Healthy isn?t something you are or aren?t. It?s a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It?s a balance between living well and taking care, and you can start right where you are.
A blog by Christina Elston
Healthy isn't something you are or aren't. It's a hundred little things: eating a banana, walking in the park, putting a bandage on a boo-boo, playing tag, reading up on ways to keep you and your family well and safe. It's a balance between living well and taking care, and you can start right where you are.


Archive for the ‘Allergies & Asthma’ Category

Eight Percent of L.A.’s Childhood Asthma Due to Traffic Pollution

Monday, September 24th, 2012

At least 24,000 children in L.A. County have asthma because they live near busy roadways and breathe in the pollution belched out by a never-ending procession of cars and trucks, says the latest in a stream of studies linking air pollution and breathing problems.

And previous estimates of how air pollution exacerbates childhood asthma may actually have underestimated the burden smog exposure places on society, USC researchers reported online Sept. 24 in the journal Environmental Health Perspectives. This study looked specifically at Los Angeles County, but the consequences of air pollution in other metropolitan areas where children live near major traffic corridors (especially within 250 feet of a busy roadway) are also likely underreported, the study’s authors conclude.

The researchers used data from the ongoing Children’s Health Study, which has been recording effects of air pollution since 1993, plus regional air pollution measurements from the U.S. Environmental Protection Agency and other sources. They concluded that cutting children’s exposure to near-roadway pollution 20% would mean 5,900 fewer cases of childhood asthma in the county, while a 20% increase would yield that many additional cases. Currently there are around 300,000 cases of childhood asthma county-wide.

The researchers also examined state of California policies intended to cut greenhouse gas emissions from vehicles by improving fuel efficiency – but also by increasing use of public transportation. The policies would offer developers incentives to build housing projects located closer to bus or rail service hubs to boost public transit use.

The problem? Bus and rail stops are often located on or near busy roads, so the state’s plan to clean up the air for our kids could actually place more of them close to the source of the pollutants. The researchers note that more study is needed so that the state can develop policies that reduce sprawl and encourage mass-transit use, while also minimizing kids’ exposure to vehicles still on the road.

Ready-For-School Allergy-Asthma Update

Monday, July 23rd, 2012

Every year, more than 15 million school days are lost to asthma and allergies, making back-to-school time a great time for a few reminders for parents:

• Have a plan. If your child has asthma or allergies of any kind, your child’s school needs to know. Make sure you have contacted the school and filled out paperwork that will make everyone aware of your child’s condition and give your child access to needed medications on campus.

• Have medications on hand. If your child needs an inhaler for asthma, or an EpiPen or antihistamines for allergies, make sure those are always available at the school. “They should have it with them. It shouldn’t be across campus with a nurse,” says pediatric allergist Roger Katz, M.D., a clinical professor at UCLA School of Medicine with a private practice in Santa Monica. He says that delays in getting these medicines could be life threatening.

• Remind kids and school personnel about food allergies. Even children who know what they aren’t supposed to eat might be tempted by food offered by a classmate.

While fall means the start of gym classes that could aggravate exercise-induced asthma, and Santa Ana winds that bring extra pollen from the high deserts to torment allergy sufferers, there are also new tests and treatments on the horizon.

One, called FENO (fractional exhaled nitric oxide), allows doctors to easily gauge inflammation in the airways. Patients exhale into a machine that measures the amount of nitric oxide (NO) they exhale, which goes up when inflammation is present. Becoming more widespread, FENO is best for ages 6 and up, is covered by some insurance companies (and costs around $50 without coverage), and Katz says his Santa Monica practice has had it available for about 18 months.

For children with allergies, identifying the sources of their suffering is now also much easier, as skin testing for allergy has become more accurate. Experts have now identified the exact antigens for things like cat, dust mite, grass, pollen bee venom and other allergies, allowing for quicker and more accurate diagnosis. “All of these are better today than they were five years ago,” Katz says.

Easier treatment of some of these allergies is also on the way. Instead of allergy shots to help kids become less sensitive to allergens like dust mites and grasses, doctors will be able to provide “oral desensitization,” placing small, controlled amounts of the allergen under the tongue to build tolerance. Katz expects these therapies to be approved by the U.S. Food and Drug Administration and on the market in the next six months.

In a study published July 19 in the New England Journal of Medicine, researchers from Johns Hopkins Children’s Center reported that this type of therapy also showed promise in children with egg allergies (which as many as 3% of children have by age 3). During their study, funded by the National Institutes of Health, they found that 11 of 35 patients treated with egg immunotherapy experienced complete, long-term elimination of allergic reactions, and the remaining 24 were able to tolerate higher doses of egg with mild or no symptoms – offering a protection against serious allergic reactions from accidental exposure.

