with higher levels, according to a new study. They also experience increased airway constriction and poorer response to steroid treatment.

In the study, published in American Journal of Respiratory and Critical Care Medicine, researchers assessed vitamin D levels and tested lung function in 54 nonsmoking adults with asthma. The lower the vitamin D level, the worse breathing test results were. For example, airway hyperresponsiveness—a marker of airway constriction—nearly doubled in those with vitamin D levels below a threshold of 30 ng/mL.

What may be at work: Low vitamin D was associated with increased production of a protein (TNF-alpha) involved in inflammation.

Having a higher body mass index also correlated with lower vitamin D levels. "Asthma is known to be associated with obesity," says E. Rand Sutherland, M.D., MPH, chief of the pulmonary division at National Jewish Health in Denver and the lead study author. "The lower levels of vitamin D in obese subjects may illuminate one factor that ties obesity and asthma together."

Will taking vitamin D supplements improve asthma treatment? That's still unclear, say the researchers. They hope future trials will clarify the issue.

What is becoming clear is that vitamin D is important for good health; in addition to possibly maintaining lung function, the vitamin helps keep bones strong and the immune system healthy.

Among the best food sources of vitamin D are fish (such as salmon, tuna, and mackerel) and fish liver oils. Vitamin D is also produced through exposure to sunlight. According to current NIH recommendations, adults under age 50 may take 200 IU of vitamin D daily and adults over 50, 400 IU—but those amounts will likely change.

5 Ways to Enjoy an Allergy-Free Valentine's Day

February 2, 2010

Spread the love this Valentine's Day. But if you or a loved one has allergies, also keep a lookout for potential allergy triggers that lurk in popular goodies and gifts. Follow these savvy pointers, culled from information from the American Academy of Allergy, Asthma & Immunology (AAAAI).

  1. Trustworthy Treats: Read the ingredient label on gifts of chocolate, cookies, candies or desserts that you or your child receives. Many treats—including those you wouldn't suspect—contain peanuts, tree nuts, milk, egg, wheat and/or soy. "You may not recognize the names of some ingredients made from these foods; for example, ovalbumin from egg," says Rebecca G. Piltch, M.D., an allergist/immunologist in San Rafael, CA. "For a primer on troublesome ingredients, visit the Food Allergy and Anaphylaxis Network's web site."

    Remember, smaller sizes of popular candies may contain different ingredients than the regular size. Goodies also may be processed in facilities, where exposure to allergens like peanuts is possible, so be especially vigilant: check the label for notes such as, "Made on equipment that processes peanuts." "Although any given batch of the food may or may not include the allergens listed, think of these allergens as additional ingredients to avoid," says Dr. Piltch. Holiday food boxes and baskets may not carry labels; so when in doubt about the ingredients, don't eat from them.

  2. School Rules: If there will be a Valentine's Day party in the classroom, explain to the teacher that your child can't eat certain treats. "Make sure the teacher understands that a food allergy is involved, which foods need to be avoided and what may happen if those foods are eaten," says Dr. Piltch. "Don't be shy: If a life-threatening reaction is possible, tell the teacher outright."

    "You probably discussed these precautions with your child's teacher at the beginning of the school year. Now is a good time to remind the teacher of your instructions and the emergency action plan."

    To help your child celebrate the holiday safely, send along an allergy-free dessert, such as this Chocolate Snicker Doodle Cookies recipe from the AAAAI.

  3. Flower Power: If you're allergic to pollen, Valentine's Day flowers may bring on sneezing and watery eyes, not smiles. What provokes an allergic reaction differs from person to person.

    Quick tips: "Plants with large, colorful flowers are less likely to have pollens that cause allergic reactions,” says Dr. Piltch.

    These flowers and plants are also less likely to cause a reaction: azalea, begonia, bougainvillea, cacti daffodil, daisy, dahlia, gladiola, iris, lily, marigold, narcissus, orchid, pansy, petunia, snapdragon, sunflower, tulip, violet, and zinnia.

    Drop a gentle hint to your special someone about the gift you prefer to receive.

  4. Common Scents Advice: Perfumes, colognes and scented products (e.g., candles, bath and beauty items, lingerie, teddy bears, etc.) may trigger reactions or asthma attacks in people who are sensitive. If that's you, be sure to tell your honey to cross those items off the gift list.

    When you go shopping, beware that perfumed products may appear in unusual locations for Valentine's Day—such as near the cash register—not just in the perfume section. To stay on the safe side, bring along your rescue medication.

  5. Better Bling: Jewelry is a girl's best friend, except if you have nickel allergies. Even some gold jewelry contains traces of nickel, so it pays to be cautious. Before you try anything on, be sure that it won’t irritate your skin.

Armed with these tips and the right management strategies, you can enjoy Valentine's Day allergy-free.

