Deodorant and Antiperspirant Allergy

 Deodorants and antiperspirants are cosmetic products that are used by the majority of adults in the United States. Deodorants and antiperspirants are available individually or as combination products. These cosmetics are typically applied daily to the underarms in the attempt to mask odors and prevent perspiration.

Deodorants, which are classified as cosmetic agents by the Food and Drug Administration (FDA), have antimicrobial activities to reduce the growth of bacteria, as well as fragrances to mask any odors that are produced by the bacteria. Antiperspirants are classified as drugs by the FDA, and usually contain aluminum, which acts to reduce the production of sweat by the sweat glands.

Deodorants and antiperspirants are generally considered to be safe products. In the past, there was concern that parabens (used as a preservative) in these products were responsible for the increase in breast cancer rates in women. While this has been disproven in a number of studies, most manufacturers no longer use parabens in deodorants and antiperspirants. Aluminum, found in antiperspirants, has been blamed on the increase in Alzheimer’s disease. While somewhat controversial, a few studies do show a slight increase in the risk of developing Alzheimer’s disease from the use of aluminum containing cosmetic products, such as antiperspirants.

Allergic reactions to deodorants and antiperspirants are known to occur, which most often result in contact dermatitis of the underarm area. The rash that occurs is itchy, bumpy, and red and can blister, peel, flake and ooze. Contact dermatitis to deodorants and antiperspirants is usually limited to the site of application, namely the underarm area.

There are a number of chemicals responsible for contact dermatitis from deodorants and antiperspirants, the most common of which are fragrances. Fragrance allergy is very common, affecting up to 4% of all people. Since 90% deodorants and antiperspirants contain fragrances, people with fragrance allergy may have a difficult time finding a product that doesn’t cause a rash.

Other common causes of contact dermatitis to deodorants and antiperspirants include propylene glycol (a vehicle agent used as a "carrier" for active ingredients), parabens, vitamin E (as an antioxidant and moisturizer) and lanolin.

The diagnosis of contact dermatitis to deodorants and antiperspirants is made by patch testing. The only FDA approved patch testing system in the United States is the T.R.U.E test, which can fail to detect an allergy to uncommon fragrances and propylene glycol. Therefore, it is important that an allergist patch tests a patient's own deodorant or antiperspirant that is suspected of causing the problem.

There are other causes of underarm rashes not caused by contact dermatitis to deodorants and antiperspirants. These include (but are not limited to) fungal and yeast infections (such as tinea corporis and candidiasis), inverse psoriasis, acanthosis nigricans, and certain forms of cancer. If treatments are ineffective, then a person with a persistent underarm rash should be evaluated by a dermatologist, with the consideration for a skin biopsy.

The immediate treatment of deodorant and antiperspirant allergy is the use of topical corticosteroids on the underarm skin. Topical corticosteroids are the treatment of choice for mild to moderate contact dermatitis involving limited areas of the body. Severe forms may require oral or injected corticosteroids.

The long-term treatment of deodorant and antiperspirant allergy involves the avoidance of the chemical responsible for the reaction. If patch testing identifies the specific chemical, then that chemical can be avoided. If the cause of the contact dermatitis is not known, then a hypoallergenic formula of a deodorant or antiperspirant can be tried. Alternatively, naturally available zeolite crystals are available commercially as natural alternatives to deodorants and antiperspirants. These include the Crystal Body Deodorant, which is available at common drugstores nationwide. Almay Hypo-Allergenic Fragrance Free Roll On (Deodorant and Antiperspirant) Mitchum Roll-On Unscented (Deodorant and Antiperspirant) Stiefel B-Drier (Deodorant and Antiperspirant) Certain Dri (Antiperspirant) Crystal Roll-On Body Deodorant for Sensitive Skin (Deodorant) Crystal Stick Body Deodorant for Sensitive Skin (Deodorant) Secret Soft Solid Platinum Deodorant Unscented

Read more about cosmetic allergies.

Source:

Zirwas MJ, Moennich J. Antiperspirant and Deodorant Allergy. Journal of Clinical and Aesthetic Dermatology. 2008; 3: 38-43.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Are There Any Generic Asthma Inhalers?

 There are currently no generic asthma inhalers, either as rescue or controller medications. Since the transition to HFA-based propellant inhalers, generic albuterol is no longer available. Albuterol is now only available in multiple brand name versions, including Proventil, ProAir, Ventolin, and Xopenex (levalbuterol, which is the active form of albuterol).

Controller inhalers for asthma, which are used to prevent symptoms of asthma, are also only available in brand name versions. There are a number of inhaled steroids available for this purpose, including Flovent, Asmanex, QVAR, Alvesco, and Pulmicort. Inhalers that combine inhaled steroids and long-acting bronchodilators, such as Advair, Symbicort and Dulera, are also only available in brand name form.

Nebulizer solutions for asthma, as both rescue and controller therapies, are available in generic versions. Albuterol nebulizer solution is available only as a generic medication. Budesonide is the generic version of Pulmicort Respules, an inhaled steroid used as a controller therapy for the treatment of asthma. Budesonide is available as a generic nebulizer steroid solution, as well as in brand name form.

Learn about the differences between brands of inhaled steroids used to prevent the symptoms of asthma.

Source:

Practice Parameters for the Diagnosis and Treatment of Asthma. J Allergy Clin Immunol 1995;96:S707-870.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Beach Allergies

 Most people who live or vacation near the coast spend time at the beach during the summer months. The sunny weather, warm sand, and cool ocean or lake water makes the beach a popular attraction. While time spent at the beach is a joy for most people, others may experience allergic reactions while at the beach. Despite the ocean breezes blowing onshore keeping the pollen further inland, other causes of allergies may still be present at the beach. The growing concern over skin damage and skin cancer has led most people to use sunscreen before spending a day at the beach. This increased use of sunscreens has lead to the development of allergic reactions to the chemicals found in sunscreens. Most of these allergic reactions are contact dermatitis, a poison oak-like rash that occurs on the skin within hours of sunscreen application. This reaction can occur anywhere the substance is applied on the body, although it tends to be more common on the areas of the body with the most exposure to the sun.

Learn more about the causes and treatment of sunscreen allergies.

Many people complain of various skin symptoms with prolonged exposure to sunlight, such as itching, hives, or burning and stinging of the skin. Some people have visible rashes while others have no rash. Certain people with underlying medical conditions (such as lupus or porphyria) are more sensitive to sunlight; still others are using various medications (such as certain high blood pressure medications) that cause a reaction on the skin when exposed to sun.

Read more about the most common types of sun allergy, including solar urticaria, cholinergic urticaria, and polymorphic light eruption.

The act of swimming can also lead to allergic reactions, and the cause of this reaction depends on whether the swimming occurred in a freshwater lake or in the ocean. Swimmer's itch occurs when people swim in water contaminated with parasites. Generally, swimmer's itch occurs in freshwater, where aquatic birds and snails are likely to live. These animals serve as carriers for the parasite, although when this parasite enters human skin, it causes an irritating allergic rash as it dies.

Seabather's eruption is a different type of allergic rash that occurs after swimming in the ocean and being exposed to jellyfish larvae. These larvae get trapped between a person's skin and bathing suit, resulting in an itchy skin rash on areas covered by clothing. These symptoms usually start while the person is still swimming, but may also occur hours later. Rubbing the skin often makes the symptoms worse, since the larvae release toxin into the skin as a result of pressure or friction. Rarely, a person may also experience systemic symptoms from the toxin, such as fevers, nausea and vomiting, headache and diarrhea.

Learn more about allergic reactions that may occur from swimming.

Everyone loves a barbeque after a long day at the beach. Certain types of wood (such as mesquite, oak, cedar and hickory) are burned, the smoke from which adds flavor to the barbequed meat. Wood is obtained from trees that produce pollen to which many people with seasonal allergies are allergic. The allergen in the pollen also is present in the wood of the tree; these allergens survive combustion and remain in smoke once the wood is burned. Therefore, it is possible to be allergic to the smoke, and to any food barbequed with the smoke.

Read more about barbeque smoke allergy.

What would a day at the beach be without the annoying yellow jackets or honeybees swarming around the picnic blanket? Unfortunately, people get insect stings commonly at the beach, and allergic reactions to these stings can be extremely dangerous. Therefore, people with a history of allergic reactions to insect stings should take special precautions to prevent being stung, and be prepared to treat an allergic reaction should they get stung.

Read more about the prevention, diagnosis and treatment of insect sting allergies.

Sources:

Brant SV, Loker ES. Schistosomes in the Southwest United States and Their Potential for Causing Cercarial Dermatitis or "Swimmers Itch". J Helminthol. 2009;83:191-98.

Rossetto AL, Dellatorre G, Silveira FL. Seabather’s Eruption: A Clinical and Epidemiological Study of 38 Cases in Santa Catarina State, Brazil. Rev Inst Med Trop San Paulo. 2009;51:169-75.

Scheuer E, Warshaw E. Sunscreen Allergy: A Review of Epidemiology, Clinical Characteristics, and Responsible Allergens. Dermatitis. 2006;17(1):3-11.

Moffett JE, Golden DBK, Reisman RE, et al. Sting Insect Hypersensitivity: A Practice Parameter Update. J Allergy Clin Immunol. 2004;114:869-886.

