FCAAIA Notes: The herbal medication market in the United States is a multi-billion dollar industry. Unfortunately, most of the products sold have not been studied or proven effective for the things they claim to treat. That is why most products carry disclaimer labels. You may have seen this report in the Science Times section of the New York Times a couple weeks ago. The researchers did not want to single out any one company or product, so did not release that information. But, their findings were pretty clear: You are probably not buying what you think you are. Continue reading
FCAAIA Notes: Is this a cool concept or what? The idea from the headline is not that if a mother and child both have allergies that the child will get better if the mother takes allergy shots. Rather, it suggests the possibility that a woman who goes on allergy shots BEFORE pregnancy decreases (not eliminates) the chance that her child will have allergies. This can only work through epigenetics (about which I have commented in other articles posted). By “turning off” the activation of some of her genes, the mother might decrease the likelihood that those genes will be “turned on” in her child.
Allergy shots may safely be administered during pregnancy, Continue reading
FCAAIA Notes: Chronic hives (urticaria) are those that are present for 6 weeks or longer. The majority of those cases are idiopathic (no identifiable cause). Some so-called “idiopathic” hives are actually caused by an auto-antibody to the receptor for the “allergic antibody”, IgE on the surface of cells called mast cells. The mainstay of treatment has been high doses of antihistamines to control itch, but even that is not enough for some patients.
Omalizumab (Xolair®) is a humanized monoclonal antibody to IgE. It is approved for patients with poorly controlled asthma. Some insurance companies resist approving it because of cost. Now, omalizumab has been proven effective in antihistamine-resistant chronic urticaria. The results of this study are so strong, Continue reading
FCAAIA Notes: Nobody ever said using an asthma inhaler was easy! This study looked at how often parents did every step correctly in administering inhaled medications with a chamber/mask. Missing any step decreases the amount of medication that gets in to the lungs. Using an inhaler/chamber without a mask is even more difficult and using an inhaler without a chamber correctly is even tougher. Continue reading
FCAAIA Notes: In our area, schools are pretty aware of how to keep children with food allergy safe. Nonetheless, if the have questions, these VOLUNTARY guidelines are an appropriate place to start. Our major professional organizations are preparing another set of guidelines for the diagnosis and management of food allergy. I don’t anticipate that there will be major changes from those published by the NIH a few years ago. Continue reading
FCAAIA Notes: This is not the first, but it is one of the more recent studies to associate the use of acetaminophen and antibiotics with increased risk of childhood asthma. There are data indicating how some of the pharmacologic actions of acetaminophen might affect that risk. Could antibiotics affect the human microbiome adversely, increasing the risk? On the other hand, maybe children already at risk of developing asthma are more likely to require acetaminophen or antibiotics for other reasons early in life. Chicken or egg or both?
Important points here are that children should only be given antibiotics for proven bacterial infections. Some might bear observation before prescribing…some ear infections resolve spontaneously. Also, not every fever requires immediate suppression with medication. In fact, fever might even help FIGHT infection. Continue reading
FCAAIA Notes: I have posted little about allergic conjunctivitis on our website because there is not a whole lot of new information to report. However, this is a very nice review about the differential diagnosis of conjunctivitis and treatment options for ocular allergy. Anyone who has allergic conjunctivitis will tell you how uncomfortable it is. In fact, many patients find that their ocular symptoms are far more bothersome than their nasal symptoms. Ocular allergies can be triggered by perennial or seasonal allergens. But, in Connecticut, spring is typically the worst season. Be sure to let us know if your eyes are bothering you! Continue reading
FCAAIA Notes: As common as food allergy is, it is over diagnosed. It is important for clinicians to understand how to take a focused history surrounding suspected food reactions, to interpret test results correctly (test results are not “black and white”!), and to know how to differentiate between various types of food reactions.This review is an outstanding and up-to-date summary of how we approach food reactions to make and accurate diagnosis. It also gives a glimpse of current research in to treatments that go beyond avoidance of the offending food. The senior author (dr. Nadeau) is a rising star in the world of food allergy treatment research. Continue reading
FCAAIA Notes: I posted this article for you because it portends something about which we will read more in the future. The role of the human microbiome (the microorganisms that normally live in and on us) is a topic of recent research. These organisms somehow affect us in innumerable ways. Pre- and probiotics affect the quality of the microbiome. But, not all supplements are created equally! Some pre- and probiotic supplementation may help control or prevent some illnesses. Others might not. One could also make the theoretical argument that pre- or probiotics might change the microbiome with adverse effects, making some conditions worse. Things get even more complicated when you factor in the possible role of epigenetics (the way some of your genes Continue reading
FCAAIA Notes: Rhinitis simply means “inflammation of the nose.” There are many types and causes of rhinitis including many kinds that are not from allergy. This review is a short and simple summary of the differential diagnosis of common forms of rhinitis including allergic and non-allergic. Approaches to treatment are touched upon.
(Source: http://www.medscape.com/viewarticle/810615_1 September 24, 2013. For Medscape articles: User name: FCAAIA, Password: Allergies. Adapted from Dion GR, et. al., South Med J. 2013;106(9):526-531.)
Rhinitis affects >20% of the population and is a common reason patients visit their primary care physician. Proper therapeutic intervention initially requires differentiating rhinitis from acute and chronic rhinosinusitis. After establishing rhinitis as the etiology of a patient’s symptoms, a careful, thoughtful history and physical examination aids the cause. Rhinitis can be allergic, nonallergic, or mixed (having features of both allergic and nonallergic rhinitis). Therapeutic interventions vary, Continue reading