Friday June 23, 2017

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October 09

Asthmatic Children

Your Child Has Asthma

Advice about the condition.

By Dr. Leonard Bielory, M.D., and Dr. Loren Rosenberg

If your child has been diagnosed with asthma, the first step is for you to understand what is happening to your child when asthma strikes. During an asthma attack, the tubes (bronchi) carrying oxygen from the windpipe to the lungs are narrowing as the muscles around those tubes tighten, and the lining of those tubes are swelling with inflammation while the tubes are filling with mucous.

What brought on a first asthmatic episode and what might spur future episodes? If inflammation is the major culprit, what can cause inflammation in your child?

Triggers

  • Infection. Especially in young children, infection is the most common cause and maybe the only cause of asthma. As a child ages beyond 2 to 3 years, episodes caused by infection decline and may disappear.
  • Chemicals. Cleaning agents used in the home, second-hand tobacco smoke and scented cosmetics are frequent irritants that precipitate an asthmatic episode in a sensitive child.
  • Outdoor air pollution. Stagnant air increases pollution in times of high humidity, such as when there’s a smog alert. This especially occurs in metropolitan areas with high vehicle emissions and residences that are adjacent to industrial sections of the neighborhood with significant smokestack and vehicle emissions.
  • Cold air. Sudden cold air inhalation and intense exercise can also provoke attacks.

Allergens

Some of us are wired differently. And instead of accepting a substance, our bodies get upset. The part of the body that gets out of whack is called the immune system. It sends out messages that cause us to itch, sneeze, wheeze and weep, as well as incite our noses to drip.

The most common allergens are household agents such as dust mites, pet dander, down/feathers and roaches.

Outdoor agents like pollens are seasonal allergens, beginning with tree pollination in the early spring and subsiding late in May. Grasses mainly affect people in late spring into early summer, while weeds cause allergic reactions in late spring through the summer. Ragweed pollen causes reactions from mid-August through September. Blanketing this whole period are mold spores from early spring to a hard frost with peaks during high humidity and decaying vegetation in the fall.

Foods may also generate the allergic antibody causing different reactions like asthma in people. Though it’s common to hear about allergies provoked by milk, egg, wheat, nuts and peanuts, unusual items like celery can cause allergic reactions, notably when eaten by certain individuals just before intense exercise. Some foods precipitate an episode only when eaten during a patient’s “allergy season” and may be eaten with impunity at all other times.

From aspirin to penicillin, medications can also be allergens. However, there is no way to predict or test if a person is allergic to a medication if a reaction has never occurred. If you or your child experience a reaction while taking a medication, seek a specialist’s advice.

If a child has asthma, is it likely that he or she will react to all or most of the above agents? Not at all. Be aware of the exposures that occurred during the few hours before the onset of an episode. This proves a great help for a trained physician to evaluate and possibly test for highly suspect culprits that can cause asthmatic attacks. Once you’re able to identify the triggers and/or the allergens that cause an episode, you can proceed to the next steps.

Prevention

Follow these tips to eliminate or minimize exposure to triggers.

  • Don’t allow smoking anywhere in the entire home nor in the vehicle the asthmatic child travels in.
  • Identify and eliminate household cleansing agents and cosmetics that have precipitated an episode.
  • Minimize exposure to the outside environment if known to precipitate or exacerbate respiratory distress. If exposure is necessary, insist that the child wears a quality mask, like a HEPA filter mask.
  • Minimize sudden cold temperature exposure. And when known to precipitate an attack, strenuous elective physical activity in a cold environment should be eliminated. That said, no one should become an “asthma cripple.” Encourage continued exercise in the proper conditions.
  • Eliminate known allergic agents and triggers. Whether your child appears allergic to an animal, feathers in furnishings, foods, medications or scented agents, removing allergens to which your child reacts is the best prevention for avoiding episodes. Some allergens that cannot be eliminated from the household can be reduced by protective covers, filters and bedding washed frequently in very hot water (130-plus degrees). For people allergic to roaches, frequently inspect for the bugs and appropriately rid the home of any.

While outdoor allergens and triggers cannot be eliminated, you can significantly reduce if not eliminate activities that bring your child into contact with problematic agents. This reduces the frequency and severity of asthmatic episodes and/or allergic reactions.