Before You Wine and Dine…

  • Think twice before you toast. Some wines and champagnes contain sulfites, which can trigger a reaction in someone who's allergic to them.
  • Chat with the restaurant chef. If you'll be eating out, call ahead to the restaurant to discuss your dietary restrictions. The best time to reach the chef is around 2:00 in the afternoon, between the lunch and dinner rush. Discuss how the food will be prepared to avoid cross-contamination.
  • Scrutinize the menu. Are dinner reservations a surprise? Some restaurant menus list potential allergens in the ingredient list or note when something is, say, wheat-free. If you have further questions about the ingredients in a dish or how it's being prepared, ask the chef.

Is Your Child Truly Allergic to Peanuts?

February 2, 2010

Peanut allergy is one of the most commonly diagnosed food allergies, and it's believed to be on the rise. But a majority of children with peanut sensitivities may not actually have peanut allergy, according to a British study. When it comes to peanut allergy diagnosis, standard tests—including the skin prick test and radioallergosorbent blood test or RAST—appear to have limitations.

Currently, the best way to identify peanut allergy—a true allergic reaction to peanuts—is a food challenge. During a challenge, a child is exposed to increasing amounts of peanuts while being monitored by health care professionals.

Unfortunately, food challenges can be time-consuming and expensive. And many parents avoid them because they worry that exposing children to even tiny amounts of peanuts will trigger an allergic reaction or anaphylaxis. Finding a more accurate and tolerable way to diagnose peanut allergy is an important goal.

For the study, published in the Journal of Allergy and Clinical Immunology, researchers looked at over 900 children and found that 110 had peanut sensitivity. Twelve clearly had peanut allergy. The remaining 79 children were presented with food challenges to sort out who had allergic reactions and who didn't. Remarkably, just 7 of the 79 children were found to have real peanut allergies.

Next, blood tests results from the children with true peanut allergies were compared to those with peanut sensitivity using a novel testing method called component-resolved diagnostics (CRD). The result: The CRD test revealed that a reaction to a peanut protein called Ara h 2 correctly identified peanut allergy. While intriguing, more research needs to be done before such testing would be available through doctors' offices.

Allergy Shots Save Money

January 19, 2010

If your child has allergic rhinitis, also known as hay fever, immunotherapy (allergy shots) might help lower your medical and prescription costs in the long run. This news comes from recent research published in the January issue of the Annals of Allergy & Asthma Immunology.

The 10-year study looked back at Florida Medicaid claims to examine whether immunotherapy—which is a series of allergy shots that contain a small amount of the substance to which you are allergic (called an allergen), thereby allowing your body to become used to the substance—saved money. Researchers compared data from more than 2,700 children with allergic rhinitis who had immunotherapy to about 11,000 children who also had allergic rhinitis but did not receive allergy shots.

The researchers found that after 18 months, the total healthcare costs for children receiving allergy shots were less compared with the kids who didn't receive the shots. Pharmacy costs were also less.

Immunotherapy is a good option for children and adults with allergic rhinitis, so talk to your doctor about allergy shots to see whether they are right for you or your kids.

Don't Let Exercise-Induced Asthma Keep You Down

January 19, 2010

If you love skiing down a mountain, the cold air hitting your face as you rush down the slope, then exercise-induced asthma can certainly put a damper on your favorite winter sports. For many people this is the case, according to the American Academy of Allergy Asthma & Immunology (AAAAI).

According to the AAAAI, symptoms of exercise-induced asthma, also called exercise-induced bronchoconstriction, usually occur about 5 to 20 minutes into exercise and include wheezing, coughing, and shortness of breath.

Why does it occur? The cold, dry winter air irritates the bronchial tubes in your lungs, which leads you to develop symptoms of asthma. If you find yourself having trouble breathing, especially when running outside in the cold air, sledding, skiing, or doing other winter activities, make an appointment to see your doctor.

For more information on exercise-induced asthma visit the AAAAI website.

Transmission of H1N1 at Home

January 5, 2010

If someone in your home has the H1N1 flu, will you get it? That's exactly what a group of British and American researchers sought to find out.

The study, published in the December 31st issue of The New England Journal of Medicine, looked at data from the United States Centers for Disease Control and Prevention (CDC) of 216 patients infected with the H1N1 virus and their 600 household members (family members, etc.). Among household members, such as a sibling or spouse, the researchers analyzed age, date of onset symptoms (which would demonstrate that they may have contacted the flu too), and symptoms themselves, such as runny nose, fever, cough, or diarrhea, that occurred within seven days of the original patient contracting the flu.

The results: Among the 600 household members, 13% developed an acute respiratory illness, which according to the researchers may have been the flu, and 10% developed an influenza-like illness. Plus children four years of age and younger and kids ages five to 18 were at a much higher risk of getting an acute respiratory illness. The good news? In 72% of households no one developed an acute respiratory illness. This means the H1N1 virus may have a lower rate of transmission than other pandemics, report the authors.

