Skin Numbing Creams May Cause Death

Medically Reviewed On: February 12, 2007

(iVillage Total Health) - Adults and children who use skin numbing creams to dull the pain of injuries or cosmetic procedures were urged to be cautious when using the products.

The U.S. Food and Drug Administration (FDA) issued a warning February 6 alerting consumers that the skin creams can cause life-threatening side effects, including irregular heartbeats, seizures and even death. The FDA urged people using these products to first consult with their physician and to ask about proper application.

Topical anesthetics are commonly used before and after medical and cosmetic procedures (tattoos and tattoo removal, dermabrasion, laser hair removal) to relieve pain . These gels, creams and ointments contain such anesthetic drugs as lidocaine, tetracaine, benzocaine and prilocaine. In addition to pain relief, the products help ease burning and itching caused by a variety of conditions.

The consumer alert came after the FDA reported the deaths of two women—ages 22 and 25—who used topical anesthetics following laser hair removal treatments. Both women followed the instructions of the persons performing the procedures and wrapped their legs with plastic wrap to increase the cream's numbing ability. Both women had seizures, went into comas and later died from the toxic effects of the medications in the creams. The FDA noted that the creams were formulated by pharmacies and contained high concentrations of the drugs lidocaine and tetracaine, common anesthetics used in topical creams, ointments and gels.

Authorities were concerned about the creams because although some are prescribed by physicians as part of medical care, some products are available without prescription and are used by people who are not supervised by healthcare professionals. This increases the risk that people will apply too much of the creams and increase their toxic effects. The FDA has received reports of slowed or stopped breathing, irregular heart beats, seizures and coma in both adults and children using the product. The reports involved people using the creams for approved and unapproved conditions.

The medications in the creams are absorbed by the skin and act to block pain sensations. However, these drugs can pass into your bloodstream and, in large concentrations, cause serious side effects. The chances of these harmful effects increase if large amounts of numbing creams are used, if they are allowed to remain on the skin for long periods of time or if they are applied over areas where the skin is already irritated (such as from a rash or wound). Elevated skin temperatures, which may occur from wrapping the skin or using a heating pad, can also increase absorption of the anesthetic.

The FDA recommends consumers consider the following when using topical numbing products:

• Use only products approved by the FDA. To verify if your product has been approved, go to the FDA's Web site at http://www.fda.gov/cder/ob/default.htm.
• Use topical anesthetics that contain the lowest amount of anesthetic possible to relieve pain. Consult your physician about the amount needed in your procedure, including any side effects associated with this use.

Obtain instructions from your physician on the proper use of the products, especially if you are undergoing a cosmetic procedure at a location other than a healthcare facility. If you are instructed to wrap or cover your skin with dressing or other materials, be aware that this may increase the risk of side effects.

Copyright 2007 iVillage Total Health.

RELATED PROGRAMS

Medications That Can Raise Cholesterol Levels

Anytime your health care provider prescibes a new medication to you, be sure to ask questions. Although new drugs are supposed to help you on to the road to good health, they may have some undesirable side effects. For instance, there are some drugs on the market that may actually cause triglycerides and LDL cholesterol ("bad" cholesterol) to increase and/or HDL cholesterol ("good" cholesterol) to decrease. This may be bothersome to those of you who have never had high cholesterol before. Additionally, if you are currently on medication to lower your cholesterol, you might notice that your therapy may need to be adjusted.

If your health care provider places you on one of the following drugs, you may need to discuss with them what cholesterol lowering measures you need to take during your treatment.

Prednisone

Prednisone is a glucocorticoid that is used to reduce the swelling, warmth, and tenderness associated with many inflammatory conditions. Despite the relief they may give to you, they can raise triglycerides, LDL cholesterol levels, and HDL cholesterol levels. It doesn’t take long to see a substantial rise in cholesterol levels: Some studies showed that patiens had higher cholesterol levels within two weeks of treatment.

Beta blockers

Beta blockers are normally prescribed to treat high blood pressure. Despite the significant advantages they offer in treating several forms of heart disease, beta blockers also have been noted to decrease HDL levels and elevate triglyceride levels. In most cases, however, these lipid changes have been very small. It is important to note that not all beta blockers have this effect. The following beta blockers have been noted to slightly alter lipid profiles:

* Atenolol (Tenormin®)
* Betaxolol (Kerlone®)
* Bisoprolol (Zebeta®)
* Metoprolol (Toprol®, Lopressor®)
* Nadolol (Corgard ®)
* Propanolol (Inderal ®)

Beta blockers not only help lower blood pressure, they also are instrumental in prolonging the survival of individuals with active heart disease (such as congestive heart failure and previous heart attack). Therefore, even if slight alterations of your lipids are observed, it is very important that beta blockers are not discontinued.

Amiodarone

Amiodarone is drug used to treat a variety of heart arrhythmias and is associated with a wide range of side effects. One of the smaller side effects is related to high cholesterol. It mainly raises LDL cholesterol levels and has no effect on HDL cholesterol or triglyceride levels.