More DR, Hagan LL, Whisman BA, Jordan-Wagner D. Identification of Specific IgE to Mesquite Wood Smoke in Individuals with Mesquite Pollen Allergy. J Allergy Clin Immunol. 2002;110(5):814-6.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Food Allergies

 Approximately 8% of children and 2% of adults suffer from true food allergies. When the culprit food is eaten, most allergic reactions will occur within minutes. Skin symptoms (itching, urticaria, angioedema) are the most common, and occur during most food reactions. Other symptoms can include nasal (sneezing, runny nose, itchy nose and eyes), gastrointestinal (nausea, vomiting, cramping, diarrhea), lung (shortness of breath, wheezing, coughing, chest tightness), and vascular (low blood pressure, light-headedness, rapid heart beat) symptoms. When severe, this reaction is called anaphylaxis, and can be life threatening.
Most reactions to food are probably not allergic in nature, but rather intolerance. This means that there is no allergic antibody present against the food in the person. Intolerance can be classified as toxic and non-toxic. Toxic reactions would be expected to occur in most people if enough of the food was eaten, examples include alcohol, caffeine or in cases of food-poisoning. Non-toxic food intolerance occurs only in certain people, such as lactose intolerance, which is due to the deficiency of lactase, the enzyme which breaks down the sugar in milk and dairy foods. Patients with lactose intolerance experience bloating, cramping and diarrhea within minutes to hours after eating lactose-containing foods, but do not experience other symptoms of food allergies. A less common form of non-allergic reactions to food involves the immune system, but there are no allergic antibodies present. This group includes celiac sprue and FPIES (food protein induced enteropathy syndromes). FPIES typically occurs in infants and young children, with gastrointestinal symptoms (vomiting, diarrhea, bloody stools, and weight loss) as the presenting signs. Milk, soy and cereal grains are the most common triggers in FPIES. Children typically outgrow FPIES by 2 to 3 years of age. Milk, soy, wheat, egg, peanut, tree nuts, fish and shellfish compromise more than 90 percent of food allergies in children. Allergy to milk and egg are by far the most common, and are usually outgrown by age 5 years. Peanut, tree nut, fish and shellfish allergies are typically the more severe and potentially life-threatening, and frequently persist into adulthood. Cross-reactivity refers to a person having allergies to similar foods within a food group. For example, all shellfish are closely related; if a person is allergic to one shellfish, there is a strong chance that person is allergic to other shellfish. The same holds true for tree-nuts, such as almonds, cashews and walnuts.

Cross-contamination refers to a food contaminating another, unrelated food leading to a "hidden allergy". For example, peanuts and tree nuts are not related foods. Peanuts are legumes, and related to the bean family, while tree nuts are true nuts. There is no cross-reactivity between the two, but both can be found in candy shops and in a can of mixed nuts, for instance.

The diagnosis is made with an appropriate history of a reaction to a specific food, along with a positive test for the allergic antibody against that food. Testing for the allergic antibody is typically accomplished with skin testing, although can be done with a blood test as well.

The blood test, called a RAST test, is not quite as good of a test as skin testing, but can be helpful in predicting if a person has outgrown a food allergy. This is especially true since in many cases the skin test can still be positive in children who have actually outgrown the food allergy.

If the diagnosis of food allergy is in question despite testing, an allergist may decide to perform an oral food challenge for the patient. This involves having the person eat increasing amounts of food over many hours under medical supervision. Since the potential for life-threatening anaphylaxis exists, this procedure should only be performed by a physician experienced in the diagnosis and treatment of allergic diseases. An oral food challenge is the only way to truly remove a diagnosis of food allergy in a patient.

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Hay Fever Symptoms

Allergic rhinitis, or hay fever, is a collection of symptoms, predominantly in the nose and eyes, to allergens such as dust, animal dander and pollen.

adam.about.net Hay fever, or allergic rhinitis, is the most common chronic disease, affecting up to 30 percent of the population. It is the most common reason for chronic sinus and nose problems. Children and young adults are the most common age groups affected by this disease, although many older adults and elderly people also experience symptoms.

Allergic rhinitis is defined as inflammation and irritation of the nasal passages due to seasonal and year-round allergens. Symptoms include sneezing, runny nose, nasal congestion, itching of the nose, and post nasal drip. Half of all people with allergic rhinitis also have a component of non-allergic rhinitis to their symptoms.

Those at risk for the development of allergic rhinitis include people with a family history of atopy, those with atopic dermatitis, a mother who smoked during pregnancy, and living a modernized lifestyle (urban setting, higher socioeconomic status, small family size). The presence of pets, especially multiple dogs, in the home at the time of birth appears to protect against the development of allergic diseases such as hay fever.

The above phenomenon is explained by the “hygiene hypothesis,” which suggests that since we live in a cleaner environment, our immune systems do not need to fight as many infections as in the past. We don't grow up on farms around animals, we don't play in the dirt, we receive vaccines to protect against infections, and we receive antibiotics when we do have infections. As a result, the immune system is less stimulated from an infection-fighting mode, and switches to allergy mode. Early pet exposure, especially to dogs, may help prevent this.

Wrong. Allergic rhinitis affects nearly 39 million Americans, leading to millions of missed work days, school days, and days of reduced productivity each year as a result. The costs of this disease process are measured in the multiple billions of dollars annually (doctor visits, missed work/school days, and medication costs). The effect of allergic rhinitis on a person’s quality of life is comparable to that of a severe asthmatic.

Allergic rhinitis also influences other diseases. Uncontrolled hay fever symptoms can lead to sinus infections, ear infections and worsening of asthma. And people with allergic rhinitis are more prone to illnesses, since the inflammation in the nose makes them more susceptible to the virus that causes the common cold.

History. Diagnosis is made by a person’s symptoms that are consistent with allergies, a physical exam by a medical professional showing signs suggestive of allergies, as well as positive allergy testing. It may be difficult to tell the difference between a common cold and allergies in some people; clues which suggest allergies include: Presence of other atopic diseases (such as atopic dermatitis) Family history of allergic diseases Symptoms associated with a season or trigger (such as a cat) Improvement of the allergy symptoms with medications The presence of itching (of the nose, eyes, ears, roof of mouth) is highly suggestive of allergiesPhysical exam. A physician will also perform a physical exam, looking for clues for allergies. The exam includes looking in the ears (fluid behind the ear drum can suggest allergies), in the nose (pale, swollen mucus membranes in the nasal passages suggest allergies), and in the mouth (evidence of post nasal drip may also suggest allergies). Dark circles under the eyes are called “allergic shiners,” and are due to nasal congestion. A horizontal crease on the nasal bridge is from upward rubbing of the nose with the palm of the hand, called an “allergic salute”.

Allergy testing. Positive allergy tests are required to diagnose allergic rhinitis; negative allergy testing suggests non-allergic rhinitis. Allergy testing is accomplished with skin testing or blood tests (called a RAST). Skin testing is considered the standard, and is performed in a variety of ways, the most common being prick (or scratch) tests.

Find out more about allergy testing and treatments for allergic rhinitis.

Sources:

Bousquet J, van Cauwenberge P, Khaltaev N. Allergic Rhinitis and Its Impact on Asthma. J Clin Allergy Immunol. 2001;108:S147-344.

Buttram J, More D, Quinn J. Allergy and Immunology. The Complete History and Physical Exam Guide. 2003:53-69.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Milk Allergy

 Milk allergy is the most common food allergy for children, and is the second most common food allergy for adults. The rate of milk allergy, similar to other food allergies, seems to be increasing, and affects at least 3% of all children. While it is relatively common for children to outgrow their milk allergy, sometimes at very young ages, milk allergy can persist into adulthood and even last a lifetime. Cow’s milk contains many allergens, which are most commonly broken down into the casein and whey components. The whey components include alpha and beta-lactoglobulins, as well as bovine immunoglobulin. The casein components include alpha and beta-casein components. Allergies to the lactoglobulin components tend to be more easily outgrown by children, whereas allergies to the casein components tend to persist into adolescence or adulthood.

In children and adults who are predisposed to allergic diseases, the body produces allergic antibodies against various milk allergens. These allergic antibodies bind to allergic cells in the body, called mast calls and basophils. When milk or dairy products are consumed, these allergic antibodies bind to the milk proteins, causing the allergic cells to release histamine and other allergic chemicals. These allergic chemicals are responsible for the allergic symptoms that occur.

Symptoms of milk allergy may vary from person to person. Classically, milk allergy most often causes allergic skin symptoms such as urticaria (hives), angioedema (swelling), pruritus (itching), atopic dermatitis (eczema) or other skin rashes. Other symptoms may involve the respiratory tract (asthma symptoms, nasal allergy symptoms), gastrointestinal tract (nausea, vomiting, diarrhea), and even anaphylaxis. These classic symptoms of milk allergy are caused by the presence of allergic antibody, and are referred to as being “IgE mediated”.

Milk allergy not caused by allergic antibodies, referred to as “non-IgE mediated,” can also occur. These reactions are still caused by the immune system, as opposed to reactions not caused by the immune system, such as with lactose intolerance. These non-IgE mediated forms of milk allergy include the food protein-induced enterocolitis syndrome (FPIES), food protein-induced proctitis, eosinophilic esophagitis (EoE; which can also be IgE-mediated) and Heiner syndrome.

IgE-mediated reactions to milk are typically diagnosed with allergy testing, which can be performed using skin testing or by demonstration of IgE against milk protein in the blood. Skin testing is the most accurate way to diagnose milk allergy, although blood testing is helpful in determining when and if a person is likely to have outgrown a milk allergy.