  • Use high efficiency filtering systems in air conditioning systems to reduce allergens and other triggers generated within the home and those that find entrance through the opening of windows and doors.
  • Encourage the elimination of window opening during early springtime (tree pollen season) through times of frost (the decline of the outdoor mold season).
  • Avoid outdoor activities during high pollen counts (dawn to 10am and in the late afternoon until dark), if your child is sensitive to those agents.

If the above steps do not significantly reduce the frequency and the severity of episodes of asthma, numerous preventive medications can be taken on a daily basis.

The leading agent of prevention to airborne allergens is immunotherapy. It reprograms people with susceptible immune systems by decreasing the body’s production of the allergic antibody, which starts the chain reaction to asthma. It also increases one’s protective cells.

Most people should be evaluated for discontinuance of allergy shots, after the person has been getting monthly injections for four to five years. Youngsters who have asthmatic episodes once or twice a month or less should not be considered for immunotherapy, except for children who have had a life-threatening experience from a venom sting.

Many other agents work mainly by lessening a person’s nose or airway symptoms that are caused by an antibody chain reaction. The duration of such treatment is probably similar to that of dental prevention.
Learn about all the potential triggers, allergens and prevention methods for dealing with asthma. Seek expert help in determining which triggers affect your child, eliminating triggers and minimizing your child’s exposure to allergens. Seek information from your family doctor, a trained allergist or someone from the Asthma & Allergy Foundation of America.

Source: parentguidenews.com


October 08

Alternate Medicine for Allergies

ALTERNATIVE MEDICINE: 
I
IVIABLE IN ASTHMA AND ALLERGY?

SAN ANTONIO, TEX—Herbal remedies, relaxation therapy, chiropractic care, and other forms of complementary or alternative medicine (CAM) have increased tremendously in popularity in the United States. “Only 10% to 30% of our health care is actually delivered by what we consider conventional or biomedical-oriented practitioners,” claims Leonard Bielory, MD, Director of the Asthma and Allergy Research Center at the New Jersey Medical School in Newark.

At a provocative symposium held during the recent annual meeting of the American College of Allergy, Asthma and Immunology, Dr. Bielory and other researchers explored the safety and efficacy of CAM in the management of allergy and asthma.[1,2] The primary goal of the symposium was to provide “scientific integrity” to the relationship of CAM in the field of allergy, asthma, and immunology. Their findings suggest that there are some interesting data to support the use of CAM for these conditions—but safety remains a concern, particularly when herbal therapies are used.

For example, anaphylaxis is a potential side effect of the popular remedy echinacea, which has been used to treat rhinitis and the common cold. Bee pollen, a CAM treatment ostensibly effective for asthma and allergies (as well as for prostatism, cancer, and heart disease), has been associated with sore throat, stridor, breathing difficulties, and other symptoms of an acute hypersensitivity reaction.

There are no known adverse effects of tincture of benzoin (also known as balsam) when it is applied topically as a mucosal protectant or administered through steam inhalation for sinus problems. “However, ingestion leads to severe gastritis,” Dr. Bielory noted.

Products containing ginkgo biloba have been shown to produce bronchodilation, smooth muscle relaxation, and other positive effects on the lungs of patients with allergy and asthma. A major problem with such products remains, however: “You do not know what you are taking, because they are not standardized,” cautioned Dr. Bielory.

EFFECTS OF STRESS

Evidence is mounting to support what physicians have suspected all along—that anxiety, depression, and other forms of psychological stress may worsen asthma and allergies. “Most of us who take care of patients would say, ‘That is absolutely true,’ ” stated Gailen D. Marshall, MD, PhD, Director of the Division of Allergy and Clinical Immunology at the University of Texas Medical School in Houston.

In a study designed to test that belief, 24 patients with mild to moderate asthma were compared to an equal number of age-matched controls.[3] Both groups were exposed to stress in two ways: They were asked to complete subtraction problems while someone pressured them, and they viewed emotionally charged films and slides. The asthma patients responded to the stress with greater increases in respiratory resistance, minute volume, blood pressure, and skin conductance than the control group experienced; they also reported higher levels of depression, arousal, and shortness of breath.