Estrogen

Estrogen is a female sex hormone found in female hormonal birth control and in other forms of hormone replacement therapy. For many years, estrogen had been considered "cardioprotective," thus promoting a healthy heart. This is mainly due its ability to raise HDL levels. This caused many post-menopausal women taking hormone replacement therapy to help their heart. However, recent studies have found that it does not protect against heart disease after menopause. The mechanism by which it causes heart attacks is unknown. Additionally, estrogens may also increase triglyceride levels.

Progestin

Progestin is a form of progesterone, another female sex hormone, which is used in oral contraceptives and hormone replacement therapy alone or in combination with estrogen. Higher levels of progestin have been associated with lower HDL levels. In combination with estrogen, progestin may cancel out the healthy effect estrogen has in raising HDL levels.

Anabolic Steroids

Anabolic steroids include testosterone, the male sex hormone that is used to treat delayed puberty in boys and some forms of impotence. It is also used illegally to build muscle mass. These drugs raise LDL levels and lower HDL levels. The detrimental effects this drug has towards cholesterol levels are more noticeable in the oral medications in comparison to the injectable medications.

Cyclosporine

Cyclosporine (Sandimmune ®, Neoral®, Gengraf®) is a drug used to suppress the immune system. It is commonly used after an organ transplant in order to prevent rejection. However, it may also be used to treat rheumatoid arthritis and psoriasis. Studies have shown that cyclosporine raises LDL cholesterol levels.

Protease Inhibitors

Protease inhibitors are used to treat human immunodeficiency virus (HIV). Although the mechanism by which these drugs raise cholesterol levels is not known, they appear to especially raise triglyceride levels and lower HDL cholesterol levels. Currently, fibrates and statins have shown promise in lowering triglycerides and raising HDL levels in these individuals.

Diuretics

Diuretics are used to treat high blood pressure and water retention. There are two types of diuretics that cause increased cholesterol levels:

* Thiazide diuretics (including hydrochlorothiazide, chlorothiazide, metolazone)
* Loop diuretics (including furosemide, torsemide, bumetanide)

Thiazide diuretics cause a temporary increase in total cholesterol levels, triglyceride levels, and LDL cholesterol levels. HDL cholesterol levels are not typically affected. This increase may range between 5 to 10 milligrams per deciliter. Currently, indipamide is the only thiazide diuretic that has not been shown to raise cholesterol levels. Loop diuretics share the same pattern as thiazide diuretics; however, some of these drugs have shown a slight decrease in HDL cholesterol. Since diuretics are very important in the treatment of lowering blood pressure, your health care provider may also place you on a low-fat diet while you are on this medication.

Sources:
Graham NM. Metabolic disorders among HIV-infected patients treated with protease inhibitors: a review. J Acquir Immune Defic Syndr 2000;25(suppl 1):S4-S11.

Hudig F et al. Amiodarone-induced hypercholesterolemia is associated with a decrease in liver LDL receptor mRNA. FEBS Lett 341(1):86-90.

Stone NJ. Secondary causes of hyperlipidemia. Med Clin North Am 1994 Jan;78(1):117-41

Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (PDF), July 2004, The National Institutes of Heath: The National Heart, Lung, and Blood Institute.
Updated: November 10, 2006

Thư mục những trang web hay nhất bằng tiếng Việt và Anh

http://trangnhat.net/

Rural doctors' office also not properly sterilizing equipment

Last Updated: Monday, March 26, 2007 | 5:07 PM MT

CBC News

A doctors' office in the same health region as the troubled Vegreville hospital also was not properly sterilizing medical equipment, health minister Dave Hancock confirmed Monday.

Hancock said he can't identify the doctors involved or the office's location in the East Central Health region because the incident was under investigation by the College of Physicians and Surgeons of Alberta.

"But I can tell you that it involved a sterilization process with respect to equipment being used in the doctor's office for examinations and procedures," he said.

"The matter has been investigated by the college, processes stopped on a timely basis, and all patients have been identified and are in the process of notification and followup."

In total, 261 of the patients from the doctors' office are being encouraged to be tested for possible disease, he said.

Health regions asked to launch reviews

Hancock also announced Monday that every health region in the province has now been ordered to review their infection control programs by the end of April.

The review was prompted by revelations that St. Joseph's hospital in the town of Vegreville wasn't properly sterilizing medical equipment.

A team from the Health Quality Council of Alberta was in Vegreville last week to look into a superbug outbreak at the hospital and shortcomings in the hospital's sterilization room, which is now closed.

The sterilization room was supposed to be closed on Feb. 13 after a routine surgical audit uncovered problems.

But when the region's medical health officer went to the hospital on March 16 to investigate a superbug outbreak — seven patients in the 25-bed hospital contracted the infection over a one-month period beginning in mid-January — the room was still in operation, so he ordered it shut down.

Health officials are checking records of hospital patients back to April 2003. Although they say the risk to patients is low, they are sending letters to those who were exposed to surgical equipment that had been inadequately sterilized, advising them to get tested for HIV, and hepatitis B and C.