The diagnosis of the non-IgE mediated milk allergy reactions is more difficult to make, and allergy testing is not useful. Most commonly, the diagnosis is made based on symptoms and the lack of allergic antibodies being present. Sometimes, patch testing can be helpful in the diagnosis of FPIES and EoE, and blood testing for IgG antibodies is used to diagnose Heiner syndrome.

The only widely accepted treatment of milk allergy at the present time is avoidance of milk and dairy products. Oral immunotherapy (OIT) for milk allergy is currently being studied at medical universities around the world, with promising results. OIT involves giving very small amounts of milk protein orally to people with milk allergy, and gradually increasing the amount over time. This often results in a person being able to tolerate fairly large amounts of milk protein over time. It is important to realize, however, that OIT for milk allergy can be extremely dangerous, is only being performed in university settings under close medical supervision. OIT for milk allergy is likely to be many years away from being performed by your local allergist.

Learn how to follow a milk-free diet.

Many children will eventually outgrow their allergy to milk, especially those with non-IgE mediated allergy. For those with an IgE-mediated milk allergy, it may not occur as quickly as previously thought. Older studies suggested that 80% of children outgrow milk allergy by age 5; a more recent study performed on a larger number of children suggests that nearly 80% of children do outgrow milk allergy – but not until their 16th birthday.

Measuring the amount of allergic antibody to milk can help predict the likelihood of a person outgrowing their allergy to milk. If the allergic antibody to milk is below a certain level, an allergist may recommend performing an oral food challenge to milk under medical supervision. This is the only safe way to truly see if a person has outgrown their milk allergy.

Learn more about outgrowing food allergies.

Sources:

Fiocchi A, Schunemann HJ, Brozek J, et al. Diagnosis and Rationale for Action Against Cow’s Milk Allergy (DRACMA): A Summary Report. J Allergy Clin Immunol. 2010;126:1119-28.

Skripak JM, Matsui EC, Mudd K, Wood RA. The Natural History of IgE-Mediated Cow’s Milk Allergy. 2007; 120:1172-7.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Hayfever downgrades children's exam hopes

15th May 2012 - Thousands of children face a struggle to make the grade in their exams this summer because of the debilitating effect of hayfever.

An estimated 38% of young people have hayfever - also known as seasonal allergic rhinitis. The national charity Allergy UK says its survey of parents of children with hayfever found that 31% said their child struggled to concentrate, while 22% said the condition made their life a misery.

Allergy UK says research has shown that 40% of children can drop a grade between mocks and final exams because of their hayfever. It says, if nothing else, hayfever adds to the pressures put on youngsters when they sit their GCSEs or Scottish Standard Grades.

Lindsey McManus from the charity says, because it will be the peak of the hayfever season, "they're going to have a streaming nose, itchy sore eyes, feel bunged up and have their sleep affected".

In fact, the survey revealed that 43% of children with hay fever found it difficult to sleep. In more extreme cases, 12% of youngsters did not even want to leave the house when their symptoms are worst.

Allergy UK wants to highlight practical solutions that can ease the impact of hayfever for children heading into their exams.

It says anti-histamines have a proven track record, and the modern one-a-day, non-drowsy kind are suitable for children over the age of 12. "Getting their symptoms under control is the key thing," says Lindsey McManus, "so check out the best medication for them. It may be that they need eye drops and nasal sprays as well."

GPs and pharmacists can advise about suitable medication.

A top tip from Allergy UK is that it might take a while to find the right medication, so avoid leaving it too close to the first exam to try them out for the first time.

Among other key advice:

Monitor pollen forecasts during exam time and take extra precautions when the pollen count is highIf you do drive children to school on exam days, keep car windows closed and the air intake on re-circulateInvest in a pair of wraparound sunglasses for your child to keep allergens out of their eyes when they are outside at schoolHelp your child get a good night's sleep by keeping windows and doors closed overnight in their bedroomMake sure they wash their hair and change their clothes before they go into their bedroom, which will help to keep pollen outTry using an air purifier in your child's bedroom to help to trap pollen particlesApply an effective pollen barrier around the edge of each nostril to trap or block pollens, these are available as balms, gels or spraysIf you have a pet, keep them away from your child during exam time as they can carry pollen in their furIf your child's hay fever is unbearable on the day of an exam, speak to a senior invigilator. There is a chance they could be given special consideration if symptoms are particularly bad. If you have any concerns in the lead up to the exams speak to your child's school as they may be able to make special arrangements

Lindsey McManus says schools can play their part by being understanding about the effect that hayfever can have on their pupils. "Something that most people see as quite a minor condition can actually be quite debilitating for children," she says.

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Dairy free without diagnosis

1st March 2013 -- Allergy UK is warning that thousands of people could be missing out on vital nutrients by self-diagnosing themselves as dairy intolerant.

The charity is expressing concern, after new research revealed that 44% of individuals who class themselves as dairy intolerant, are self-diagnosed, relying on the internet and other 'non-conventional' methods of diagnosis.

It's highlighting an urgent need for more credible information and guidance from qualified health professionals.

Dairy intolerance is not an allergy. Food allergies occur when the body's immune system wrongly thinks that a food protein is harmful and acts against it. Food intolerances do not involve the immune system and are rarely life threatening.

Cows' milk allergy is common in young children but is far rarer in older children and adults - less than one in 1000 people.

In comparison, around one in five people will suffer symptoms suggestive of lactose (found mostly in dairy products) intolerance. It happens when a person can't properly digest lactose (milk sugar) because of low levels of lactase, the enzyme responsible for digesting lactose.

High levels of lactose are present in cow's milk, goat's milk, sheep's milk, butter, ice cream and cheese. Lactose can also be found in processed products like sausage, pies and some crisps and in some medications and vitamin/mineral supplements.

The common symptoms of lactose intolerance are diarrhoea, bloating and discomfort. For some people there is a dose related response, so they may be able to tolerate milk in tea, but a glass of milk would cause symptoms.

As with all intolerances the only solution is avoidance of the offending food until it can once again be tolerated.

In an attempt to find a solution to an ongoing health problem Allergy UK found 72% of those suffering from dairy intolerance symptoms removed all dairy sources (the main source of calcium in the UK) from their diet and a further 25%  cut out some dairy food groups.

Gut symptoms, including stomach or abdominal discomfort, bloating and diarrhoea were the main reasons for individuals going dairy free.  Eczema and nasal/sinus congestion were the fourth and fifth most common symptoms.

Lindsey McManus, deputy CEO, Allergy UK said the findings were worrying. In a prepared statement she has this advice: "To help identify whether food is a cause of symptoms, a food/symptoms diary can help to identify a pattern. We would always recommend taking the diary to your GP (or allergy specialist) who can diagnose what may be causing the symptoms or refer to a dietitian."

Three quarters (75%) of the individuals surveyed said their preference was to be assessed through a face-to-face consultation with a health professional.

If you think you are lactose intolerant, it is important to make an appointment to get a diagnosis confirmed (or ruled out) by a doctor.

Lactose intolerance can be diagnosed with a breath or blood test that can assess how the body reacts to lactose.

In the UK, lactose intolerance is more common in people of Asian or African-Caribbean descent.

The Allergy UK research was funded by Alpro and conducted amongst 1,225 dairy intolerance sufferers in January.

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Allergy Symptoms

 Most everyone has an idea of what an allergy is. Allergies are so common, in fact, that it seems acceptable to discuss allergy symptoms at a cocktail party with perfect strangers.

An allergy is an abnormal reaction by a person's immune system to a normally harmless substance. A person without allergies would have no reaction to this substance, but when a person who is allergic encounters the trigger, the body reacts by releasing chemicals which cause allergy symptoms.

Find out more about what happens during an allergic reaction.

In children, allergic disease first occurs as atopic dermatitis (eczema) or food allergies. Children with atopic dermatitis are then at an increased risk of developing allergic rhinitis and asthma; both are more likely to occur in school-age children.

Typically, atopic dermatitis goes away by adulthood, as do many types of food allergies. Allergic rhinitis and asthma, however, most often start during the adolescent, teenage and young adult years, and are likely to persist throughout a person’s life. The severity of allergic symptoms, however, may wax and wane, and even temporarily disappear during a person’s life.

This is typically the first sign of allergies and is seen in 10 to 20% of all children, frequently during infancy. Atopic dermatitis, or eczema, is characterized by itching, with rash formation at the sites of scratching. The rash is typically red and dry, may have small blisters, and can flake and ooze over time.

In infants and very young children, this rash involves the face (especially the cheeks), chest and trunk, back of the scalp and may involve the arms and legs. This distribution reflects where the child is able to scratch, and therefore usually spares the diaper area. The location of the rash changes in older children and adults to classically involve the skin in front of the elbows and behind the knees. Food and environmental allergies have been shown to worsen atopic dermatitis.

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Food allergies can occur at any age. Almost all people with food allergies will have a skin symptom, such as hives, swelling, itching or redness of the skin, as a result of eating the culprit food. These symptoms typically occur within a few minutes of eating the food in question, although they can be delayed up to a couple of hours.

Other symptoms of food allergies can include nausea, vomiting, stomach aches, diarrhea, breathing difficulties (asthma symptoms), runny nose, sneezing, and lightheadedness. In some cases, children can experience a severe allergic reaction, called anaphylaxis, which can be life-threatening.