In a previous study, Dr. Marshall and his colleagues found that the stress of medical school examinations triggered immune dysregulation.[4] This finding may help explain the increased incidence of asthma, allergy, and other type-2 cytokine-mediated conditions often linked to high stress. Recent unpublished data by Dr. Marshall’s group show that employees who are highly anxious about returning to work in a previously “sick” building (one that used to contain high mold levels) have twice the rate of respiratory symptoms than do other employees.

Not all types of stress have the same effects, though. Periodic episodes of acute stress may actually be beneficial because they activate the innate immune system, Dr. Marshall noted, whereas chronic stress has been linked to a worsening of asthma and allergies. He added that it may be possible to alleviate chronic stress, and thereby reduce the severity of asthma and allergies, with very simple stress management techniques, such as having patients write about their stressful experiences.

 

CAN CAM ALTER THE IMMUNE SYSTEM?

Like Dr. Marshall, Rosalind J. Wright, MD, has seen firsthand evidence of the negative effect of stress on respiratory and immune function. In a prospective study of 496 new mothers and their infants, she showed that an infant was 60% more likely to have two or more episodes of wheeze within the first 14 months of life when the mother perceived herself to be under high stress.[5]

The association between maternal stress and infant wheezing remained significant—albeit slightly lower (40%)—even when the analysis was controlled for myriad confounders. Furthermore, the association persisted until the offspring reached age 5 to 6 years, reported Dr. Wright, Instructor in Medicine at Harvard Medical School in Boston.

Many randomized controlled trials have attempted to assess the ability of stress management and other types of CAM to favorably alter the immune system, but these trials have been fraught with limitations, such as the failure to clearly define the populations under stress or to standardize the treatment modality in question. Perhaps that is why even the best of these investigations, a recent meta-analysis by Miller and Cohen,[6] revealed only modest evidence in support of four CAM modalities—relaxation therapy, hypnosis, behavioral conditioning, and disclosure of stress-related feelings.

“There was a better effect with hypnosis and conditioning interventions than with the other modalities, and there was some indication that there was some impact on immune function,” related Dr. Wright. Physicians should not be disheartened by the results of the meta-analysis, she said, because the limitations of the pooled data make it premature to conclude that the immune system is unresponsive to CAM.

 

CHIROPRACTIC CARE IN ASTHMA AND ALLERGIES

With the number of chiropractors now exceeding 65,000 in the United States and 6,000 in Canada, chiropractic care has grown to be the third largest primary health care profession in North America. The many reports from chiropractors and their patients suggesting that chiropractic care is beneficial for a variety of conditions, including asthma, have undoubtedly contributed to that growth.

But how reliable are these anecdotes, and are there any hard data to justify the chiropractic treatment of asthma? “Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma,” asserted Jeffrey Balon, MD, a chiropractor and family physician practicing in Ottawa. “I do not feel that manual therapy is a first-line treatment for asthma or allergy,” added Dr. Balon, who is also a research associate at the Canadian Memorial College in Toronto.

He based those statements on the three existing randomized controlled trials of chiropractic care for asthma, including one that he performed himself.[7] These trials all showed that manual therapy does not significantly alter pulmonary function tests, peak expiratory flow, or other objective measures of asthma severity in patients with mild to moderate stable asthma.

“But, we do see significant subjective improvement with less symptoms, less bronchodilator use, and better quality-of-life measures,” pointed out Dr. Balon. It is possible that chiropractic treatment only produced subjective improvement because the patients’ asthma was already so well controlled that there was not much room for further objective improvement, he suggested.—Timothy Begany

Source: http://www.respiratoryreviews.com/jan03/rr_jan03_alternasthma.html


October 05

Does salt help?

Taking a Mound of Salt for What Ails You

Sink into a chair, relax and breathe in the salt air. You aren't at the beach, but rather in one of a growing number of indoor salt rooms whose owners say small salt particles can soothe respiratory and skin conditions. Scientific evidence in English-language publications is scant and some doctors urge caution for asthmatics.

Across the U.S., salt rooms have been popping up in cities such as New York, Orlando, Naples, Fla., Boulder, Colo., Chicago and Los Angeles.