'Not the norm in the system'

Hancock said he finds the two incidents troubling, but Albertans should not lose faith in the health system.

One was at a hospital, which falls under the health region's jurisdiction, while the other was at a doctors' office, which "is an entirely different situation," he said.

"I still believe … those are not the norm in the system, that those are aberrations."

The college began the investigation into problems at the doctors' office in 2005 and only notified his office on Friday, Hancock said. He is concerned that the college did not report the incident until after the situation at the Vegreville hospital came to light, he said.

Bad Cholesterol's Comeback

Matthew Herper and Robert Langreth 03.26.07, 12:30 PM ET

Cardiologist Evan Stein remembers the moment he decided what he was going to do with his life. When he was just beginning his medical career, a patient in his 20s died of a heart attack under his care.

The man had a genetic disease that causes levels of bad cholesterol, so-called LDL, to skyrocket. These patients have defective versions of the gene that processes cholesterol in the body. They often die young. Even modern cholesterol drugs such as Lipitor can't get cholesterol fully under control in these patients. The problem is so bad that some have their cholesterol laboriously filtered from the blood, at a cost of $70,000 a year.

On Monday, at the American College of Cardiology's annual meeting, Stein presented data from a new drug that had "more dramatic lipid-lowering effects in these patients than we have ever seen." The new drug, 301012 from Isis Pharmaceuticals (nasdaq: ISIS - news - people ), works directly on DNA to prevent production of the protein that is the main component of LDL. The trial contained only three patients, but it provides new hope for a difficult to treat group. One concern: The drug has elevated liver enzymes.

"It's definitely worth keeping an eye on," says Daniel Rader, a cholesterol researcher at the University of Pennsylvania. "Safety is still going to be a big question; they need to treat a lot more people to know that." Willis Maddrey, of a hepatologist at the University of Texas Southwestern Medical Center who is consulting for Isis on safety, says he is not overly concerned. "There is nothing so far that gives me undue concern about the liver, but we have to watch it."

The Isis results present a stark contrast to reports that drugs to treat the so-called "good cholesterol" are delivering dramatic disappointments. Drug companies have been focusing on new drugs to boost good cholesterol. But the terrible trial results of the first drugs to raise good cholesterol may force doctors to reconsider how important HDL really is. It will likely cause them to focus once again on doing a better job lowering bad cholesterol in their patients.

"LDL is a pretty easy molecule to understand," says Stein. "It's consistent no matter how we've looked at it for 50 years. Genetically, it always makes sense. No matter how you lower LDL, you reduce risk."

Researchers promoting HDL-boosting drugs presented a simple picture based on population research: The higher your HDL, the less your chance of a heart attack. But this straightforward finding masks a far more complex reality. Unlike bad cholesterol, HDL isn't a single type of particle but a chemical chameleon whose precise composition fluctuates, like a flatbed truck that is constantly taking on different types of cargo. HDL may be different in healthy people (the kind in the population studies) compared with those sick with heart disease.

But the results of Pfizer's (nyse: PFE - news - people ) big experimental drug to raise HDL have been negative. It hurt patients in a large trial and didn't clear plaque from the arteries. John Kastelein of the University of Amsterdam, who presented data on the drug, said it reminded him of "a Dutch pancake. You can't get any flatter."

"We were naive about HDL, because nothing in nature is all good or all bad," says UCLA cardiologist Alan Fogelman. His lab studies hint that HDL may be helpful in healthy people but sometimes turns harmful in heart patients with inflamed arteries. Fogelman says researchers need to develop blood tests that measure the efficiency of HDL at removing cholesterol from blood vessels, rather than just measuring the amount.

Further complicating matters, HDL doesn't act independently, but it usually is inversely correlated with levels of blood fats called triglycerides. Patients with high triglycerides usually also have low HDL.

In any case, drug researchers have relatively few good ideas about how to raise HDL, besides the mechanism that yielded such bad results for Pfizer. "One of the discouraging facts is there are not a lot of other drugs in the pipeline that are good candidates for raising HDL," says Bryan Brewer of the MedStar Research Institute in Washington, D.C.

Many doctors argue for a renewed focus on LDL, given that many patients still have high levels. James O'Keefe Jr. of Mid America Heart Institute in Kansas City argued that LDL is the prime mover in causing heart disease; doctors should pay more attention to getting it as low as possible rather than worrying about HDL. "It is too soon to be relying on drugs to raise HDL," he said. But, he added, "LDL is an essential element for atherosclerosis."

In a debate at the meeting, he argued that the natural levels of LDL throughout most of human history were far below typical levels today in the Western world. Studies of remote tribes that eat leafy, nutty diets have found that they often have total cholesterol levels of around 100, he said.

But when industrialized nations adopted calorie-dense, carb-heavy diets, cholesterol levels started to soar far beyond what the body has evolved to handle, he said. "There may have been a lot of hunter-gatherers with low HDL, but they didn't get heart disease because they had low LDL," he said.