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Allergic rhinitis occurs in up to 30% of adults and up to 40% of children. Symptoms of allergic rhinitis include sneezing, runny nose, itchy nose and eyes and nasal congestion. Some people may also experience post-nasal drip, allergic shiners (dark circles under the eyes), and a line across the nasal bridge from an upward rubbing of the palm of the hand on the nose, a sign called the “allergic salute.”

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Allergies are a major cause of asthma, a condition that occurs in about 8% of all people. Though it can occur at any age, it is most often seen in males in the pre-teen years and in females in the teenage years; asthma is the most common chronic disease in children and young adults. Sometimes asthma is difficult to diagnose in very young children, and may require a physician who is an asthma specialist.

Symptoms of asthma may include: Coughing -- This can be the only symptom in some people who have “cough-variant asthma.” The cough is often dry, hacking, and may be worse with allergic triggers and after exercise. The cough may only be present at night. Cold air may also trigger this symptom. Wheezing -- This is a high-pitched, musical-like sound that can occur with breathing in and out in people with asthma. Wheezing usually occurs along with other asthma symptoms, may get worse with exercise and with allergic triggers. Shortness of breath -- Most people with asthma feel as if they’re not getting enough air at times, particularly when they are physically exerting themselves or when an allergic trigger is present. People with more severe asthma have shortness of breath at rest or wake-up with this symptom during the night. Chest tightness -- Some people describe this as a sensation that someone is squeezing or hugging them. Children may say that their chest hurts or feels “funny.”

Many asthmatics have symptoms with exercise; this does not necessarily mean that their asthma is severe or uncontrolled.

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Do you have an interesting story on how you first determined that you had allergies? Share your story, and learn from other people, about how you figured out that your symptoms were allergies.

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Does sun exposure help eczema (atopic...

Yes, it has long been known that judicious exposure to natural sunlight is helpful for the treatment of atopic dermatitis. In fact, for people with severe atopic dermatitis, some dermatologists recommend treatment with medical-grade ultraviolet light. People with atopic dermatitis, however, may be more prone to sunburn, especially when they are using topical steroids or Elidel/Protopic. Therefore, most people with eczema should be very cautious about too much exposure to the sun.

It isn’t completely clear why sun exposure helps atopic dermatitis, but a recent study suggests that vitamin D may be playing a role. Supplementation with oral vitamin D has been shown to increase the production of cathelicidin in the skin of people with atopic dermatitis. Cathelicidin is a skin protein that protects against skin infections from viruses, bacteria and fungi in healthy skin. People with atopic dermatitis have low amounts of cathelicidin in their skin. This may result in colonization and infection of the skin with bacteria, viruses and fungi, which is known to worsen eczema in people with atopic dermatitis.

This may explain why people with atopic dermatitis get better with moderate amounts of sun exposure. Natural sun exposure leads to production of vitamin D within the skin, which may help people with atopic dermatitis produce cathelicidin. People should check with their doctor before taking any vitamin D dietary supplements, and while cautious amounts of exposure to natural sunlight may be very healthy, tanning salons should be avoided.

Learn more about the treatment of atopic dermatitis.

Sources:

Hata TR, et al. Administration of Oral Vitamin D Induces Cathelicidin Production in Atopic Individuals. J Allergy Clin Immunol. 2008; 122:829-31.

Atopic Dermatitis Practice Parameters. Ann Allergy Asthma Immunol. 2004;93:S1-21.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Relief From Ragweed Allergy Symptoms Offered By Once-A-Day Pill

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Ask the Allergist: Oral Allergy Syndrome

Food allergies come in all flavors – from annoying to life-threatening. In this edition of Ask the Allergist, Dr. Richard Weber, president elect of the American College of Allergy, Asthma & Immunology and a board-certified allergist at National Jewish Research, discusses those at the lower end of the scale: oral allergy syndrome caused by fruits related to tree pollen. He also talks about the future of immunotherapy for food allergies.

 

Related posts: Ask the Allergist: Oral Allergy SyndromeOral Allergy SyndromeAsk the Allergist: Can you help me with my pollen allergy?Does it Matter What I’m Allergic To?

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Olde Thompson Inc. Issues a Voluntary Recall of Earth’s Pride Organics: Organic Oregano 2.2 Oz Glass Jars With Cork Closure Due to Possible Salmonella Risk

Why Did My Albuterol Inhaler Change?

 Many people with asthma have noticed a change in their albuterol inhaler recently – the old, white generic CFC (chlorofluorocarbon)-propellant albuterol inhalers have been replaced by brand-name HFA-propellant albuterol inhalers. While this change is in the interest of the environment and preservation of the earth’s ozone layer, many asthmatics are less than thrilled about the change. First, since there are no generic HFA albuterol inhalers, the cost is dramatically higher than before. Second, many of my patients have told me that they feel that the new inhalers don’t work as well – often because the spray isn’t as forceful from the HFA inhalers – and therefore the medication doesn’t seem to get into the lungs as well.

While people may still be able to find some generic CFC-albuterol inhalers on pharmacy shelves, there will be none left within the next year. This change to HFA-based inhalers also affects inhaled steroids, none of which are currently generic. There are only three brands of HFA albuterol: ProAir, Proventil and Ventolin. Of these, ProAir is the least expensive, but also has the weakest spray, which some asthmatics find less satisfying, and maybe less effective. Ventolin seems to have the most powerful spray of the three, and also has a dose-counter to track medication usage and amount remaining.

While I doubt there is a difference in the effectiveness of the three HFA albuterol inhalers, some asthmatics certainly think so. Correct inhaler technique should always be used, and the use of a spacer may make the less forceful sprays more effective. Still, when an asthmatic can’t breathe, a stronger spray from an albuterol rescue inhaler may be more satisfying, even if there’s no real difference in the amount of medication delivered to the lungs.

Read more about living with asthma.

Source:

Leo HL, Dombkowski KJ, Clark NM. The Economic Effect of the Hydrofluoroalkane Albuterol Transition on Children with Asthma. J Allergy Clin Immunol. 2008; 121:776-7.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Autism and Food Allergies

Autism is a disorder that affects brain development in children. This disease causes problems with social interaction and communication skills, and limitations in behavior patterns. Autism is likely genetic, although there also seems to be environmental factors that influence the disease. In recent years, various studies -- mostly in the alternative medicine literature -- have suggested that food allergies play a role in causing or worsening autism. Specifically, gluten (a wheat protein) and casein (a milk protein) have been blamed for worsening symptoms in children with autism. These food proteins are felt to be broken down into smaller proteins (peptides) that function like narcotics in children with autism, thereby worsening the behavioral changes of autism.

Many other foods are blamed for worsening autism as well, including eggs, tomatoes, eggplant, avocado, red peppers, soy and corn. However, authors of alternative medicine literature on the subject of autism and food allergies admit that allergy tests to these foods, as well as to wheat and milk, are usually negative, and most of these children do not seem to experience typical symptoms of food allergies. Therefore, they recommend testing for specific antibodies (IgG) against these foods. However, a set of guidelines known as the Practice Parameters for Allergy Diagnostic Testing states that IgG antibodies have no role in the diagnosis of food allergies.

Diets free from the above foods, mostly gluten-free and casein-free diets, have been studied for children with autism. Most of these studies are of very poor quality and not up to modern-day scientific standards. Recently, a Cochrane analysis on this subject found only one small, well-designed study that showed some improvement in autistic traits in the children receiving a gluten-free/casein-free diet. Studies of larger numbers of children are needed to confirm the results of this small study.

It’s not completely clear that foods do worsen autism, although there are many theories about how this could occur. It's been suggested that autism could result from a loss of regulation of the immune system, causing an increase in inflammatory-causing chemical signals from white blood cells. It is felt that these chemicals (cytokines) may be responsible for the neurological abnormalities seen in children with autism.

Recent studies suggest that children with autism may respond to certain foods, particularly gluten- and casein-containing foods, by producing more of these inflammatory cytokines. Blood cells from autistic children were cultured with various foods in a lab, and various inflammatory cytokines were measured. The cytokines from the autistic children were much higher than those from normal (non-autistic) children after being exposed to gluten or casein. This increase may help predict when an autistic child would benefit from dietary avoidance of these proteins.

It has also recently been suggested that the immune system changes a pregnant woman experiences could place her child at risk for autism. Many reports of women with various autoimmune diseases, such as type 1 diabetes, are at increased risk for having children with autism.

A recent study assessed the relationship between autoimmune diseases and autism. It found that only psoriasis predisposes a woman to having a child with autism. However, the study also showed that having allergic rhinitis and/or asthma, particularly when diagnosed during pregnancy, places a woman at increased risk of having a child with autism.

Again, the reason for this is not completely clear; however, most theories involve changes to the immune system during pregnancy and the production of these inflammatory chemicals. These cytokines may somehow contribute to symptoms of autism in genetically predisposed children.

At the present time, there does not appear to be enough information to support following a gluten-free/casein-free diet for children with autism. Furthermore, limiting a child’s dietary intake, especially by avoiding nutritionally important foods such as milk and wheat, may be dangerous. Be sure to contact your child’s physicians before limiting his or her diet in any way.

Find out about:

Sources:

Croen LA, Grether JK, Yoshida CK, et al. Maternal Autoimmune Diseases, Asthma and Allergies, and Childhood Autism Spectrum Disorders. Arch Pediatr Adolesc Med. 2005; 159:151-7.

Millward C, Ferriter M, Calver S, Connell-Jones G. Gluten- and casein-free diets for autistic spectrum disorder. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD003498.