They note, however, that the treatment is still considered experimental, and should yet be used outside medical research studies.

 

 

Many Obese Children With Asthma Held Back By Weight, Not Breath

Wednesday, May 9th, 2012

Two current health crises in children – asthma and obesity – often strike together. And among kids dealing with both, lack of physical activity frequently comes in to create a “perfect storm” that hits health hard.

Looking at one of these kids, it is easy to imagine a sequence of events:

1. The child is diagnosed with asthma.

2. Asthma impairs the child’s ability to exercise.

3. The child gains weight.

But if a child’s asthma is well controlled, this doesn’t have to be the case. That is the message from new research out of The Children’s Hospital at Montefiore and Albert Einstein College of Medicine in New York.

Pediatric pulmonologist Deepa Rastogi, M.D., and colleagues found that when obese children with asthma were asked to walk for six minutes, it was their obesity – not their lung function – that held them back.

Researchers looked at 140 children, among them obese children with and without asthma, and normal-weight children with and without asthma. All children in the study with asthma had their disease under good control, meaning they had not needed prednisone, a medication used to treat an exacerbation, in at least three months. Researchers tested each child’s lung function and measured the distance they could walk in six minutes.

For children who were not obese, both asthmatic and non-asthmatic, their distance was linked to their lung function. The lower their lung function, the less ground they could cover.

But for obese children, their distance was linked to their BMI (a measure of weight compared to height). Whether or not they had asthma, the higher their BMI, the shorter the distance they could walk.

“If you have well-controlled asthma, then your exercise limitation may not be your asthma, it may be your body weight,” says Rastogi.

She explains that parents often discourage children with asthma from being active because they are afraid of bringing on attacks. “By the time they are in school they become programmed that they have asthma and they can’t exercise, and by then we have missed the opportunity to teach parents about keeping their children active with appropriate use of controller medications,” Rastogi says. Instead, the focus should be on keeping kids as active as they can be while maintaining good control of asthma.

Her message to parents is to partner with their healthcare provider to get their child’s asthma under control. “That’s the first step, always,” she says. “Then, with good control, encourage activity. If it appears that your child is limited in their exercise ability, talk to your health care provider to investigate further into the cause for the limited ability.”

Her study was published in March in the journal Pediatric Pulmonology.

Allergic To Peanuts or Tree Nuts? Know What One Looks Like?

Monday, March 26th, 2012

Just over 1 percent of us in the U.S. are allergic to peanuts or tree nuts, and much of the effort to protect those with allergies has been focused on food labeling and rules about food served in schools. It turns out one simple area has been neglected: Helping people identify the nuts in their raw form.

Adults and children in a study out this month from Ohio State University could identify fewer than half of nuts shown to them.

Stationed outside an exhibit at the Columbus Center Of Science and Industry, researchers convinced 649 adults and 456 children to try their luck identifying samples of peanuts, cashews, Brazil nuts, pistachios, almonds, pecans, walnuts, hazelnuts, Macadamia nuts and pine nuts. The 19 samples included nuts both in and out of the shell, whole, chopped, sliced or diced as they might appear in a grocery store.

On average, participants could identify just over 44 percent of the samples. Those with food allergies, or who were parents of children with food allergies, did no better than those without. Adults overall did slightly better than children. Peanuts in the shell were the easiest for people to identifiy, and hazelnuts in the shell proved toughest. The study was published in Annals of Allergy, Asthma & Immunology.

Lead author of the study Todd Hostetler, M.D., says nut knowledge in the general population could be even lower, as people who felt less confident in their success would be less likely to agree to take the survey. Either way, the results point to the need for better education for those with nut allergies and their families. In his allergy clinic, Hostetler says he uses the samples from the study to help his patients brush up on their nut identification skills, but he realizes this tool might be too clunky for mass production. A photo flip book or an online tool might be more practical.

“In my opinion, looking at real peanuts and tree nuts is better than looking at pictures,” he says, “but at this point any education done about this is better than none!”

Though most people with an allergy to peanuts and tree nuts are told to avoid all nuts, Hostetler says he and other allergists see many patients who accidentally ingest them anyway. “My hope is that the more educated patients and their families are about what peanuts and tree nuts look like, especially in different forms (e.g. which nuts are often slivered or often crushed) the more successful they will be at avoiding them,” he says.