While most of us associate salt air with the beach, from a medical standpoint, the experience is designed to mimic salt caves, which have long been considered therapeutic in Eastern Europe. Salt room owners say salt can help skin conditions such as psoriasis and eczema and a range of respiratory ailments, including colds, asthma, allergies and bronchitis.

Sometimes called halotherapy chambers, the rooms are designed to provide a relaxing and unusual experience. The walls and ceilings are salt-coated, and grains are often scattered a few inches deep on the floor. Children are often allowed to play in it, as in a sandbox. Some places have cave-like decor, complete with salt-coated stalactites.

Healing Salt

Indoor salt rooms have been popping up in cities across the U.S. as marketers tout salty air as a remedy for allergies, asthma, colds and even skin problems.

Some facilities just pile up salt in the room, while others use special "salt generators," machines that grind the salt into very tiny breathable particles and blow it into the air. Orlando's Salt Room uses a generator sold by Indium Top LLC of Tallinn, Estonia. Halo Air LLC of New York, which recently opened a Halo/Air salt room in Manhattan, uses a generator from Halomed UAB, of Vilnius, Lithuania. Halo Air hopes to open dozens more locations in the U.S.

Generally, pure salt from natural sources is used; Halo Air uses rock salt from a cave in Ukraine. The smell of a salt room is a little like ocean air and visitors experience a salty taste on the lips, says Richard Zagrobelny, owner of Iris Salt Rooms LLC, a Kitchener, Ontario, firm that builds salt rooms using Indium Top's Iiris machine. Costs for a session vary, depending on location and privacy; some rooms offer discounts for multiple sessions. A one-hour adult session in a communal room at the Salt Room in Orlando costs $45. Halo Air says a private room with a personal television costs $100 for an hour. If you like you can wear nothing but a thin robe and booties on your feet.

So far the Iiris machine hasn't been studied clinically. The Halomed device has been shown effective for respiratory and skin conditions in Russian-language research publications, says Russian pulmonologist Alina Chervinskaya, a minority owner of Halomed. The machine is set to different levels of salt concentration depending on the condition being treated, she says. Halo Air says concentrations in its salt rooms range from five to 10 milligrams per cubic meter of air for adults.

Salt helps respiratory conditions by drawing water into airways, thinning mucus and improving the function of cilia, or small hairs that help move mucus out of the lungs, Dr. Chervinskaya says. In higher concentrations, salt therapy also can help skin conditions such as acne and psoriasis, she says.

Salt inhalation therapy, an alternative form of medicine believed to help with skin conditions and respiratory ailments, is making its way to the U.S. The Wall Street Journal visits a salt cave in Florida to find out more.

And a 160-person study Dr. Chervinskaya presented last year at a Vienna medical conference found that a tabletop salt generator, not available in the U.S., helped prevent colds. Dr. Chervinskaya says the tabletop unit produces a dry salt aerosol comparable to the Halomed generator used in salt rooms.

English-language studies on salt rooms are rare. Often quoted by salt rooms as evidence of their efficacy is a landmark New England Journal of Medicine study that found improvement in cystic-fibrosis symptoms from salt therapy. But the study used a handheld nebulizer twice daily to deliver a concentrated salt mist into the mouth, and the results don't apply to salt rooms, says Australian scientist Mark R. Elkins, the lead author of the 2006 paper.

Orlando pulmonologist Daniel Layish says rigorous studies are lacking on salt rooms, but he has found cystic-fibrosis patients he has referred to the Orlando Salt Room are experiencing "less shortness of breath, less coughing and decreased sinus pressure."

Springfield, N.J., allergist Leonard Bielory, chairman of the American College of Allergy, Asthma & Immunology's integrative-medicine committee, says it's logical that salt rooms could help a variety of respiratory conditions—but probably only in the short term. "It's like a massage," he says. "Great while you get it but after that [the benefit is] gone."

Dr. Bielory and others caution that asthma could potentially be worsened. Salt is an irritant that could cause airways to constrict, posing a serious danger to asthmatics, says allergist Alvin M. Sanico, an assistant professor at Johns Hopkins University School of Medicine in Baltimore. Salt, by stimulating nerves in the nasal passages, may worsen allergy symptoms, he adds.