Kidd PM. Autism, An Extreme Challenge to Integrative Medicine. Alternative Medicine Review. 2002; 7(6):472-99.

Sun S, Itokazu N, Le HT, et al. Innate Immune Responses and Cytokine Production Against Dietary Proteins in Children with Autism Spectrum Disorder and Those with Dietary Protein Intolerances. J Allergy Clin Immunol. 2002; 109:S222.

Jyonouchi H, Sun S, Le HT, et al. Cytokine Production Against Common Dietary Proteins in Patients with Autism Spectrum Disorder and Developmental Regression in Comparison with Patients with Dietary Protein Intolerance. J Allergy Clin Immunol. 2002; 109:S221.

Practice Parameters for Allergy Diagnostic Testing. Ann Allergy Asthma Immunol. 1995; 75(6): 543-625.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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OMG! It's Not Gluten-Free!?

For people with celiac disease, wheat is a no-no. For everyone, pretending that products are gluten-free should be a no-no.

Jacob Van Houten/iStockphoto

This story may not be that significant to some people, but as a person who suffers from celiac disease, (a digestive disorder that prevents me from being able to process wheat, oats, barley, etc) it is heartbreaking.

This week, the Charlotte News & Observer reported that a North Carolina man was sentenced to 11 years in prison after he sold what he claimed was gluten-free bread. Turns out, the bread wasn't sans gluten and it ended up making more than two dozen people sick.

Prosecutors said that Paul Seelig, owner of Great Specialty Products, claimed he owned a dedicated gluten-free facility and was testing his products weekly to make sure they were safe. But according to prosecutors, the bread tested positive for gluten.

In his opening arguments, assistant district attorney Shawn Evans said that the case "is about is misrepresentations built on top of misrepresentations."

And there seem to be even more lies. A former employee testified that instead of getting the ingredients for his bread from his 400-acre farm, Seelig actually bought bread from commercial retailers, repackaged it, and sold it online and at street fairs.

Seelig's attorney claims that Seelig's bread supplier lied to him.

This is particularly disheartening, because not only did these people experience physical discomfort, but they'll probably have a hard time trusting products in the future. When you have a dietary restriction and you're out and about at a street fair looking at the sandwiches, cupcakes and tasty treats that you can't eat, and you see gluten-free products for sale, it's so exciting! But when something like this happens, it literally makes you sick.

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Momentum builds on Alzheimer's drug research, quality of life issues

 

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Last week, I attended the 2013 Alzheimer's Association International Conference in Boston. It's the world's largest conference of its kind.

The annual weeklong meeting brings together researchers and dedicated persons from around the world to share research and information on the cause, diagnosis, treatment and prevention, as well as caring for those living with Alzheimer's or a related dementia.

There was no announcement of a cure or major breakthrough promising to significantly alter the course of the disease.

Analyses from a much-anticipated phase 3 clinical trial of IVIG (intravenous immunoglobulin) were reported as negative and therefore not effective in treating people with mild to moderate Alzheimer's.

And yet, the conference did reassure me, and hopefully others, that there's progress and forward momentum to discover new therapies and most importantly to improve the quality of life for those affected today. Some examples:

Two new drugs show promise in early experiments and will likely progress to the next round of clinical trials. One reduces levels of beta amyloid, a sticky protein that forms plaques in the brains of Alzheimer's patients. The second is thought to reduce damaging inflammation that could lead to improvements in memory and thinking. But these studies are very early and have a long way to go before we should feel too optimistic. A new study of nearly half a million French people reported that elderly individuals who delay retirement have less risk of developing Alzheimer's or other types of dementia. It makes sense because working tends to keep people physically active, socially connected and mentally challenged — all things known to help prevent mental decline.Multiple studies focused on improving early diagnosis showed that an individual's own concerns about his or her memory serve as a good early warning sign for dementia and Alzheimer's. It's an emerging field in Alzheimer's research called "SCD" for subjective cognitive decline.

In addition to improving early detection and diagnosis of Alzheimer's, efforts aimed at increasing the utilization of information and support services were reported. Some examples:

An evidence-based tool created by experts with Minnesota ACT on Alzheimer's. The tool offers primary care doctors support in making an early diagnosis and then provides specific ways to demystify and simplify dementia care and ongoing management. The U.S. Centers for Disease Control and Prevention and the Alzheimer's Association unveiled an excellent resource called The Healthy Brain Initiative. The goals of the initiative are to enhance understanding of the public health burden of cognitive impairment and help create evidence-based programs and effective public health practices in states and communities.Steven Sabat, Ph.D. from Georgetown University, spoke at a keynote session about the risk and unjustness of defining people through their disease, which is not only a narrow view of that person, but also has a damaging impact upon that person's sense of social identity. Seeing a whole person and all of their attributes is the focus of Dr. Sabat's extraordinary work. A program out of Northwestern University Cognitive Neurology and Alzheimer's Disease Center in Chicago pairs medical students with individuals living with dementia for a year. The "Buddy Program" has demonstrated that it improves medical student knowledge and familiarity with Alzheimer's while also heightening sensitivity and empathy toward people with the disease. The successful program is now being replicated in other states.

What a great conference. Clearly, I've offered only limited highlights. On a personal note, one of my most meaningful days was spent with Dr. John Zeisel, president of Hearthstone Alzheimer's Care in Woburn, Mass., and the "I'm Still Here" Foundation.

I joined John and a few others from all corners of the world for a day of inspirational conversation focused on the shared belief that people living with dementia thrive with meaningful engagement.

Finally, The Alzheimer's Association recognized two leading scientists with a Lifetime Achievement Award — William H. Thies, Ph.D., of the Alzheimer's Association, and our own Ronald Petersen, Ph.D., M.D., from the Mayo Clinic.

Hats off to them for their vision and leadership. Thank you to the Alzheimer's Association for this conference. It not only takes a village, it takes the world.

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What is Asthma

When an asthma attack occurs, mucus production is increased, muscles of the bronchial tree become tight, and the lining of the air passages swells, reducing airflow and producing the characteristic wheezing sound.

A.D.A.M Asthma is a chronic lung disease, which cannot be cured, yet can be well-controlled with close follow-up with a physician and appropriate medical therapies. In people with asthma, lung airways become inflamed, leading to narrowing of the airways. The muscles around the airways become more sensitive, and can react to allergens and irritants. Asthma can be a life-threatening disease, and there are typically a few thousand deaths in the United States every year as a result of this disease. The most common symptoms of asthma include wheezing (a high-pitched squeaking sound occurring during breathing in and out), a sensation of chest tightness or heaviness, a sense of not getting enough air, and coughing. Not all people with asthma will have all of these symptoms. Many people with asthma may only have a cough – this type is termed “cough-variant asthma”. In a person with asthma, the lining of the airways is swollen and produces more mucus than normal. This can lead to the muscles around the outside of the airways to constrict and narrow the airways. Air has a more difficult time getting in and out of the lungs, which causes the symptoms of asthma. Like allergies, the tendency to develop asthma runs in families. If a person has a mother with asthma, or the mother smoked during the pregnancy, then that person has a higher risk for asthma. People with allergic rhinitis have about a 1 in 4 chance of developing asthma.

Some types of respiratory tract infections, especially if occurring during infancy, place a person at increased risk of developing asthma. Environmental triggers, including allergens and other irritants, can influence the development of asthma. There is probably not a single cause for asthma, but rather an interaction between a person’s genetic makeup and environmental triggers.

The most common trigger of asthma is a respiratory tract infection. In adults, it is the common cold virus. In children, RSV (respiratory syncytial virus) is the common culprit.

Other common triggers include allergens and irritants. The most common allergens include environmental allergens such as pollens, animal dander, dust mite and molds. Food allergies may also trigger asthma symptoms, and may lead to anaphylaxis. Irritants, such as smoke and strong odors, can also trigger asthma symptoms.

The majority of people with asthma will have symptoms worsen with exercise and strenuous activity. However, the term “exercise-induced asthma” is overused and usually applies only to a small group of asthmatics.

Strong emotions, such as laughing and crying, as well as emotional stress, can also trigger the symptoms of asthma.

One of the most important aspects of controlling asthma is the ability to recognize when asthma is just starting to get worse, and treating these symptoms. Therefore, it is also important to know which asthma medication to use at the right time. Early treatment of an asthma attack usually resolves the problem and prevents asthma from continuing to get worse. An asthmatic should also notify his or her doctor if their asthma symptoms are starting to worsen.

Avoidance of allergic triggers (such as dust mites, pet dander and mold) as well as irritants (such as cigarette smoke, strong odors) can prevent worsening asthma symptoms in those people sensitive to these allergens. And, since the nose and lungs are both part of the respiratory tract, good control of allergic rhinitis will help to control asthma symptoms.

The goals of asthma treatment are for an asthmatic to essentially be able to live as if they did not have asthma. These include:

To be active in sports and exercise with minimal to no asthma symptoms

To avoid severe asthma attacks that lead to emergency room visits and hospital stays

To sleep through the night without asthma symptoms

To have normal lung function as measured in the doctor’s office

To avoid side effects from asthma medications

Remember, these are goals, and many asthmatics may never achieve these. However, with close follow-up with a physician, or with a referral to an asthma expert (such as an allergist), and if a person follows the directions of the physician, these goals should be able to be achieved.

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Angioedema

  Angioedema may include swelling of the face, especially the lips, the skin around the eyes, and the throat.