Until the science of HDL is better understand, he suggests a greater focus on diet and exercise, which can have a huge impact on HDL. O'Keefe's own HDL increased from 29 to 60 when he adopted a hunter-gatherer type of diet, high in vegetables, fruits and nuts and low in refined carbs. "If you exercise daily and eat a hunter-gatherer diet, you can double your HDL," O'Keefe said.

Anh khoa's Birthday

Hộp thư Gmail

Hiện tại có thể tự đăng ký hộp thư Gmail, chứ không cần thư mời như trước đây, tại địa chỉ http://mail.google.com/mail/signup

LỜI NGUYỆN CỦA EM BÉ CHƯA RA ĐỜI

Thi sĩ George Migot

Hỡi ba má tương lai
Hãy yêu nhau hết lòng
Cho lòng con tươi tốt
Hãy yêu trong thể xác
Để thể xác con lành
Hãy yêu bằng linh hồn
Cho hồn con thắm đẹp
Yêu nhau đi
Yêu nhau đi ba má
Hãy yêu và nghĩ đến con
Chưa nằm trong tay ba má
Để ngày mai khi sinh hạ
Con là kết thủy ái ân
Không là một khối đau thương
Hãy yêu bằng mối đồng tâm
Cho con thành dây thắt chặt
Hai người trong cảnh ly phân
Kết đời trong mối ái ân
Để con làm giải đồng tâm mặn nồng
Ba má yêu nhau hết lòng
Con làm hình ảnh tơ đồng gắn ghi
Yêu cho con được vỗ về
Từ khi chưa thấy má kề bên ba
Yêu nhau nồng đượm thiết tha
Cho đời mẹ đẹp như hoa trong vườn
Cho con bú giọt sữa lòng
Của người thiếu phụ thắm hồng tơ xuân
Má ba tiếng đẹp muôn vàn
Tình yêu ba má là nguồn hoa tươi
Để khi con gọi hai người
Má ba hai tiếng sáng ngời yêu thương
Yêu thương phủ lấy đời con
Đôi tay cùng đặt đôi lòng cùng trao
Má ba hai tiếng ngọt ngào
Là đôi cánh dẫn chim vào trời xanh
Là con chim nhỏ xinh xinh
Dẫn hồn thơ trẻ trong lành yên vui
Yêu thương nhau má ba ơi!

High blood sugar tied to increased cancer risk

Thu Mar 15, 2007 8:27PM EDT

NEW YORK (Reuters Health) - Results of a study involving nearly 65,000 people point to an association between cancer and abnormally high blood sugar levels.

These results "have obvious implications for lifestyle guidance, as it is well known what factors cause blood glucose increases," Dr. Par Stattin from Umea University Medical Center, Sweden noted in comments to Reuters Health.

By avoiding excessive fat and other dietary risk factors, and by getting regular exercise, "you can decrease your risk of cardiovascular disease, diabetes -- and cancer," he added.

Type 2 diabetes is associated with an increased risk of liver, pancreas, colon cancer, as well as other cancers, Stattin and colleagues note in the journal Diabetes Care. However, less is known about the effect on cancer risk associated with moderately elevated blood sugar levels among non-diabetic subjects.
To investigate further, the researchers examined data from 31,304 men and 33,293 women who participated in a larger study and had glucose (blood sugar) measurements available. In total 2,478 cases of cancer were identified in this group.
In women, the total cancer risk increased with rising blood sugar levels. The relative risk of cancer was 26 percent higher for women with the highest fasting blood sugar compared with women with the lowest fasting blood sugar.

Adjustment for errors in measurement further increased the relative risk of cancer for women with abnormally high blood sugar levels.

Overall, there was no significant association between total cancer risk and blood sugar measurements in men.

However, for men and women, high fasting glucose was significantly associated with an increased risk of cancer of the pancreas, endometrium, urinary tract and malignant melanoma.

These associations were independent of body weight.

These findings, the authors say, provide "further evidence for an association between abnormal glucose metabolism and cancer."

SOURCE: Diabetes Care March 2007.

Tired eyes? Hyperopia? Myopia? Eye training: Exercise your eyes and see better

Tired eyes? Hyperopia? Myopia? Eye training: Exercise your eyes and see better - perhaps you also will be able to get rid of your glasses and loose some headache in the deal.

http://maxmagnusnorman.com/artist_blog/art_day_73.shtml

It's not unusual that visual defects and headache is the result of people using their eyes in the wrong way and that they never exercise their eyes. To sit for hours and stare into a book or a computer screen at the same distance and from the same angle is for the muscles of the eye the same thing as it is for the legs to sit still on an aeroplane or a train for several hours - the problem is that people in today's society have gotten used to this eye torment and take hardly no notice of it. This has gone so far that for some the muscles of the eye are so stiff that they rather turn the whole head than just the eyes when seeing something in the periphery.
The eyes needs training, and if you utilize the following simple exercises it might even happen that you can discard your reading glasses after a while.
Do like this:

* The first part of the eye exercise is good for the muscles surrounding the eyeball. Look at something on the right in your field of vision. Keep your eyes on that object and turn your head to the left as far as possible without loosing sight of whatever you've choose to look at. Do the same thing but in reverse; fix your stare at something on the left and turn your head rightwards as far as you can. Repeat the procedure in all directions; up and down and in the four diagonal directions. Repeat the entire exercise a few times.
The first times you perform this exercise you will probably experience some pain and perhaps even headache and nausea - but those symptoms will disappear in time and are signs that you really are in need of this exercise. But be careful.
It might be a good idea not to perform this exercise on the bus or in similar circumstances - people might believe that you are having a seizure of some kind.