Dr. Chervinskaya says that 10 to 20 sessions in salt rooms using the Halomed machine can have long-term benefits of up to six months or a year. Generators should be set to a lower dose for asthma patients to minimize irritation, she adds, and patients with any serious lung issues should consult their doctors before using a salt room. Halo Air says it follows Dr. Chervinskaya's recommendations. Salt rooms in rare cases can cause mild irritation to the skin and eyes, and a scratchiness in the throat that goes away after drinking water.

Comment; Dr. Bielory reflects that this is not a proven or a standard therapy and should not be used as an alternative mode of treatment. 

Source: http://online.wsj.com/article/SB10001424052748703880304575236282972152968.html 


August 16

Ragweed

Ambrosia trifida - Great Ragweed, Buffalo Weed, Horseweed, Giant Ragweed, Tall Ambrosia. Ambrosia – the nectar of the gods. An unlikely name for the genus of 24 species native to the United States which causes so much discomfort to us mere humans. At least one of these species is found in every state; Ambrosia trifida is found in all but 3 – Alaska, Hawaii, and Nevada. It is the tallest of the Ambrosia species, sometimes growing to more than 10 feet tall. 

The ragweeds generally cause much hayfever, allergic reaction, and asthma exacerbation due to their tiny airborne pollen, which can drift and be inhaled far from the source plant. Giant Ragweed of New York/New Jersey


August 09

Climate Change Creates Longer Ragweed Season

Dr. Bielory’s Research Cited in the News - Publication date March 2011 in the Proceedings of the National Academy of Science

WASHINGTON (Reuters) Feb 21 - A changing climate means allergy-causing ragweed pollen has a longer season that extends further north than it did just 16 years ago, U.S. scientists reported on Monday. In research that agrees with projections by the U.N. Intergovernmental Panel on Climate Change, plant and allergy experts found that ragweed pollen season lasted as much as 27 days longer in 2009 than it did in 1995. The further north in the Western Hemisphere, the more dramatic the change in the length of pollen season.

Ragweed pollen can cause asthma flare-ups and hay fever, and costs about $21 billion a year in the United States, according to the study, which is scheduled for publication online in the Proceedings of the National Academy of Sciences.

"This is not something that's hypothesized, this is not something that's modeled, this is not something that may or may not occur depending on the math that you do," said study author Dr. Lewis Ziska of the U.S. Department of Agriculture. "This is something that we're actually seeing on the ground in recent years."

Even in places where ragweed season didn't lengthen or where it shortened slightly -- such as Texas, Oklahoma and Arkansas -- there was lots more pollen, which caused more intense symptoms, said co-author Dr. Jay Portnoy of the Allergy, Asthma and Immunology Section at Children's Mercy Hospital, the University of Missouri-Kansas City School of Medicine.

Ragweed is probably not the only pollen likely to have a longer season as the planet warms, Dr. Portnoy said in a telephone interview.

"We used ragweed as a marker but it's probably true for other pollens too," he said, including tree pollen that causes allergy symptoms in the U.S. spring.

Ragweed pollen was a reasonable marker because its season is naturally easy to track.

It's what's known as a short-day plant, which begins blooming when the days start getting shorter, that is, after the Northern Hemisphere summer solstice around June 21. It stops flowering with the first frost.

As global average temperatures have warmed, the first frost has been delayed, especially at higher latitudes, which has meant a longer season for ragweed. Because warming is greater at these high latitudes, the length of the season has been more pronounced.

For example, in Georgetown, Texas, the ragweed season actually shrank by 4 days between 1995 and 2009. But further north in Papillion, Nebraska, it got 11 days longer; in Minneapolis, it was 16 days longer, and in Saskatoon, Saskatchewan in Canada, the season was 27 days longer.

Dr. Ziska said he was surprised by how big the change was in such a relatively short period of time: "I thought maybe 10 days, or a couple of weeks, but to see it up to almost 4 weeks was kind of interesting."

This could mean a change in the way ragweed-triggered allergies are diagnosed and treated. Clinicians who are unaccustomed to checking their patients for ragweed-related symptoms will likely have to start doing this.

"Things that used to be a fairly minor disease are now going to be a much more significant problem," Dr. Portnoy said.

Proc Natl Acad Sci USA. 2011


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Location: Springfield, NJ
Today's Date: June 23, 2017
Station Director: Leonard Bielory, M.D
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