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FCAAIA Notes: A few years ago, there was some discussion in the literature (that has since faded away) as to whether early use of acetaminophen (Tylenol and other brands) was a risk factor for developing asthma. More than 3 years ago, I asked whether it might be those needing acetaminophen for any reason who were already predisposed to develop asthma.
This study further supports the safety of acetaminophen Continue reading
FCAAIA Notes: I have written about the upper-lower airway connection in this blog many times. Most young people with asthma have allergies and 20-60% of those with allergies will develop asthma. The two conditions can be thought of as the same disease affecting different ends of the respiratory system or “allergic airway disease”.
There is a large literature supporting the fact that treating the upper airway (nose) can lead to improved control of the lower airway (asthma). In fact, the most recent iteration of national guidelines for the care of asthma tell us that anyone with persistent asthma (defined in part as symptoms >2 days per week or night time symptoms > 2 nights per month) and allergies should consider allergy shots as a potential cure for his allergic airway disease. Continue reading
FCAAIA Notes: Nasal saline (salt water) irrigations (NSI) are a simple and often useful means of diminishing symptoms related to allergic rhinitis, colds, and possible sinus infections. It is completely natural and essentially free. So, why not try it? You might find yourself using fewer colds medications and perhaps fewer antibiotics. Continue reading
FCAAIA Notes: Vitamin D is a hot topic in medicine, not just in allergy and immunology. Like many hot topics that have come and gone over the years, it is not a panacea and we still have a lot to learn.
I wouldn’t worry about the basic immunology here, but the idea that sufficient vitamin D levels (30-50 ng/ml) might help prevent allergic disease is intriguing as so many studies have looked at vitamin D levels and the effect of supplementation after the disease is already established. Continue reading
FCAAIA Notes: This report obviously has more to do with the practice of medicine than medicine itself. The electronic medical record (or electronic health record, EMR, EHR) can be a powerful tool. Emailing prescriptions to a pharmacy or lab test orders directly to the lab while the patient is still in the office probably decreases errors.
But overall does that mean the EMR really improves patient care or just particular aspects of patient care? Continue reading
FCAAIA Notes: There are many types of “eczema” so the term is more a description, than a diagnosis. Atopic dermatitis (AD) is the type of eczema studied in this paper.
AD is among other things a condition involving water loss from the skin (transepidermal water loss) resulting in dry skin. It is also a condition that might be thought of as a “rashy itch” rather than an “itchy rash.” That is, the itch precedes the rash. Continue reading
FCAAIA Notes: I only posted this article because I thought the idea of the study was an interesting concept. I think the results fall into the “You never really know, do you?” Continue reading
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