* The second part of the eye training prevents the lens of the eye from getting stiff and exercises the small muscles inside the eye which shape the lens and thus help you focus on things you look at. Hold up your finger in front of you and focus on it. Move the finger towards you as close as you can get without loosing focus. Then look outside the window and focus on the horizon. Repeat a few times.



Many visual defects such as myopia - short-sightedness - and hyperopia - long-sightedness are a result of that the eyeball is not perfectly spherical. Many times myopia is the result of the growth of the brain which has "flattened" the eyeball from behind. The exercises described above might if practised regularly help shape the eyeball into a more spherical shape and thus also improve your sight.

Eye care

From Pfizer Australia

Tired eye

Tired eye symptoms can occur when the sufferer has been concentrating on something for a long time, such as when reading or working at a computer, and have been blinking less often.

This means that the tear film is not being replaced often enough, and that some of the water contained in the film has evaporated from the surface of the eye. In some cases, the eyes start watering as the eye produces excess tear fluid to try and relieve the dryness.

Treatment

Obviously, the best way to avoid symptoms is to blink or close the eyes regularly, and to reduce the amount of time the eyes are looking at the same thing without a break (eye straining activity).

In many cases, such as in the work situation, simple avoidance techniques are not always possible, and the application of eyedrops, washes or ointments may provide temporary relief from symptoms.

In most cases, however, by replenishing the tear film appropiately, all of the symptoms of tired eye, including redness, should be relieved.

Always read the label. Use only as directed. If symptoms persist, see your healthcare professional.

Weight Gain Linked to Breast Cancer

According to new data obtained from the Nurses' Health Study, weight gain after menopause increased the risk of developing breast cancer. The large study found those women who gained 55 or more pounds since the age of 18 were 1 ½ times more likely to get breast cancer than women who did not gain weight. Those who gained 22 pounds after menopause were 18% more likely to have breast cancer than those whose weight remained stable.

As Reported by The Today Show / NBC News

A Potential Drawback to Daily Aspirin

Men who take doses of acetaminophen or nonsteroidal anti-inflammatory drugs like ibuprofen 6 or 7 times a week increased their risk for high-blood pressure by more than one-third, according to a study in the Archives of Internal Medicine. The same use of aspirin increased the risk by 26%, researchers said.

As Reported by The New York Times

The Basics of Food Allergies

From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!

Recognizing 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.

Allergy or Intolerance?

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.

Non-allergic Immunologic Reactions

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.

Common Childhood Food Allergies

Milk, soy, wheat, egg, peanut, tree nuts, fish and shellfish compromise more than 90% 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 and Cross-Contamination

Cross-reactivity refers to a person having allergies to similiar 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.

Diagnosing Food Allergies

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.

Managing Food Allergies

Treat the reaction: If a reaction to the food is present, the person should seek immediate emergency medical care. Most patients with food allergies should carry a self-injectable form of epinephrine, or adrenaline (such as an Epi-pen®, with them at all times. These medications can be prescribed by a physician and the patient should know how to use this device before an allergic reaction occurs.

Avoid the food: This is the main way to prevent future reactions to the culprit foods, although can be difficult in cases of common foods such as milk, egg, soy, wheat and peanut. Organizations such as the Food Allergy and Anaphylaxis Network offer help and support to patients and parents of children with food allergies.

Allergy physicians can also offer additional information and advice on avoidance.

Read food labels: Since accidental exposure to the allergic food is common, reading labels on foods and asking questions about ingredients at restaurants is important and recommended.

Be prepared: Patients with food allergies should always be prepared to recognize and treat their reaction, should one occur. Remember, since exposures to the allergic foods are frequently accidental, being prepared to treat the reaction with epinephrine is paramount. Emergency medical care should always be sought if an allergic reaction to food occurs, whether or not epinephrine is used.

Communicate with others:Communication with family members, friends, and school staff about the patient’s medical condition and knowledge of how to administer epinephrine is also important. It is also recommended that the patient wear a medical alert bracelet (such as a Medic-Alert® bracelet) detailing their food allergies and use of injectable epinephrine, in the case the patient is unable to communicate during a reaction.

Source: The American Academy of Allergy, Asthma and Immunology, and Food Allergy Practice Parameters. Ann Allergy Asthma Immunol. 2006; 96:S1-68.

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.