If you have asthma you may be particularly concerned about the flu—since the respiratory illness could cause complications. If you develop symptoms of the flu, such as a cough or fever, and have asthma make an appointment to see your doctor immediately.

Air Pollution May Affect Asthma Meds' Success

January 5, 2010

Past research has shown that people with asthma may use their rescue inhalers more frequently when they are in an air-polluted environment. And now a new study from the University of Pittsburgh found that outdoor air pollution may actually affect how well certain asthma inhalers work.

The study, published in the journal Chest, included 85 children with asthma ages seven to 12. All of the children were from Mexico City. Researchers measured nitrogen oxide, ozone, and fine particle matter in the air to determine air pollution. Then they tested the participants' lung function before and after they used their inhalers, particularly short-acting β (beta) agonists (SABA).

The researchers found that when participants were exposed to air pollution, SABA inhalers did not work as well in improving lung function.

If your child has asthma and you live in an air polluted environment, make sure to talk to your doctor about different therapies that can help control the chronic lung condition.

Celebrating the Holidays with Asthma & Allergies

December 22, 2009

Picking the perfect Christmas tree, eating cookies and sweets, going for walks in the cold winter air—all of these activities are fun, especially during the holiday season. But if you or a loved one has seasonal allergies, asthma, or are allergic to certain foods, the holidays can be stressful—and not just because of last minute shopping. Luckily, the Asthma and Allergy Foundation of America (AAFA) has compiled some helpful tips for making this holiday season your healthiest and happiest.

Food Allergies

  • Heading to a holiday party? Let your friends or family know if you or your child has a food allergy. For instance, if your son is allergic to peanuts, ask that they offer some non-peanut treats or meals. Or, consider bringing some "safe" foods from home so he can enjoy the festivities too.
  • Eating out. If you are going out for a special holiday dinner, call the hostess or manager beforehand to see what menu items contain the food. Make sure to ask about oils and additives too.
  • Always carry your epinephrine injection kit in case an allergic reaction occurs.


  • If you have a mold allergy, try to avoid doing chores where you are exposed to mold, such as cleaning the gutters. If it's your turn to do the yardwork make sure to wear gloves, a facemask, and other protective gear. Also, keep your allergy medicine on hand.
  • Monitor humidity levels in your house—since humidity can cause mold to grow. Consider using a dehumidifier.
  • If you have a real evergreen, "Wipe the trunk thoroughly with a solution of lukewarm water and diluted bleach (1 part bleach to 20 parts water) to eliminate any mold," says the AAFA. Make sure to vacuum around the tree to remove any pollen.


  • Wood-burning stoves can certainly be cozy, but the smoke can irritate your lungs. Speak to your doctor about how to limit irritants.
  • Avoid using scented candles, potpourri, and air fresheners. All of which may irritate the chronic lung disease.
  • Cold air can exacerbate your asthma. To protect yourself, cover your mouth and nose with a scarf or muffler to warm up the cold air before it enters your lungs.
  • If you plan to exercise outside, ask your doctor for medications to help prevent exacerbations.

A Gene's Effect on Asthma, COPD

December 22, 2009

A gene variant may protect lung function in children with asthma and adult smokers—and lower some smoker's risk of developing chronic obstructive pulmonary disease (COPD). This news comes from a recent study published online in The New England Journal of Medicine.

To arrive at their findings, researchers from across the globe analyzed seven groups of people, which included more than 8,300 adults and children. They tested for an association between lung function and the MM12 gene.

The study authors found that a variant of MM12 was associated with better lung function in kids with asthma. The same went for smokers, both past and current. Plus, people who had a variant of the gene and smoked were less likely to develop chronic obstructive pulmonary disease.

What does a variant gene have to do with asthma or COPD? According to an editorial accompanying the study, MM12 may play a role in lung inflammation and elasticity of the lungs.

Although this study certainly won't affect your life right now, it is important because it adds to our knowledge about the link between asthma and other chronic lung diseases.

Educate at Home to Improve Your Child's Asthma

December 4, 2009

Managing asthma well, such as using your inhaler regularly—is the key to living a healthy life with the chronic lung disease. Unfortunately, many kids, especially low-income minority children, continue to have poor asthma control. But recent research from Johns Hopkins Children's Center found that working with an asthma educator at home could improve this control.

The study, published in the December issue of the journal Pediatrics, included 250 inner-city children with an average age of seven, who had been hospitalized for an asthma attack in the past year, and their families.

The families were randomly divided into three groups. One group received usual care, which was an asthma education booklet and information on asthma providers for low-income families. The second and third groups met with an asthma educator at their home for 30 to 45 minutes five times over an eight-week period.