 

Costs From Childhood Asthma Soaring

Friday, January 27th, 2012

In Long Beach and Riverside, traffic-related pollution is adding $18 million per year to the cost of childhood asthma, almost half of which is due to new asthma cases caused by pollution. That’s the finding from a study released Jan. 25 in the online European Respiratory Journal. The study is the first cost estimate to include cases attributable to air pollution.

Researchers from University of Massachusetts Amherst with colleagues from Switzerland and USC looked at costs such as parents’ missed time from work, extra doctor visits, travel time and prescriptions. Their findings include:

• A single episode of bronchitic symptoms (cough, congestion or bronchitis for three months in a row) in a child with asthma cost an average $972 in Riverside and $915 in Long Beach

• Total annual cost for a typical asthma case was $3,819 in Long Beach and $4,063 in Riverside

• The estimated yearly cost for families coping with asthma in Long Beach and Riverside represents 7 percent of median household income in those communities, a level too high to be sustainable for most.

The largest share of the cost of asthma was the indirect costs to parents missing work because their children are out of school, the authors noted. They say traditional assessment methods have underestimated the financial burden of asthma on families, and the cost of the disease due to air pollution. And because Riverside and Long Beach account for 7 percent of California’s total population, they estimate that air pollution’s contribution to the cost of asthma state-wide is “truly substantial.”

What We All Need To Know About EpiPens

Friday, January 13th, 2012

The death of a 7-year-old girl at her Virginia elementary school earlier this year grabbed national headlines and left school officials and others scrambling to explain the lack of a simple little device that could have saved her life.

The girl was allergic to peanuts and died of a severe reaction. The device is an epinephrine auto-injector, more commonly known by its brand name, EpiPen. And with the food allergy rate among American children at around 4 percent (and climbing by many accounts), it isn’t just parents of allergic children who need to know a thing or two about these potentially life-saving gizmos.

 

Who Needs One?

Epinephrine auto-injectors are designed to allow a person without medical training to easily inject someone having a serious allergic reaction with the drug epinephrine, which should halt the reaction and could save the person’s life. You just remove the safety cap, hold the device against the thigh and push the plunger to release the spring-loaded hypodermic.

Nut allergies account for 85 percent of fatal allergic reactions in the United States, so people with nut allergies make up the majority of the EpiPen-holding population. “Anyone who has a nut allergy needs an Epi Pen,” says Roger Friedman, M.D., an allergist with Nationwide Children’s Hospital in Ohio. But people with other types of serious allergies also have EpiPen prescriptions.

Click here for tips on storing and using an EpiPen …

Back To School … Back To Asthma

Friday, August 26th, 2011

back-to-asthmaAs classrooms welcome students back each year, emergency departments welcome a 46% increase in asthma-related visits from kids. Here are a few tips from the American College of Allergy, Asthma and Immunology to help yours stay out of the ER:

Stay off the carpet. Dust mites and other allergens can multiply in classroom carpet, so have your child sit on a chair instead of the floor for story time.

Check the bathrooms. Ask your school principal to let you have a look in the school bathrooms. Alert the school about any mold you see growing, so it can be cleaned up.

Shut pollen out. Ask your child’s teacher to keep classroom windows closed, especially in the morning when pollen counts are highest.

Give them a shot. A seasonal flu shot can help bolster your child’s immune system.

Practice hand hygiene. Teach your child to wash frequently, and use tissues and hand sanitizer, to fend off colds that can aggravate asthma.

Exercise caution. If your child is one of the 80-90% of kids with asthma who have trouble breathing during or after exercise, see an allergist who can help with a prevention and treatment program. Share it with your child’s gym and homeroom teachers.

Pick hairless pets. Fish and hermit crabs make great class pets without the allergy-triggering dander of hamsters and bunnies. If your child’s class does have a furry pet, make sure they keep hands off.

Manage the menu. Many kids with asthma also have food allergies. Let your child’s teacher, scout masters and other club leaders know about any foods that cause problems for your child.

Find plenty more tips for this school year and beyond at www.AllergyAndAsthmaRelief.org.

1 Million Kids With Asthma Wrongly Prescribed Antibiotics Yearly

Tuesday, May 24th, 2011

asthmaWhen should doctors prescribe antibiotics to treat asthma? “The answer in 2011 is that they shouldn’t,” says Ian M. Paul, M.D., associate professor of pediatrics at the College of Medicine at Penn. State. Yet Paul and his colleagues have found that doctors do – about a million times a year.

Their study, published online May 23 and in print in the June issue of Pediatrics, looked at more than 60 million cases where children across the U.S. visited their doctors or the emergency room for asthma treatment from 1998 to 2007. They found that antibiotics were prescribed inappropriately at as many as 1 in 6 of these visits.