Updated: January 21, 2007

'Tis the Season to be Sneezy

From Daniel More, MD,
Your Guide to Allergies.
FREE Newsletter. Sign Up Now!

Spring is in full bloom, and many areas of the country are experiencing high pollen levels, leading to misery in allergy sufferers. Will this be a bad year for allergies? It sure seems like it's starting out that way. So, if you're one of the 40 million Americans with allergic rhinitis (hayfever), it's time to be prepared to treat your symptoms.

The spring season typically brings tree pollen, the summer brings grass pollen and the fall brings weed pollen. Molds can be present all year long, although may be the highest in the late summer months. These are only general rules, and many areas of the country can have any type of pollen present throughout the year, especially after rains. Learn more about seasonal allergies.

If you have allergies, be prepared and read the following:

• Find out the pollen counts in your area
• Learn about allergic rhinitis symptoms
• Discover the best treatments for hayfever

What is Hay Fever?

From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!

What is Allergic Rhinitis?

What is hay fever?

Hay fever, or allergic rhinitis, is the most common chronic disease, affecting up to 30% 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.

What puts someone at risk for developing hay fever?

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.

What’s the big deal, it’s just a runny nose, right?

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.

How is allergic rhinitis diagnosed?

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 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 allergies

Physical 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.

Find out about the treatment of allergic rhinitis.

Sources:

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

2. 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.

Updated: March 10, 2007

Treatment of Allergic Rhinitis, Part 2: Medications

From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!

Use of Medications

When avoidance measures fail or are not possible, many people will require medications to treat their allergic rhinitis symptoms. The choice of medication depends on numerous questions to be answered by the person or person’s physician:

1. How severe are the symptoms?

2. What are the symptoms?

3. What medication can the person get (over the counter, prescription)?

4. What medication will the person take?

5. Is the medication needed daily or intermittently?

6. What side effects might the person experience from the medications?

Oral anti-histamines. This is the most common class of medications used for allergic rhinitis.

The first generation anti-histamines, which includes Benadryl®, are generally considered too sedating for routine use. These medications have been shown to affect work performance and alter a person's ability to operate an automobile.

Newer, second-generation anti-histamines have now become first-line therapy for people with allergic rhinitis. These prescription medication include cetirizine (Zyrtec®), fexofenadine (Allegra®), and desloratadine (Clarinex®). Loratadine (Claritin®, Alavert® and generic forms) is now available over the counter.

These medications have the advantage of being relatively inexpensive, easy for people to take, start working within a few hours, and therefore can be given on as “as needed” basis. The medications are particularly good at treating sneezing, runny nose, and itching of the nose as a result of allergic rhinitis. Side effects are rare, and include a low-rate of sedation or sleepiness, but much less than the first-generation anti-histamines.

Topical nasal steroids. This class of allergy medications is probably the most effective at treating nasal allergies, as well as non-allergic rhinitis. There are numerous topical nasal steroids on the market, and are all available by prescription. Some people note that one smells or tastes better than another, but they all work about the same.

This group of medications includes fluticasone (Flonase®), mometasone (Nasonex®), budesonide (Rhinocort Aqua®), flunisolide (Nasarel®), triamcinolone (Nasacort AQ®) and beclomethasone (Beconase AQ®).

Nasal steroids are excellent at controlling allergic rhinitis symptoms. However, the sprays need to be used daily for best effect and therefore don’t work well as needed. Side effects are mild and limited to nasal irritation and nose bleeds. The use of these nasal sprays should be stopped if irritation or bleeding is persistent or severe.

Other prescription nasal sprays. There are two other prescription nasal sprays available, a nasal anti-histamine and a nasal anti-cholinergic. The anti-histamine, azelastine (Astelin®), is effective at treating allergic and non-allergic rhinitis. It treats all nasal symptoms similar to nasal steroids, and should be used routinely for best effect. Side effects are generally mild and include local nasal irritation and some reports of sleepiness, as it is a first-generation anti-histamine.

Nasal ipratropium (Atrovent nasal®) works to dry up nasal secretions, and is indicated at treating allergic rhinitis, non-allergic rhinitis and symptoms of the common cold. It works great at treating a “drippy nose”, but will not treat nasal itching or nasal congestion symptoms. Side effects are mild and typically include local nasal irritation and dryness.

Over-the-counter nasal sprays. This group includes cromolyn nasal spray (NasalCrom®) and topical decongestants such as oxymetazoline (Afrin®) and phenylephrine (Neo-Synephrine®). Cromolyn works by preventing allergic rhinitis symptoms only if used before exposure to allergic triggers. This medication therefore does not work on an as-needed basis.

Topical decongestants are helpful in treating nasal congestion. These medications should be used for limited periods of 3 days every 2-4 weeks; otherwise there can be a rebound/worsening of nasal congestion called rhinitis medicamentosa.

The side effects of the above are both generally mild and include local nasal irritation and bleeding, but topical decongestants should be used with caution in patients with heart or blood pressure problems.