In both groups, the asthma educators worked on the following five points:

  1. Reviewed asthma medication and treatments. Demonstrated how to use the inhaler properly.
  2. Developed an asthma action plan. For example, identifying asthma triggers, recognizing symptoms and signs of an asthma attack, and learning what to do if the child has an asthma exacerbation.
  3. Identified problems the family had in accessing healthcare and developed ways to reduce these issues.
  4. Discussed concerns about the lung disease and asthma medications.
  5. Provided written asthma educational materials.

However, among families in the third group, the asthma educator also used various strategies, such as goal setting and electronic monitoring of medication, to give feedback on adherence.

After follow-up at six, 12, and 18 months, the researchers found children in the asthma educator groups were less likely to visit the emergency department because of an asthma attack. They were also more likely to have a shorter course of steroids, a common treatment for asthma. However, most of these benefits were for the short-term.

Traffic Pollution and Indoor Allergens Could Add Up to Big Trouble

December 4, 2009

Research has shown exposure to air pollution can exacerbate existing asthma and certain indoor allergens may cause airway inflammation. But can these substances cause asthma? Well, according to a recent American Journal of Respiratory and Critical Care Medicine study, when infants already at high-risk of developing asthma because of a family history are exposed to air pollution and allergens, it increases their chance of developing persistent wheezing, a symptom of asthma.

In the study, researchers from the University of Cincinnati College of Medicine measured exposure to traffic pollution and certain indoor allergens (called endotoxin, a type of bacteria found in dust) among 624 young children.

They found that 36% of children exposed to both high levels of traffic air pollution and high levels of endotoxin had persistent wheezing by the time they turned three-years-old. However, 18% of children who were exposed to high levels of traffic pollution but low levels of endotoxin still developed wheezing.

This study demonstrates that there seems to be a link between traffic pollution exposure and wheezing, and this link may be exacerbated by exposure to endotoxin. Speak to your doctor about how to limit your child's exposure to air pollution.

More Kids With Food Allergies

November 23, 2009

If your child has food allergies, you certainly are not alone. According to a study published in the November issue of Pediatrics, food allergy rates among children in the United States are on the rise.

The study used data from the large-scale National Health Interview Survey that asked questions regarding various medical conditions, including food allergies.

The researchers found that, according to survey results, from 1997 to 2007 the number of children ages 17 and younger with food allergies increased by 18 percent. This means, by 2007, 3.9 percent of children in the United States had food or digestive allergies. Plus, from 2003 to 2006, there were approximately 317,000 visits to ambulatory care facilities that resulted in food allergy diagnoses. This increase in food allergies was similar among both boys and girls.

The higher prevalence of food allergies might actually be because there is more awareness among parents, physicians, and other health care providers, say the researchers. But regardless of why more children have food allergies, if yours does—or if you suspect they might—make an appointment to see your doctor right away.

Birth Control Pills Ease Asthma Symptoms

November 23, 2009

Past research had found a link between a woman's hormone levels during her menstrual cycle and varying asthma symptoms. A new small study, however, found that women who take oral contraceptives are less likely to experience changes to their asthma symptoms during their period than women not on the pill.

In the study, published in the November issue of Chest, 17 women with asthma—eight on a birth control pill containing estrogen and progesterone—were followed during their menstrual cycle. Researchers took daily measurements of their asthma symptoms, lung function, and hormone levels starting from the first day of their period.

Among women not on birth control, the researchers found that when estrogen levels were high (before menstruation) levels of exhaled nitric oxide, which indicates there is a decrease in airway inflammation, were low. On the flipside, when progesterone levels were high (during menstruation), nitric oxide levels increased—meaning the airways were more inflamed, which exacerbates asthma symptoms. This link did not exist among women taking birth control pills.

Now, this study is certainly interesting, but it is very small and the women in the birth control pill group were 25-years-old on average and the women not taking the pill were 37.5 on average. This means, the two groups were not completely similar. More importantly, these results do not mean you should go get a prescription for birth control pills to reduce your asthma symptoms. The best way to control your asthma is through good management with medication and lifestyle.

November 10, 2009

You probably have acetaminophen (Tylenol®) stocked in your medicine cabinet for fever and pain relief. But a recent review of 19 studies, published in the journal Chest, found that this commonly used drug might be linked to asthma and wheezing in children and adults.

In the study, Canadian researchers pooled together data from clinical and observational trials that involved more than 420,000 people and focused on acetaminophen use and asthma diagnosis. After analyzing the data, the researchers found that participants who used acetaminophen were 63 percent more likely to be diagnosed with asthma or develop asthma symptoms, such as wheezing than those who did not use the pain reliever.

What does a pain reliever have to do with asthma? Acetaminophen, according to the researchers, has been shown to lower levels of a certain antioxidant found in the lung tissue, called glutathione. This antioxidant is important because it helps protect the lungs from damage and inflammation. Since chronic inflammation is a component of asthma, this could explain why frequent use of acetaminophen may increase a person's risk of the lung disorder.

