FCAAIA Notes: We have known for many years that some patients with asthma (a “reversible” air way disease) develop air flow obstruction that is, at least in part, irreversible. Initially, the thought was that chronic low-grade air way inflammation was a risk and maybe even the cause. Those data did not hold up, however. While chronic inflammation is a risk for asthma exacerbations and chronic low-grade symptoms, it does not cause this “air way remodeling”.
The recognition of this problem has led to a lot of research on what is now called the “Asthma-COPD Overlap Syndrome” Continue reading
FCAAIA Notes: About 4 years ago, I posted an abstract indicating that giving infant’s fish oil did not decrease their incidence of allergic disease (“Fish Oil Does Not Prevent Early Allergies in Infants). In this study, the children of women who took either fish oil or placebo during the second half of pregnancy did not ultimately show any difference in their rates of allergic disease. Children whose mothers took fish oil were less likely to have a positive skin test to dust mites but did not have less allergic disease.
Here’s an important point however: The thymus gland which is essential for the development of white blood cells called T cells and the development of “tolerance” (not having allergy) forms early in gestation and is already formed by 20 weeks. To really answer the question the authors asked, I would like to see this study repeated with fish oil supplements being started as soon as the woman is known to be pregnant. Continue reading
FCAAIA Notes: I don’t really have to write any commentary here. The fact is that air pollution (outdoor and indoor) adversely affects every aspect of respiratory health and has no redeeming qualities.
So what’s my advice? Think globally and act locally. Continue reading
FCAAIA Notes: Well, this study gives us something to think about, doesn’t it? Of course, we don’t know if more stress led to more severe asthma or if poorly controlled asthma leads to more stress. Or, maybe it works both ways Continue reading
FCAAIA Notes: I think EVERY doctor (myself included) is guilty from time to time of prescribing antibiotics when they are not necessary. This study shows that about 1/3 of those prescriptions are unnecessary.
Frequently, it is best to let new-onset symptoms run their course. Continue reading
FCAAIA Notes: Has the prevalence of food allergy in children increased in the last 30 years or not? Prevalence studies that actually ask patients about their allergies indicate that it has. But, this study finds that the proportion of children who make food-specific IgE (the “allergy” antibody) has not changed.
The presence of IgE to a specific food (or other allergen) is called sensitization. Allergy occurs when there is Continue reading
FCAAIA Notes: I have posted many articles about sublingual immunotherapy (SLIT, under-the –tongue) on our web site. Only grass and ragweed tablets are currently licensed in the United States. All other forms of SLIT in the US are not FDA approved and are “off-label”.
In general, allergy shots are at least as or more effective than SLIT. In this study, dust mite SLIT was compared to placebo, but not to dust mite shots. Continue reading
FCAAIA Notes: Children drink less milk than they did a generation or so ago. Even children without milk allergy have a very high rate of vitamin D insufficiency and deficiency as was the case in this study. However, the cow’s milk allergic patients in this study had lower bone mineral density than non-allergic controls. Their calcium intake was significantly lower.
If your child has cow’s milk allergy, check with your pediatrician about supplements Continue reading
FCAAIA Notes: Epinephrine (adrenalin) is the treatment of choice for anaphylaxis. Delay in administration of epinephrine is the major risk factor for poor outcomes in anaphylaxis, including anaphylactic death.
Patients at risk for anaphylaxis should own an epinephrine auto-injector (e.g., EpiPen) and know how to use it. Continue reading
FCAAIA Notes: There have numerous studies over the last 25 years showing that specialists’ care of asthma results in better control and is less expensive over time (including hospitalizations and emergency visits) than that of non-specialists. This is one more study making the same conclusion.
Why do specialists have better outcomes? There must be many reasons, but some of the most likely possibilities include Continue reading