Oral decongestants. Oral decongestants, with or without oral anti-histamines, are useful medications in the treatment of nasal congestion in people with allergic rhinitis. This class of medications includes pseudoephrine (Sudafed®), phenylephrine, and numerous combination products. Decongestant/anti-histamine combination products (such as Allegra-D®, Zyrtec-D®, Clarinex-D® and Claritin-D® are indicated for treating allergic rhinitis in people 12 years of age and older.

This class of medication works well for occasional and as-needed use, but side effects with long-term use can include insomnia, headaches, elevated blood pressure, rapid heart rate and nervousness.

Leukotriene blockers. Montelukast (Singulair®), was originally developed for asthma approximately 10 years ago, and is now approved for the treatment of allergic rhinitis as well.

Studies show that this medication is not as good at treating allergies as the oral anti-histamines, but may be better at treating nasal congestion. In addition, the combination of montelukast and an oral anti-histamine may be better at treating allergies than either medication alone.

Montelukast may be of particular benefit for people with mild asthma and allergic rhinitis, since it is indicated for both medical conditions. The medication must be taken daily for best effects, and usually takes a few days before it starts working. Side effects are usually mild and include headaches, abdominal pains and fatigue.

Want to keep learning? Discover the only potential cure for allergies: allergy shots.

Sources:

1. Dykewicz MS, Fineman S, editors. Diagnosis and Management of Rhinitis: Complete Guidelines of the Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology.

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.

Hayfever Symptoms Caused by More Than Just Pollen

Spring is the major time of the year for hayfever, or allergic rhinitis, to occur. Classically, people who suffer from this type of allergy are allergic to pollens in the air. However, a recent study shows that people with hayfever are also more likely to suffer from non-allergic rhinitis.

Non-allergic rhinitis is due to irritants, rather than allergens, and can mimic symptoms of hayfever. Triggers for non-allergic rhinitis include cigarette smoke, perfumes, cold air, weather changes and exercise. These triggers caused symptoms in 42% of people with hayfever, compared with only 3% of people without hayfever.

Seasonal Allergies

From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!

Hay Fever

What is a Seasonal Allergy?

A seasonal allergy is an allergic reaction to a trigger that is typically only present for part of a year, such as spring or fall. This type of allergy refers to a pollen allergy, such as trees, weeds and grasses. Perennial allergies, on the other hand, are usually present year-round, and include allergens such as pet dander and house dust mite. Molds can be a seasonal or perennial allergy trigger.

What are Pollens?

Pollens are tiny egg-shaped powdery grains released from flowering plants, which are carried by the wind or insects, and serve to cross-pollinate other plants of the same type for reproductive purposes. When pollen is present in the air, it can land in a person’s eyes, nose, lungs and skin to set up an allergic reaction.

Symptoms may include allergic rhinitis (hay fever), allergic conjunctivitis (eye allergies) and allergic asthma.

Pollens that are spread by the wind are usually the main cause of seasonal allergies, while pollens that rely on insects (such as the honeybee) to be carried to other plants do not. Most plants with bright, vibrant flowers (such as roses) are insect pollinated and do not generally cause seasonal allergies since the pollen is not usually present in the air.

Pollen can travel long distances and the levels in the air can vary from day to day. The pollen level can be quite different in various areas of a particular city or area. Levels of pollen tend to be highest from early morning to mid-morning, from 5AM to 10AM.

What Causes Springtime Allergies?

Spring allergies are a result of pollen from trees, which can start pollinating anytime from January to April, depending on the climate and location. Trees that are known to cause severe allergies include oak, olive, elm, birch, ash, hickory, poplar, sycamore, maple, cypress and walnut.

In some areas of the world, some weeds will also pollinate in the springtime.

What Causes Summertime Allergies?

Grass pollen is typically the main cause of late spring and early summer allergies. Grass pollen is highest at these times, although grass may cause allergies through much of the year if someone is mowing the lawn or lying in the grass. Contact with grass can result in itching and hives in people who are allergic to grass pollen, this is called contact urticaria.

Grasses can be divided into two major classes, northern and southern grasses. Northern grasses are common in colder climates, and include timothy, rye, orchard, sweet vernal, red top and blue grasses. Southern grasses are present in warmer climates, with Bermuda grass being the major grass in this category.

What Causes Fall Allergies?

Weed pollen is the main cause of seasonal allergy in the late summer and early fall. Depending on the area of North America, these weeds include ragweed, sagebrush, pigweed, tumbleweed (Russian thistle) and cocklebur.

In some areas of the world, some trees can pollinate in the fall as well.

How Do I Know What Pollens are Present?

In most areas, pollen is measured and counted, with the different types of pollen identified. This may be reported in terms of trees, weeds and grasses, or may be further divided into the types of trees and weeds identified. Specific grasses are not usually identified on pollen counts, as grasses look the same under a microscope.

Find out what the pollen counts and types of pollen currently found in your area.

How Do I Know Which Pollens I am Allergic To?