However, no randomized clinical trial has proved that using acetaminophen causes asthma, so you certainly should not toss out your Tylenol or be afraid to use the medicine. It may simply be that children and adults who often develop respiratory infections use acetaminophen more often. Just remember that if you or your child has symptoms of asthma, such as trouble breathing, coughing, or wheezing, make sure to see your doctor.

Stress and Asthma?

November 10, 2009

Stressful events, such as divorce, or having a personality that tends to fall on the neurotic side might increase your risk of developing asthma, reports German researchers.

The study published in the journal Allergy, used questionnaires to gather information on personality, stressful life events, and asthma diagnosis among more than 4,000 middle-aged adults. The participants answered these questionnaires (with questions such as: Do you have asthma? Are you currently unemployed?) between 1992 and 1995 and then, those who were still available, answered again in 2002 and 2003.

Among the participants, 334 or 6.8 percent reported asthma at baseline—and 68 more people (1.8 percent) developed the lung disorder after a median of 8.5 years according to the second questionnaire. Adults who were highly neurotic were three times as likely to have developed asthma as those with low neuroticism. Stressful life events, like breaking off a relationship, were also linked to higher rates of developing asthma.

Past studies have shown a link between personality, stress, and inflammation—and since chronic inflammation is the trademark of asthma, this could explain the link.

5 Ways to Have an Allergy-Free Halloween!

October 29, 2009

The pumpkins are carved, costumes planned, and house decorated. But if your child has food allergies, Halloween can be more worrisome than fun. Luckily, there are steps you can take to make sure your son or daughter has a healthy and safe holiday.

Below is a summary of allergy tips from the Food Allergy & Anaphylaxis Network and the American Academy of Allergy, Asthma & Immunology, for having a food allergy-free Halloween.

  1. Let your neighbors know beforehand about your child's food allergy. Consider providing your neighbors a special treat or candy bag that is safe for them to give to your child to eat.
  2. Before Halloween, carefully read the ingredients label of popular candies. Make sure to check both the bite-size and full-size candy labels because a regular-size chocolate bar might have different ingredients than the mini-version. Once you determine which candy is safe, write a list of "off-limit" candies and go over it carefully with your child. Explain why certain candies would cause them to have an allergic reaction.
  3. Ask your child what they would like to do with the candies they can't eat, rather than just taking the candy and throwing it away.
  4. Have a Halloween party at your house and ask guests to only bring candy or snacks that are food allergy safe. Consider making the party about Halloween movies, games, or pumpkin carving—taking the focus off candy and food.
  5. Make sure your child does not eat any candy before getting home so you can check it off the list of "safe" candies.

Low-Weight Babies at Greater Risk for Asthma?

October 29, 2009

Past research demonstrated a link between low birth weight and gestational age with asthma, but experts were unsure whether this association was related to family history or the infant's birth characteristics—until now. A recent Swedish study, published in the October issue of Pediatrics, found that an infant's birth weight and gestational age might influence his or her risk of developing asthma later in life.

Using the Swedish Twin Register and Medical Birth Register, researchers gathered data about birth weight, gestational age (how long a baby was in the womb), maternal characteristics (such as if the woman smokes, age, weight), asthma history, and other variables on 10,918 nine- and 12-year-old twins.

After analyzing the data, researchers found 13.7 percent of the twins had asthma. They also found, children with a birth weight of 4.4 lbs or less were the most likely to develop the chronic lung condition. As for gestational age, infants who were born at 31 weeks or earlier were twice as likely to develop asthma compared with infants born between weeks 39 to 40. (The average length of pregnancy is 38 weeks; less than 37 weeks in the womb is considered premature birth.)

This link between birth weight, gestational age, and asthma supports the idea that impaired fetal growth affects lung development—increasing the risk of chronic lung disease later in life, say the study authors.

If your baby was premature or had a low birth weight, be sure to keep an eye out for signs he or she may be developing asthma, such as wheezing, coughing, and trouble breathing.

Genes and Your Inhaler?

October 13, 2009

If your child has asthma, chances are, you are quite familiar with salmeterol and albuterol, two popular beta-agonist medications used for long- and short-term control of symptoms and exacerbations. But recently, British researchers discovered that these medications might not work effectively if your child carries two copies of a certain gene.

This asthma research, which was published in the October issue of the Journal of Allergy and Clinical Immunology, included more than 1,000 Scottish children and young adults with asthma ranging in age from three to 22.

At the start of the asthma study, researchers took a DNA sample to test for copies of the Arg16 allele—which, in previous research, has been linked to an increased risk of asthma exacerbations in kids. They also looked at lung function, frequency of asthma attacks, and asthma medication use over the previous six months.