© ADAM Swelling of the tongue, lips, throat and area around the eyes is often caused by angioedema. Angioedema is caused by the release of histamine into the skin by allergic cells such as mast cells. This is the same process that causes urticaria, or hives, but angioedema occurs in deeper skin tissues such as the lips, tongue, throat, around the eyes, hands, feet and genitals. Angioedema does not make the skin red, normally it is not itchy, and it most often involves swelling of only one side of the face at a time. Many people describe the symptoms of angioedema as tingling, numbness or a burning sensation, like after going to the dentist. The swelling of angioedema typically lasts for many hours, and once the swelling has gone away, the skin appears completely normal –- there is not typically any bruising, flaking, peeling or scar formation. Often, the causes of angioedema are the same as the causes of urticaria: histamine release from allergic cells. Approximately half of people with these symptoms experience both urticaria and angioedema; 40% experience only urticaria, and 10% experience only angioedema.

Angioedema may be a sign of an allergic reaction, especially to medicines, foods, or insect stings. However, when symptoms become chronic (greater than 6 weeks), the cause is more likely to not be caused by allergies. Chronic angioedema may be caused by an autoimmune disease, thyroid disease, parasitic infections, alcohol use, non-steroidal anti-inflammatory medicines (NSAIDs), ACE inhibitors (a common blood pressure medicine) and hereditary angioedema.

When food allergies are the cause, you can often tell what the trigger is, because most reactions to foods occur within 20-30 minutes of eating the food. Medications may not be as obvious as a cause, except when a new medication is started and symptoms occur. NSAIDs and ACE inhibitors are well-known causes of angioedema, although any medication has the potential to cause the symptom.

There are a number of causes of swelling of the lips, eyes and face that are not angioedema, although they may be incorrectly diagnosed as such. These causes of pseudo-angioedema may include contact dermatitis, autoimmune diseases such as dermatomyositis, parasitic infections such as trichinosis, low thyroid function, and swelling and redness of the entire face from superior vena cava (SVC) syndrome.

The differences between these causes of true angioedema and pseudo-angioedema are as follows: The swelling from contact dermatitis may involve the eyes and lips, but not the tongue and throat. The skin is usually red and itchy, and will often peel or flake when the swelling goes away. The swelling associated with certain autoimmune diseases, such as dermatomyositis, will be present for days, weeks or months at a time, is usually red, and often will be associated with other symptoms such as extreme fatigue, weakness, fevers, weight loss and joint and muscle aches. The swelling that results from severely low thyroid function is called myxedema, and often involves swelling around the eyes. The swelling is consistent rather than intermittent, and other symptoms of low thyroid function are also present. The swelling of trichinosis should involve both eyes and is consistent rather than intermittent. Swelling from SVC syndrome is due to blood having trouble draining back to the heart, so the swelling involves the entire face, neck and upper chest, is red, is worse in the morning after lying down for many hours, and may get better once the person is standing up for a while. SVC syndrome is almost always associated with cancer. Treatment of angioedema involves removing the causative trigger or fixing the underlying medical condition, but also the use of various medications such as oral antihistamines and/or systemic corticosteroids. These medications may take hours to days to work, and if symptoms recur frequently, the use of a daily antihistamine to prevent further episodes of angioedema is a good idea. People with episodes of facial angioedema (tongue, lips, throat) should carry an injectable form of epinephrine (such as an Epi-Pen), to use if the swelling is severe enough to affect the ability to breathe. If the Epi-Pen is needed, the person should seek emergency medical care right after using this emergency medicine.

Sources:

Charlesworth E. Differential Diagnosis of Angioedema. Allergy and Asthma Proceedings. 2002;23(5):337-339.

Practice Parameters for Disease Management: Acute and Chronic Urticaria and Angioedema. Ann Allergy. 2000; 85: S525-44.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Sports nutrition basics

 

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So you've made the commitment to train for a marathon, triathlon or other endurance event. You dedicate time and follow your workout schedule, logging each hour and type of workout. But your log may be missing some key information if you're not monitoring your fluid and dietary intake.

Why is it important to pay attention to sports nutrition? The right fuel can help you optimize your training and reach your personal best — or at least finish upright and feeling good.

Here are a few suggestions to get you thinking and perhaps retooling your drinking and food habits during your training. These tips are for those training more than an hour a day.

Fluid
Dehydration will compromise performance. Drink fluids, mostly water, during and between meals.

Pre-workout. Drink enough that you can comfortably exercise.Post-workout. Weigh yourself pre- and post-exercise. For every pound of weight (fluid) loss, drink 16-24 ounces.

Carbohydrates
Carbohydrates are the primary fuel for your muscles. The longer and more intense the exercise, the more carbohydrate your muscles need. Are you eating nutritious carbohydrate foods at each meal and snack? Examples include fruits, grains, such as cereals, breads, pasta, rice, quinoa or barley, and starchy vegetables, such as peas, corn, and potatoes, as well as milk and yogurt.

Pre-workout. Eat a carbohydrate-rich snack or small meal, depending on timing and tolerance.During workout. Drink a sport drink or diluted juice, or eat a small amount of carbohydrate. Some people like the convenience of sport gels or similar products.Post-workout. Drink a carbohydrate-containing beverage soon after finishing. Including protein with carbohydrate following your workout will aid in muscle recovery.  Milk meets these criteria.

Take a close look at your meals and snacks. What are the carbohydrate-rich foods? Do you have a few servings at each meal? Do you carry a water bottle all day? How often to you refill it? Can you tolerate eating and drinking before, during and after your workout? If you're already practicing some of these tips, has it changed your performance?

Need more specific advice tailored to your body size and training needs? Seek out a registered dietitian or certified specialist in sports dietetics (CSSD).

To your health,

Katherine

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Flu Fight

By Gary Fitzgerald

First it was coughing. The next morning, it was fever. Symptoms only got worse from there. By the time I made my way to my doctor on call a day later, my body temperature had soared to 103.8!

Early December, I was diagnosed with the flu – just as one of the worst influenza seasons in recent memory was beginning.

A week into my recovery, I was diagnosed with bronchitis, a complication that kicked off another round of coughing and congestion. Even though I don’t have asthma, my doctor prescribed antibiotics and an inhaler in case my airways became inflamed and I had difficulty breathing.

Turns out my flu fight would become all too common in the weeks ahead.

Through mid-January, 47 states had reported widespread influenza. New York state and the city of Boston declared public health emergencies as flu cases flooded ERs.

The predominant strain this year is H3N2, a virus that has been associated in the past with more severe flu seasons. It’s highly contagious from the first day of symptoms to 5-10 days later. Symptoms usually start with a cough and then include headaches, achiness and fever.

The strain is so aggressive that some people who received the flu vaccine experienced symptoms (even after the two weeks it generally takes for full protection).

This year’s influenza vaccine contains about 90 percent of all circulating flu viruses, including H3N2, H1N1 and a B virus, according to Tom Frieden, MD, director of the Centers for Disease Control & Prevention (CDC).

“Those are the three most common strains and the current vaccines have only three,” Dr. Frieden says. “So the pick of vaccine strains was as good as could have been this year. The other 10 percent are a second influenza B.”

The good news? In the next 1-2 years, the CDC expects manufacturers to produce a flu vaccine that has space for four different flu viruses.

Aside from vaccination, there’s plenty you can do to protect yourself and your family from the flu, Dr. Frieden says.

“Be sure to cover your cough and sneeze and stay home if you’re sick with cough and fever,” Dr. Frieden said. “Keep your children home from school if they’re sick with cough and fever. Washing your hands regularly with soap and water is very important. Avoid touching your eyes, nose or mouth to minimize the spread of germs.

“And if you get sick with flu-like illness, if you have fever and cough, it’s very important that you contact your doctor because early treatment with antiviral medications such as Tamiflu® can reduce the severity of illness.”

Asthma And Flu? Here’s What to Do…

People with asthma are at high risk for flu complications, including pneumonia. Influenza can further inflame airways and lungs and trigger a worsening of asthma. The CDC offers these tips:

Everyone with asthma 6 months or older should get the flu vaccine. These are offered in doctor’s offices, clinics and pharmacies, among other places. People with asthma should get the flu shot made with the inactivated flu virus. They should not receive the nasal spray “FluMist®” vaccine.Children, adults over 65 and people who have asthma should get the pneumococcal vaccine to protect against pneumonia. The pneumococcal vaccine can be given at the same time as the influenza vaccine. (Read more on the pneumonia shot from Dr. Martha White on page 6!)Follow your updated, written Asthma Action Plan so that you’re on top of your asthma symptoms should you come down with the flu.If you do get sick with flu symptoms, call your doctor and take prescription antiviral medications such as Tamiflu®. (People with asthma should not use Relenza®, another antiviral medication, because there is a risk it may cause wheezing.)In addition to covering your cough and sneeze and washing hands regularly, clean and disinfect frequently touched surfaces at home, school and work and devices such as cellphones and computer keyboards.

Related posts: Antivirals, Seasonal Flu and YouFlu Tips for People with Asthma

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Allergy Meds Could Affect Your Driving

 

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If you can literally write your name in pollen on the windshield of your car, you know it’s allergy season again.

When your body comes into contact with whatever triggers your allergy—pollen, ragweed, pet dander, or dust mites, for example—it produces chemicals called histamines. Histamines cause the tissue in your nose to swell (making it feel stuffy), your nose and eyes to run, and your eyes to itch. Some people develop itchy skin rashes known as hives.