Healthcare experts have long been concerned about the over-prescribing of antibiotics because it can lead to the evolution of bacteria that is antibiotic resistant. The only time children with asthma should receive antibiotics is if they have an additional diagnosis – maybe a bacterial infection such as pneumonia – where the drugs would be needed.

Based on this study, researchers couldn’t determine why exactly doctors ignore guidelines and prescribe antibiotics for asthma. But they did note that children who received systemic corticosteroids (indicating a more severe attack) to treat their asthma were also more likely to receive antibiotics. “I can surmise from that that those kids were sicker, and the doctor wanted to throw the kitchen sink at it,” says Paul. Also, because asthma and pneumonia share some signs and symptoms, it is possible doctors prescribe antibiotics when they aren’t certain of their diagnosis.

Surprisingly to Paul, this is less likely to happen in emergency departments than at the doctor’s office, though the study offers no clues as to why. But in either type of visit, discussion with the doctor is key. “We found that when the doctors spent the time to educate families about asthma, they were 50% less likely to prescribe antibiotics,” Paul says. So parents should ask a doctor prescribing antibiotics to their asthmatic child what the medication is supposed to treat. If the doctor seems uncertain about the diagnosis, it’s reasonable to ask about a 24-hour waiting period to see whether asthma medications help with your child’s symptoms. “It’s really about communication with your doctor,” Paul says. Either way, ultimately, you’ve got to trust your doctor, so make sure your doctor is someone you trust.

New Food Allergy Guidelines Stress Need For Thorough Testing

Monday, December 13th, 2010

food-allergyIs your child one of the millions (approximately 3 million in the U.S., the CDC said in 2008) diagnosed with food allergies? New government guidelines suggest you should pay attention to how that diagnosis was made.

Among other things, the guidelines, released Dec. 6 by the National Institute of Allergy and Infectious Diseases and a panel of experts, stress that doctors should not rely on any single test to determine whether or not someone is allergic to a particular food. And this means you probably shouldn’t rely on your pediatrician to confirm a food allergy, says Stanley Fineman, M.D., president-elect of the American College of Allergy, Asthma and Immunology. Only an allergist is likely to test thoroughly enough for a good diagnosis.

This guidance suggests that the burgeoning number of food-allergy cases – which nearly tripled among kids between 1997 and 2006, according to government research – has been accompanied by at least some misdiagnosis, probably because doctors rely too much on blood tests or skin-prick tests alone. Fineman, who was not involved in writing the guidelines, says that anyone identified as having food allergies based on “one blood test in one office one time” might benefit from letting an allergist take a closer look.

Tools an allergist might employ include taking a health history, performing a full medical evaluation, a blood test, and a skin scratch test. In some cases, these are supplemented by what Fineman calls a “cautious oral challenge,” where a child eats a very small amount of the food in question in an allergist’s office, where the doctor is equipped to deal with allergic reactions. (Don’t try this at home!)

A recheck might even be in order for children with a solidly diagnosed food allergy, because many outgrow their allergies over time.

Giving allergy-free kids the all-clear to eat a regular diet is important for good nutrition, Fineman says. He’s concerned about children who visit him “and they’ve had one blood test and been told they’re allergic to half a dozen different foods and they’re on a restricted diet.” Frequently taboo are milk and eggs. “Those are two good sources of protein that children often rely on,” he explains. “You don’t want to restrict those foods without a good diagnosis.”

These initial guidelines are meant to help healthcare providers. A “translation” for the general public is due out in early 2011.

Other points stressed in the guidelines:

• Scientific evidence doesn’t support use of blood test called the IgG assay, which looks for a type of antibody thought to suggest a subtle type of food allergy, to make allergy diagnoses.

• Oral food challenges (the gold standard) aren’t used often enough to confirm suspected cases of food allergy.

• People of all ages with known food allergy should have ready access to self-injectable epinephrine in case of severe allergic reaction.

• Immunotherapy treatments – where someone is exposed to small amounts of an allergen over time to build tolerance – hasn’t yet proven safe and effective in treating food allergies.

And if you’re pregnant or breastfeeding and trying to keep your child from developing food allergies by monitoring your own diet, the jury is still out. The panel that developed the guidelines says there isn’t enough evidence yet to say that avoiding or eating certain foods will increase or decrease your child’s risk.

Check out a National Institute of Allergy and Infectious Diseases “What’s In It For Patients” guide to the guidelines … 

Visit the American College of Allergy, Asthma & Immunology and check out their “Ask the Allergist” feature …