An allergist can help determine if you have seasonal allergies, and to which types of pollens to which you are allergic. This is accomplished through allergy testing, which typically involves skin testing or a blood test (RAST). Allergy testing can be helpful in predicting the times of the year that you are likely to experience allergy symptoms, and is needed if you are interesting in taking allergy shots.

How Can I Avoid Pollen Exposure?

Unlike avoidance of pet dander and dust mites, it is more difficult to avoid exposure to pollens, since it is present in the outdoor air. Here are some tips to minimize pollen exposure:

• Keep windows closed prevent pollens from drifting into your home
• Minimize early morning activity when pollen is usually emitted-between 5-10 a.m.
• Keep your car windows closed when traveling.
• Stay indoors when the pollen count is reported to be high, and on windy days when pollen may be present in higher amounts in the air
• Take a vacation during the height of the pollen season to a more pollen-free area, such as the beach or sea.
• Avoid mowing the lawn and freshly cut grass
• Machine dry bedding and clothing. Pollen may collect in laundry if it is hung outside to dry

Want to keep learning? Find out more about the treatment of allergic rhinitis.

_{Source: American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org/patients/publicedmat/tips/outdoorallergens.stm. Accessed February 13, 2007.}

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.

Updated: March 9, 2007

Non-allergic Rhinitis

From Daniel More, MD,
Your Guide to Allergies.
Stay up to date!

What is Non-allergic Rhinitis?

Non-allergic rhinitis is a medical condition of unknown cause, leading to symptoms very similar to allergic rhinitis, or hay-fever. Approximately half of people suffering from allergies also have a non-allergic component to their symptoms. Unlike allergies, which can be a seasonal problem, symptoms of non-allergic rhinitis are typically year-round. Non-allergic rhinitis also tends to be more common as people age, whereas allergic rhinitis tends to affect children and young adults. Non-allergic rhinitis has many different forms:

• Vasomotor rhinitis is triggered by physical conditions such as strong odors, perfumes, changes in temperature and humidity, smoke, fumes and bright sunlight. Most patients experience a runny nose, post nasal drip and/or nasal congestion.

Itching of the nose and eyes is typically not present.

• Infectious rhinitis is typically related to a viral or bacterial infection, and symptoms can mimic a sinus infection, with facial pain and green nasal discharge. However, these patients do not have evidence of a sinus infection on x-rays. This disease process resolves on its own within a few days, and responds to oral antibiotics in severe or prolonged cases, just as a sinus infection would.

• Hormonal rhinitis can occur during pregnancy and in patients with low thyroid function. Pregnant women usually have symptoms of severe nasal congestion occurring during their second month of pregnancy, and this can persist until the baby is born. Symptoms typically disappear shortly after delivery.

• Medication-induced rhinitis can occur in many patients using high blood pressure medication, birth control pills and non-steroidal anti-inflammatory drugs (such as aspirin and ibuprofen).

• Rhinitis medicamentosa is related to overuse of over the counter decongestant sprays, such as oxymetazoline, with symptoms of severe nasal congestion and runny nose. People who over-use these sprays essentially become “addicted” to the medication, needing more and more medication to control their symptoms.

• Gustatory rhinitis can be related to food or alcohol intake, but is rarely due to an allergic cause. People suffering from this form of rhinitis experience a runny nose, usually of a clear, watery fluid, particularly after eating hot or spicy foods.

• Rhinitis related to acid reflux disease is particularly common in young children, with symptoms of nasal congestion, runny nose and post-nasal drip. Symptoms may tend to occur after heavy meals, or in the morning after the person has been having acid-reflux while lying flat at night.

How is Non-allergic Rhinitis Diagnosed?

It can be very difficult to diagnose non-allergic rhinitis by a person’s symptoms alone. A diagnosis is usually based on the history of symptoms, medication use, other known medical problems, and a physical examination. Allergy testing will be negative in patient with non-allergic rhinitis, and this testing is usually required to make sure that allergies are not playing a role in the person’s symptoms.

How is Non-allergic Rhinitis Treated?

Avoiding the irritant triggers which cause the symptoms is the best way to treat non-allergic rhinitis, but not always possible. Typically, patients with non-allergic rhinitis do not respond to anti-histamine medications, since histamine is not causing their symptoms.

Medications which are at least partially effective include prescription nasal steroid and antihistamine sprays, and oral decongestants. Patients with symptoms of constant “dripping” nose and post nasal drip may benefit from the drying effect of an anti-cholinergic nasal spray, and seem to be most helpful in vasomotor and gustatory rhinitis.

Rhinitis during pregnancy can respond to saline nose sprays, and rhinitis medicamentosa requires stopping the over-the-counter topical decongestant and often replacing it with a prescription nasal spray.

Treatment of other forms of non-allergic rhinitis may be patient-specific and require the care of a physician. Allergy shots, or immunotherapy, are ineffective in the treatment of non-allergic rhinitis.

Source: Diagnosis and Management of Rhinitis: Joint Task Force on Practice Parameters in Allergy, Asthma and Immunology. Ann Allergy Asthma Immunol. 1998;81:463-518.

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.

Updated: January 13, 2007