Medications containing antihistamines, drugs which counteract the effect of histamines, can help relieve many different types of allergies, including hay fever and food allergies.

But some antihistamines can make you feel drowsy, unfocused and slow to react.  If not taken responsibly and according to directions, they can pose a danger to your health and safety. Information about whether an antihistamine medication can make you drowsy can be found in the product’s label.  Consumers should read the Drug Facts label of the medication and understand the warnings before they use it.

“Any of these reactions can negatively interfere with driving or operating heavy machinery,” says Jane Filie, M.D., a medical officer at the Food and Drug Administration’s (FDA) Division of Nonprescription Regulation Development. Filie says you may experience slower reaction time, haziness, or mild confusion even if you don’t feel drowsy after taking a medication containing antihistamines.

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FDA wants to promote awareness of the potential health risks and the precautions that you should take when using antihistamines.

Different antihistamines may be dosed differently, says FDA pharmacist Ayana Rowley, Pharm.D. “Don’t assume that when you run out of one antihistamine and happen to buy another, it’s the same dose,” she explains. If one specific antihistamine worked for you before, take note of the dosage and make sure you get the same medication the next time.

It’s also important to avoid taking alcohol, sedatives (sleep medications), or tranquilizers while taking some antihistamines.  This information can also be found in the Drug Facts label, Filie says. Alcohol and sedatives can seriously increase the sedative effects that already may occur when taking antihistamines.

Rowley also cautions against self-medicating. “If the correct dosage isn’t providing you the relief you expect, don’t simply keep taking more and more of that product,” she says, “but instead, consult your health care professional”.

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Always follow directions for use and read warnings on the packages of the drug products you purchase.Some antihistamines may cause drowsiness, and you need to exercise caution when driving a motor vehicle or operating machinery. Avoid using alcohol, sedatives, and tranquilizers while taking the product because they may increase drowsiness.Know that some antihistamines take longer to work than others. Recognize that you might feel the sedating effects of these medications for some time after you’ve taken them and possibly even the next day.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

May 29, 2013

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Mentoring for new cancer survivors

 

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This week, I'd like to put a call out to all of the veteran cancer survivors who are reading and participating on the blog. One of the primary goals for the blog is to support and reassure each other on this journey.

My question to you is this: "What do you know today that you wish you'd known in the beginning as a new cancer survivor?"

We frequently partner mentors with newly diagnosed cancer patients in person. I thought it would be interesting to try virtual mentoring through this discussion.

If you're interested in posting your pearls of wisdom for other survivors, keep a few things in mind as you write your comments.

In the first year after diagnosis:

What did you experience that was most unexpected? What about your emotions in the first weeks and months? It's OK to talk about the negative feelings too — that way everyone knows this is a normal experience.What was the most difficult experience of the first year? What helped you get through?

Everyone's experience is unique — however, it can be a great comfort to hear from others who've already been down the path yet to come. Please share your words of support and wisdom.

Follow me on Twitter at @SherylNess1. Join the discussion at #livingwithcancer.

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Cat Allergy

The major cat allergen, called Fel d 1, is found in cat saliva, dander from sebaceous glands in the skin, fur, and anal sebaceous glands. Other cat allergens, including albumin, are found in the urine, saliva and blood. Allergy to cats is extremely common, occurring in up to 25 percent of people with allergies. Cat allergy is more common than allergy to dog dander, which may be related to the potency of cat hair and dander as an allergen as well as the fact that cats are not generally bathed. Cat allergen is produced in large amounts, particularly by male non-neutered cats as the allergen is partially under hormonal control. The dander is constantly airborne, sticky, and found in public places, even where there are no cats. This is due to the dander being carried on the clothing of people who have cats, then shed in public places. Therefore, cat allergen is a component of house dust, even in homes where a cat has never lived.

The size of the cat dander particles is extremely small, and is inhaled deep into the lungs. Cat dander is therefore a common cause of allergic asthma, and cat owners who are allergic to cats are more prone to the development of asthma symptoms.

For people with cat allergy, avoidance of cats is the mainstay of therapy. Allergy medications are likely to help control symptoms, but in many instances symptoms may persist if the person owns one or more indoor cats. Allergy shots may also be a good treatment option for people who are allergic to their pet cats.

Cat owners may not want to part with their pets, despite the symptoms they endure. Short of getting rid of the cat, here are some ways to decrease cat allergen exposure for cat owners: Ensure the cat is neutered Bathing the cat at least once or twice a week Wiping the cat with a wet cloth or hand towel daily Remove the cat from the bedroom, close the bedroom door and air vents to the bedroom Keep the cat outside or in the garage, or in a part of the home with an uncarpeted floor Vacuum frequently with a HEPA-equipped vacuum cleaner Purchase a HEPA room air cleaner for use in the bedroom and/or other parts of the home (it is best to keep the HEPA filter off of the floor so as to not stir up more dust) Follow house dust mite avoidance precautions If the above measures do not help to reduce allergic symptoms, getting rid of the pet cats may be needed, particularly for people with uncontrolled asthma. Cat dander will persist for months to years in the home even if the cat is gone – therefore it is important to clean thoroughly steam clean all carpets and upholstered furniture launder or dry clean all bedding and curtains vacuum all hard floors wipe down all hard surfaces and furniture replace any air conditioner and heater vent filters

Want to keep learning? Find out more about how to avoid common indoor allergens.

Source:

Platts-Mills TAE, Vaughan JW, Carter MC, Woodfolk JA. The Role of Intervention in Established Allergy: Avoidance of Indoor Allergens in the Treatment of Chronic Allergic Disease. J Allergy Clin Immunol. 2000; 106:787-804.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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Study: Food Allergies Affect 1 in 13 Kids

kids, or about 1 in 13, are allergic to at least one food. That works out to 5.9 million kids in the U.S.

Among the kids with allergies, the most common foods causing problems are peanuts (25 percent), milk (21 percent) and shellfish (17 percent).

These data suggest that food allergies in kids may be even more common than some have estimated before. A 2007 survey from the Centers for Disease Control and Prevention put the prevalence of food allergies at 4 percent.

The results from the latest study were just published online by the journal Pediatrics.

Among the findings: 39 percent of the allergies cause severe reactions. Nut allergies are the worst. And teens are the most prone to severe allergic reactions.

Note that the study was funded by the Food Allergy Initiative, an advocacy group. Dr. Ruchi Gupta, lead author and a pediatrician at Children's Memorial Hospital in Chicago, declared in the paper that she had full access to the data and takes full responsibility for the analysis.

Now, just what constitutes a food allergy is a little fuzzy. "Food allergy has no universally accepted definition," as was pointed out in a comprehensive review of the medical literature on the subject that was published in JAMA last year. That's made precise estimates of the condition a little difficult.

The authors of that big review concluded food allergies affect at least to 1 percent to 2 percent of the U.S. population, but less 10 percent.

View the original article here

Spice Allergy

 A spice is any part of a plant that is used for the purpose of seasoning or flavoring food. Spices may be obtained from the bark, leaves, seeds, roots, buds, fruit or other part of the plant. Compared with spices, an herb is usually obtained from the leafy part of a plant, and is also used to season or flavor foods. Most people use the terms spice and herb interchangeably.

As with other foods, allergy to spices is possible. While spice allergy is considered to be fairly rare, affecting between 5 to 10 people for every 10,000 people, it is probably under-diagnosed. Many species have biological functions that enhance their ability to result in sensitization. For example, black pepper inhibits cell transport of ions, causing swelling of cells; capsaicin enhances its own intestinal absorption, possibly resulting in higher rates of sensitization.

Exposure to spices can occur in a variety of ways, most commonly as a result of eating foods containing spices. However, exposure can also occur through contact with the skin, such as with handling foods and from cosmetics that contain spices, as well as through inhalation of airborne spices from occupational exposures (such as in the food industry or spice factories).

Everyone remembers the cartoons from their childhood where certain characters where made to sneeze after getting a nose full of black pepper. And, most people have experienced, during one time or another, the symptoms of a runny nose and watery eyes after eating spicy foods, such as horseradish or chili pepper. These symptoms are not caused by the immune system, but rather from irritant affects on mucus membranes. Skin rashes can also occur as a result of irritant contact dermatitis from direct skin exposure to spices found in foods or cosmetics.

True allergic reactions can also occur as a result of eating spices, inhaling spices or skin contact with spices. Allergic symptoms from eating spices most likely would include urticaria and angioedema, but could also include gastrointestinal symptoms, respiratory symptoms, as well as anaphylaxis. Inhalation of spices could result in symptoms of asthma, as well as swelling of the airway, including angioedema. Skin contact with spices could result in urticaria, atopic dermatitis, as well as allergic contact dermatitis at the site of skin contact.

The diagnosis of spice allergy is suggested by the symptoms that a person experiences with exposure to the spice. It is possible to perform allergy testing to many spices, either with a commercial allergen extract or with making a homemade extract with a fresh spice. Hot spices, such as cayenne pepper, cannot be used for skin testing because of their irritant effect. Blood testing for the presence of allergic antibodies to spices, are also available to a limited extent. Patch testing to spices can be performed to diagnose contact dermatitis to spices, likely with homemade extracts given the lack of commercially available versions. Treatment of spice allergy mainly involves the avoidance of the spice in question. The treatment of immediate symptoms of allergy would be identical to the treatment of food allergy, including the use of antihistamines and injectable epinephrine for severe reactions. Treating contact dermatitis caused by spice allergy would include the use of topical corticosteroids, or possibly systemic corticosteroids for severe symptoms.