Researchers found a 30% increase in asthma exacerbations among young people who had more than one copy of Arg16. This risk was strongest in kids who were using the short-acting reliever inhaler albuterol (i.e., Ventolin HFA) or the long-acting medication salmeterol (Serevent Diskus) more than once a day.

These results don't mean your child should stop taking his or her albuterol or salmeterol inhaler. Instead, if your child needs to use his or her inhaler frequently throughout the day to prevent asthma symptoms such as coughing, wheezing, and difficulty breathing, make an appointment with the doctor to discuss other asthma treatment options.

2009 Worst Cities for Fall Allergies

October 13, 2009

In many areas of the United States, October not only brings beautiful changing leaves and cooler weather, but also brings fall allergies. Each fall the Asthma and Allergy Foundation of America puts together a list of the top 100 most challenging places to live for people with seasonal allergies and allergy symptoms.

To determine the most difficult places to live for people with fall allergies, the Asthma and Allergy Foundation looks at the following factors: the city's pollen and mold levels; how long peak allergy season usually lasts; the number of allergy medications used by patients, such as antihistamines, nasal sprays, and oral drugs; and the number of allergy specialists in the area.

Here is a list of the top 10 worst cities in the United States for fall allergy sufferers:

  1. McAllen, Texas
  2. Wichita, Kansas
  3. Louisville, Kentucky
  4. Oklahoma City, Oklahoma
  5. Jackson, Mississippi
  6. Dayton, Ohio
  7. Augusta, Georgia
  8. Tulsa, Oklahoma
  9. Knoxville, Tennessee
  10. Little Rock, Arkansas

This list certainly won't give allergy sufferers much consolation, especially if they have been spending several days and nights coughing and sneezing. But what it does provide is incentive—especially if your city made the cut—to be especially diligent about controlling your allergies and allergy symptoms as best you can. For instance, keep your windows shut and limit your time outside during the early morning and evening when pollen counts are highest, take a shower after being outside for a long period of time, and wash your sheets and pillow case once a week.

How to Breathe Easier, Indoors and Out

January 1, 2010

It's an epidemic: More than half of Americans test positive to one or more allergy-provoking substances, according to one National Institutes of Health survey. And allergy and asthma combined affect one out of four Americans. That adds up to a lot of sneezing, wheezing, and itching—not to mention doctor visits and lost school and work days. In fact, a new study from Ohio State University shows that people with allergy symptoms lose an average of one hour of work a week.

The prevalence of asthma increased 74% from 1980 to 1996, and the rate of positive allergy skin test responses to six common allergens grew two to five times over the last few decades. Lately, the rise has slowed, possibly because of improved diagnosis and early treatment.

Still, experts are concerned that asthma and allergies have become so commonplace. They conjecture that one culprit may be our squeaky clean lifestyles. "Children who grow up in over-sanitized environments don't get exposed to micro-organisms that stimulate the immune system, creating a greater risk for allergies and asthma," says Clifford W. Bassett, M.D., an allergist at Long Island College Hospital in Brooklyn.

What's more, due to climate change, the increase in greenhouse gases has led to a three or four-fold increase in the production of pollen, a chief allergy trigger. "Global warming is here to stay and will have a major impact on allergies throughout the world," Bassett adds.

The good news: Medicine has more answers than ever for managing allergies and asthma, letting Americans feel better and breathe easier.

A Dangerous Link: Allergy and Asthma
About 22 million Americans suffer from asthma, in which the lungs become swollen and inflamed, causing wheezing, chest tightness and breathlessness. At least 60% of them have allergic asthma, which means common allergens like dust mites, pollens and mold trigger the scary symptoms. "Allergy doesn’t necessarily lead to asthma and not all asthma is allergic, but there's a huge overlap," says Henry Milgrom, M.D., professor of pediatrics and director of the Ambulatory Pediatric Care Program at the National Jewish Medical and Research Center in Denver, CO.

Although allergens are usually thought of as the final link to allergic asthma, the real culprit is the IgE (or Immunoglobulin E) antibody to dust, pollen, and other allergens, which is produced in higher amounts in people with allergies. When they come into contact with troublesome allergens, chemicals called mediators are released into the body, setting off inflammation and swelling, and the resulting symptoms.

That's why experts recommend that doctors evaluate whether allergens are causing or worsening a patient's asthma. "We’ve long recognized that allergy played an important role in asthma," says Derek K. Johnson, M.D., director of Fairfax Allergy and Asthma Center in Fairfax, VA. "But we’re now paying more attention to it and developing directed therapies that interfere with the body’s ability to mount an allergic response."

Identifying Your Allergy Triggers
If you find yourself with the sniffles every spring or fall, seasonal grasses or pollens are probably to blame. "When symptoms happen seasonally, you can pre-treat yourself with allergy medicine in anticipation of the season that bothers you," says Bassett.

But identifying other allergens can take some detective work. To find out which specific substances trigger your allergies, an allergist or immunologist can test your skin, or sometimes blood, using minute amounts of common allergens—dust mites, cockroaches, animal dander, molds, foods, latex, and medications, as well as pollens and grasses. If you are allergic to a substance, sites where they were introduced into your skin will redden and swell.

Once you know what you're allergic to, you and your doctor can devise a plan for treatment. Strategies include avoiding known allergens when possible, taking medications designed to halt the allergic response or muffle its symptoms, and getting regular allergy shots for several months.

The Clean Bedroom
Breathing easier starts at home—and especially in your bedroom. Doctors recommend these measures for making your or your child's bedroom a safe haven from life-wrecking allergens.

  • Rest Right. "In the bedroom, dust mites live off our skin flakes, which ends up in our pajamas and bedding," says John Winder, M.D., chair of the Nationwide Asthma Screening Program of the American College of Allergy, Asthma and Immunology. Add the warmth and humidity of your own body, and you create a breeding ground for mites. Solution: wash bedding once a week in hot water (130°F) and vacuum weekly. Also place your mattresses, box springs and pillows in airtight plastic or allergen-proof fabric covers.
  • Have toys and stuffed animals that are washable. Wash them in hot water or put them in the freezer, which also kills dust mites, Winder says.
  • Avoid cats and dogs, if you can. Or at least avoid sleeping with your pets.
  • Kick carpets to the curb. Dead dust mites and their fecal matter wind up in carpet and can be stirred up into the air to irritate nasal passages. "Carpets are also a reservoir for pet dander," he adds. Hardwoods, tile and linoleum make better floor coverings.
  • After spending time outdoors, shower before entering your bedroom to wash allergens away from your hair and skin. You'll transfer less pollen to your bed sheets and pillows.
  • Avoid hanging sheets or clothes outside after washing. "Seasonal pollen accumulates on linens," says Bassett. "When you bring them inside, you end up transferring it to the skin, eyes and nasal passages, which can spark an allergy attack."
  • Let new furniture air out for a few days before bringing it inside to avoid unhealthy gases.

Beyond Medicine: Novel Ways to Control Allergies and Asthma
New therapies have revolutionized the treatment of allergy and asthma. Non-sedating antihistamines, steroid nasal sprays and inflammation-decreasing leukotriene modifiers (Singulair, Accolate) help manage allergy, while newer inhaled corticosteroids safely and effectively decrease inflammation in the lungs. The newest therapy, omalizumab (Xolair), belongs to a group of medicines called immunomodulators. These drugs tackle the IgE antibody that makes life miserable for people with allergic asthma, Johnson says.

Other approaches can also make a difference in controlling allergy and asthma, however. Here, insights from new research:

Do Apples Keep Asthma Away?
It just might. Research from the University of Aberdeen in the United Kingdom shows that the children born to women who ate the most apples during pregnancy were least likely to have experienced wheezing or to have gotten a diagnosis of asthma by the age of five. Researchers suggest that the protective effect may be due to powerful antioxidants known as flavonoids.

Sniffing Relief
Help for hay fever could come from a novel source—administering, but not inhaling, carbon dioxide (CO2) into the nose. CO2 has already been shown to be effective in treating migraines, and it may treat seasonal allergies the same way—by inhibiting activity of certain nerve fibers, associated with both these powerful headaches and hay fever symptoms like congestion and sneezing. In a new study from Creighton University, half of those receiving carbon dioxide reported a 50% decrease in symptoms within 30 minutes of treatment, compared to just 27% in the placebo group.

An Anti-Allergy Diet
Children who eat a Mediterranean diet—rich in fruits, vegetables and nuts—have a lower incidence of allergies and asthma. So say investigators reporting in the journal Thorax, who gathered data on the health histories and eating habits of almost 700 children living in rural areas of the Greek Island of Crete. Oranges, grapes, apples and tomatoes were particularly beneficial, while a high consumption of margarine doubled the chances of having asthma and allergy. (Olive oil may be a better bet.)

Sticking it to Allergies
Used to be, allergies were considered a fact of life. But with today's treatments, you don't have to put up with unpleasant symptoms. A case in point: allergy shots, which enable your immune system to become more resistant to allergens, reducing symptoms and the need for medications. Called immunotherapy, the treatment involves getting increasingly higher doses of your specific allergens once a week over time. "Up to 90 percent of individuals with allergies are successful in reducing symptoms with immunotherapy, and the results are long-lasting," Bassett says.