Avoidance of specific spices may be very difficult, given that many foods simply list "spices" or "natural flavoring" on the ingredient list. In addition, dining out at restaurants for a person with a spice allergy may be virtually impossible, as many chefs may not be willing to divulge their "secret recipe" of a mixture of spices. Avoiding spices in products other than foods may also be difficult, since spices are found in a number of household toiletry items such as toothpaste, mouthwash, fragrances, cosmetics and body lotions.

Since spices are derived from plant sources, it makes sense that certain spices may be related to one another, as well as to pollens and other plant-based foods. These relationships may lead to cross-reactivity, meaning that an allergy to specific pollens might lead to an allergy to related spices. The following list shows the cross-reactivity between spices, pollens and other foods: Oregano and thyme Onion and garlic Paprika and mace Mustard and rapeseed Mustard and tree nuts Sesame and tree nuts Cottonseed and walnut Birch pollen and various spices Mugwort pollen and various spices Celery and various spices Carrot and various spices Fenugreek (often associated with curry) and peanut

Read about allergy to food additives and preservatives.

Source:

Chen JL, Bahna SL. Spice Allergy. Ann Allergy Asthma Immunol. 2011; 107:191-199.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

View the original article here

Drug Allergy

 Reactions to medication are extremely common. In fact, 15-30% of all hospitalized patients will experience an unintended reaction as a result of medications. However, true allergic reactions to medications only occur in about 1 of 10 of all adverse drug reactions. Before we can discuss the huge topical of medication allergy, we need to group reactions to drugs into one of 2 categories: Reactions which are common and predictable in any person. This would include expected side effects from medications, interactions between 2 medications that the person is taking, and reactions from using too much of the medication (overdose). This group represents the majority of all reactions to medications. Reactions which are unpredictable, and only occur in certain people. These reactions can include an unexpected side effect, medication intolerance, allergic reactions and other non-allergic immunologic reactions. True allergic reactions to medications typically follow certain features: The first time the medication was taken there was no reaction. The medication is either taken for a period of time (usually at least 1 week) without problems or there is at least a week before the medication is taken again. The reaction that occurs from the medication is different from expected side effects. The reaction is suggestive of allergy or anaphylaxis. The symptoms of the reaction disappear within a few days of the medication being stopped. Skin rashes are the most common symptoms occurring from adverse drug reactions. Urticaria and angioedema suggest an allergic cause, while blistering, peeling and sun-burn like reactions suggest a non-allergic immunologic causes. When a rash blisters and peels, is painful or involves sores in the mouth and mucous membranes, Stevens-Johnson Syndrome or toxic epidermal necrolysis is the likely diagnosis, which can be life-threatening.

Other non-allergic immunologic symptoms can include fever, kidney failure, hepatitis and blood problems (such as anemia).

People can experience allergic reactions to just about any medication, although some are more common than others. Here is a list of the most common medication allergies (or non-allergies, in some cases): 1. Penicillin (and all related antibiotics). About 1 in every 10 people reports a history of an “allergic reaction” to penicillin. It turns out that much less than 10% of those who think they are allergic to penicillin actually are. However, people with a true allergy to penicillin could have life-threatening anaphylaxis as a result, it is important to tell your doctor about your past reaction to the medication. Skin testing to penicillin can help determine if the past reaction was a true allergy or some other side effect.2. Cephalosporins (and all related antibiotics). Severe reactions to cephalosporins are much less common than with penicillins. However, there is a small chance that someone with a true penicillin allergy could also react to cephalosporins, since the drugs are related. An allergist may be able to help determine if these antibiotics are safe for you.3. Sulfonamides (including antibiotics, oral diabetes medications and some water pill diuretics). It is unclear whether these reactions are truly allergic or due to another immunologic process. There is no reliable test available to determine is a person is allergic to this class of medications.4. Non-Steroidal Anti-Inflammatory Drugs (NSAID), including aspirin, ibuprofen and naproxen. This class of medications can cause allergic and non-allergic flares of hives/swelling, worsen asthma, and result in anaphylaxis. There is no reliable test available for most people with reactions to these medications.5. IV Contrast Dye. This reaction is non-allergic but can result in anaphylaxis because the high concentration of the dye causes mast cells to release their contents, which mimics an allergic reaction. While there is no test available for reactions to IV contrast, most patients can take the dye safely by taking oral steroids and anti-histamines hours before the contrast is given. The contrast is usually given in a less concentrated form to these patients. Let your doctor know if you’ve had a past reaction to IV contrast before receiving it again.6. Local Anesthetics. True allergic reactions to local anesthetics (novocaine, lidocaine) are extremely rare, and usually due to other ingredients in the medication, such as preservatives or epinephrine (present in the local anesthetic to make the medication last longer once it’s injected). An allergist can perform testing to various local anesthetics and find one that works for almost everybody.7. General Anesthesia. Some medications used during surgery are very common causes of true allergic reactions and anaphylaxis. If you think you experienced an allergic reaction during or shortly after surgery, an allergist may be able to help determine the cause.8. Anti-Seizure Medications. Many medications used for treatment of epilepsy can cause non-allergic reactions as a result of certain enzyme deficiencies in the person taking the medication. Symptoms can include a rash, fever, body aches and hepatitis. There is no test available for this type of reaction.

Learn about the treatment for allergic drug reactions.

Sources:

Practice Parameters for Drug Hypersensitivity. Ann Allergy 1999; 83:S665-S700.

Macy E. Drug Allergies: What to expect, what to do. J Respir Dis. 2006;27:463-471.

Mellon MH, Schatz M, Patterson R. Drug Allergy. In: Lawlor GJ, Fischer TJ, Adelman DC, eds. Manual of Allergy and Immunology. 3rd ed. Boston: Little, Brown and Co;1995:262-289.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

View the original article here

Advair: Safety, Side Effects and the Black Box...

 Advair, a commonly used medication to treat asthma, has been given a "black box" warning by the FDA.

Daniel More, MD Advair (fluticasone/salmeterol) is an inhaled medication used to treat asthma and COPD. It is a combination medication consisting of an inhaled steroid and a long-acting form of albuterol, called Serevent (salmeterol). The combination of these medications works especially well to control the inflammation in asthma. The salmeterol does not replace the need for rescue inhalers, such as albuterol, which are still needed for the immediate relief of asthma symptoms. Advair currently has a “black box” warning, which a precautionary statement given to the medication by the Food and Drug Administration. This warning has come about as a result of various studies on the safety of salmeterol. The largest study, called the SMART trial, showed a small increase in the risk of death and hospitalization asthma and breathing problems when taking salmeterol, particularly in African-American patients. For this reason, the FDA has placed a “black box” warning on salmeterol, as well as Foradil (formoterol), which works in much the same way.

The SMART trial did not study Advair, but since Advair contains salmeterol, the “black box” warning was also given to this medication. In fact, any medication that contains salmeterol or formoterol also has the same “black box” warning.

Salmeterol and formoterol are long-acting beta-agonists (LABAs) used in the treatment of moderate and severe asthma. LABAs are not an adequate controller therapy by themselves for asthma, and can potentially cause life-threatening asthma attacks if used alone. This fact has been known for years, just as it is well-known that overuse of albuterol, or any other rescue medication, can place a person at risk for severe asthma attacks, and even death from asthma. A person with asthma therefore should always use an inhaled steroid for treatment of their asthma when a LABA is required.

Unfortunately, the SMART trial did not address whether a particular patient was taking an inhaled steroid for their asthma, only if salmeterol was safe by itself in the treatment of asthma. Most of the patients with the most severe asthma, particularly African-American patients, were not taking an inhaled steroid when placed on the LABA. However, when the study went back and looked at the patients who were taking an inhaled steroid along with the LABA, there did not appear to be an added risk of severe asthma attacks or death from asthma, even in the African-American patients.

The FDA states that a LABA medication should not be used if a person with asthma is controlled on an inhaled steroid alone. If asthma is not controlled on an inhaled steroid, or the level of asthma is classified as being moderate to severe, then combination therapy including an inhaled steroid and a LABA is a good choice of therapy. Other treatment choices include increasing the dose of the inhaled steroid or the addition of another medication such as Singulair (montelukast) or theophylline. These other medication choices may not control asthma as well as the combination of an inhaled steroid and LABA.

For most people with moderate to severe asthma, or those whose asthma is not controlled on an inhaled steroid alone, the benefits of a LABA medication outweigh the risks. However, it is important for a person to know the risks and benefits of taking any medication, particularly those with a “black box” warning.

See the FDA warning letters on medications containing LABAs.

Want to keep learning? Find out more about the treatments for asthma.

Sources:

Aaronson DW. The “Black Box” Warning and Allergy Drugs. J Allergy Clin Immunol. 2006;117:40-4.

Nelson HS, Weiss ST, Bleeker ER, et al. The Salmeterol Multicenter Asthma Research Trial. Chest. 2006;129:15-26.

Nelson HS. Long-Acting Beta-Agonists in Adult Asthma: Evidence that these Drugs are Safe. Primary Respiratory Care Journal. 2006;15:271-77.

DISCLAIMER: The information contained in this site is for educational purposes only, and should not be used as a substitute for personal care by a licensed physician. Please see your physician for diagnosis and treatment of any concerning symptoms or medical condition.

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