Guidelines: Taking Asthma Seriously
After decades of research and breakthroughs in treatment, asthma experts recently got together to revise the treatment recommendations that doctors follow to best care for their patients with asthma—some 22 million Americans. "The current guidelines confirm a lot of what we're doing,” says Johnson, "but they also address a huge gap between disease that doctors and asthma patients think is well controlled and what it really is." Patients, he explains, are willing to tolerate high levels of symptoms and risk, not realizing that medications now available can be used long-term with very little risk of systemic side effects.

When evaluating asthma, patients and doctors should consider the "rules of two." If you experience coughing, wheezing or other asthma symptoms or use "rescue" medications more than two days a week or two nights in a month or if you have to refill your rescue medications more than two times in one year, your asthma is probably not well controlled. In addition to using quick-relief medications that offer immediate relief from symptoms, ask your doctor about using long-term asthma control medications, such as inhaled corticosteroids, daily to reduce inflammation and gain control over your condition.

"We used to think that asthma came simply in episodes and in between them, patients were fine," adds Winder. "Now we know that asthma is a chronic inflammatory condition and sufferers need to be treated all the time, even if they’re feeling well."

Breathe Easy

January 1, 2010

Itchy eyes, runny nose, sneezing, wheezing. Whether these symptoms are triggered by dust mites, mold, pet dander, cockroaches or pollen, they add up to a lot of suffering: In this country, about 30% of adults and up to 45% of children have allergies. Some 9 million children and 11 million adults in the U.S. have asthma.

And the numbers are rising. Researchers attribute the increase to such things as energy-efficient construction—it traps allergens in airtight buildings—and, surprisingly, squeaky-clean lifestyles. "Exposure to bacteria may create immune responses [that stave off allergies]," explains Frank Virant, M.D., a physician at Seattle's Northwestern Asthma & Allergy Center and a spokesperson for the American Academy of Allergy, Asthma and Immunology.

Allergy Control
"Controlling your surroundings is the first step to limiting your exposure to allergens," says Mark Dykewicz, M.D., chief of the allergy and immunology division at Saint Louis University School of Medicine.

Outdoor Allergies

  • When pollen counts are high in your area, minimize outdoor activities in the early morning and late afternoon.
  • Keep windows closed at home and in the car, and put air conditioners on the recirculate setting.

Indoor Allergies

  • Wash sheets weekly in hot water (130° F); use impermeable dust covers on mattresses and pillows to keep dust mites under control; and consider removing wall-to-wall carpeting if you have it.
  • Store food in airtight containers. Leaving food out attracts bugs.
  • Wash moldy surfaces in a weak bleach solution, repair leaking pipes and install dehumidifiers.
  • Avoid cats and dogs if you can, or at least avoid sleeping with your pet.

"Most therapies work best preventively, before you come into contact with an allergen," says Dr. Virant. "That's much more effective than trying to chase symptoms."

Treatment Options
A number of medications control symptoms—antihistamines, which hinder the action of a chemical involved in allergic reactions; antihistamines with decongestants, which help relieve stuffiness; and leukotriene antagonists as well as nasal corticosteroids, both of which fight inflammation.

Another allergy fighter is immunotherapy, which usually involves injections of an allergen for several months; this helps you become more resistant to the substance. "Up to 90 percent of individuals with allergies are successful in reducing symptoms, and the results are long-lasting," says Clifford W. Bassett, M.D., an allergist at Long Island College Hospital in Brooklyn. The shots work best for dust mite and pollen allergies.

In sublingual immunotherapy, the allergy sufferer takes drops under the tongue. Used extensively in Europe, the shotfree approach has obvious appeal. Although it is not yet FDA-approved, Dr. Virant notes that more and more research points to its success.

Wanting to Inhale
About 20 million Americans are literally out of breath due to asthma-induced restricted airways and inflammation. As with allergy sufferers, the ranks of those with asthma are rising—for similar reasons.

Many scientists believe that early exposure to bacteria in the environment may actually safeguard us from asthma, along with allergies. The evidence: "In areas of the world where hygiene and public health have improved, the incidence of allergies and asthma tend to increase," says William E. Berger, M.D., author of Asthma for Dummies and past president of the American College of Allergy, Asthma and Immunology.

For roughly half of the country's asthma sufferers, attacks are brought on by allergies, so avoiding allergens helps. It also pays to steer clear of irritants such as smoke, cooking fumes, coal dust and strong odors.

Treatment Options
Medications are often necessary. Doctors usually prescribe two types:

  • Long-term asthma control medications. These include inhaled corticosteroids, leukotriene antagonists, cromolyn and nedocromil. The medications are used daily to reduce inflammation and maintain control of asthma. Although you may not recognize a difference immediately, they should be taken regularly to prevent problems later on. "Oral corticosteroids may also be used for a few days during particularly severe [asthma attacks]," explains Dr. Virant.
  • Quick-relief asthma medications. Medicines known as short-acting beta-agonists offer immediate relief. Even if you are on a long-term medicine, you’ll need rescue medication like this for flare-ups.

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