Asthma

I came across this on the drive in to work yesterday morning, and it reminded me of just a few short years ago.  From time to time I would babysit my godson, and for quite a while, he used a pacifier (which I always call a "binky").  Like many babies and very young children, he took comfort in a pacifier.  It was often the "go-to" thing at bedtime or when he was fussy.  When babysitting, the pacifier would inevitably fall from his mouth and land on the floor.  More often than not, I would see it happen, pick it up, make sure there was no dog hair or big chunk of dirt on it then pop it back in.  I can hear a few people gasping, but generally speaking, "dirt don't hurt" was a saying that my brothers and I practiced on a daily basis as children. My one brother's nickname was literally "dirt" since he was generally filthy from playing outside so much.  This is all a bit circuitous, but it leads me to two things, the hygiene hypothesis and a recent study published in Pediatrics.

While my approach in cleaning the pacifier is probably not taken by many, this recently published study I mention focuses not only on how parents cleaned their children's pacifier but also how it may impact the development of eczema and allergies.  In examining 184 children, researchers studied what the children were sensitive to, how parents cleaned their pacifiers, and analyzed the bacteria in the children's mouths.  At 18 and even 36 months, children whose parents cleaned their pacifiers by sucking on them, showed remarkable protection against eczema and asthma.  Yes, you read that correctly.  Some parents clean their child's pacifier by sucking it clean then giving it back to the child.  Odd as it may sound, this is believed to be the key findings of the study.

Regardless of how "clean" we, as a species, think we are, there are literally billions of bacteria living on and even inside of us.  On our skin, in our digestive tracts and in our mouths, bacteria play a very important part in everything from our immune system to the way in which we break down our food.  The theory is that by sucking on the pacifier the parent not only cleans visible dirt or debris from it, but they actually place bacteria back onto it.  That bacteria is then introduced to the child, exposing the child's immune system to a broader array of bacteria.  This ties into the hygiene hypothesis in that many believe children in western societies are "too clean," and because of this, are at an increased risk of developing things like eczema, asthma or allergies.

When we are infants, our bodies' systems are developing.  Think of the immune system like a defense mechanism that is untrained.  By nature, this system is designed to find things harmful to us and fight them, so at a very early age, the immune system is trying to determine what is dangerous and what can be ignored.  The hygiene theory suggests that lack of exposure to a variety of bacteria and germs means the system doesn't get thorough training and often identifies innocuous substances as harmful.  "Well, we have to find the shady characters to defend you against, and I don't like the looks of these guys." So when they immune system cannot find real enemies, they start identifying harmless substances as dangerous.

The hygiene hypothesis is just that, a hypothesis, and there are some studies that run counter to this.  This piece of research, though, suggests that there is some validity to it.  While it is too early to suggest that parents start sucking on their kid's pacifier to clean it, it really can't hurt.  Oh, and just for the record, most parents simply rinse the pacifier.  I guess I all into that "other" category.

For an abstract of the pacifier study.

Author: KevvyG

May is Asthma Awareness Month, as designated by the Environmental Protection Agency (EPA) and with this comes a renewed focus on asthma and how it impacts not only individuals but the larger community as a whole. In addition to this, each year a few non-profit/advocacy organizations piggyback off this and have designated May Allergy & Asthma Awareness Month. During this month there are a variety of events scheduled to help promote awareness as well as action on these two respiratory problems.

The Asthma and Allergy Foundation of America (AAFA) is planning several events to help to raise awareness across multiple age groups. Some of these include kits to help people set up and organize their own events, free webinars, a poster contest for 3rd-8th graders, a sweepstakes and their Ditch the Drip event in Memphis, May 16-18th. For more information on these events, visit the AAFA.

Our the partner, AANMA, is spending the day at on Capitol Hill. There they will focus on a multiple of things including changes in healthcare law, meeting with lawmakers, and providing a variety of free booths that offer anaphylaxis preparedness demonstrations, asthma and allergy screenings as well as consultations with allergists. All of these events are geared towards raising awareness of allergies and asthma while interacting with legislators. To learn more about Capitol Hill Day or for more info on the AANMA.

Lastly, there is the EPA. While this large governmental agency doesn't do much in terms of directly sponsored or coordinated events, they do much in the way of providing educational materials and the tools needed for advocacy groups or just individuals to help spread awareness. This PDF is chock-full of ways that people can help to raise public awareness of asthma and its impact in the community. Some way wonder why the EPA would promote Asthma Awareness Month, but the reason is actually pretty simple. The link between the environment, particularly air quality, and asthma is clear. From ground level ozone, to studies that focus on asthma rates in urban areas (often choked with vehicle emissions), many of the things the EPA does on a day to day basis can have a direct impact on asthma in the United States.

For our part here at AchooAllergy, we know that allergy season is in full swing, so we are offering a 10% discount on asthma and allergy relief products. From window filters, allergy bedding and air purifiers to HEPA vacuum cleaners and nebulizers, save an extra 10% of your purchase of most products. Happy May!

Author: K. Gilmore

One aspect of my job here at Achoo puts me in touch with people with little to no knowledge of environmental control, allergy bedding or how specific things inside the house can be causing certain symptoms. One piece of information that I commonly pass along is based on previous studies of allergies and asthma that show links between allergic diseases like allergies, asthma and eczema. About 70% of the time, if a child has asthma, s/he also has at least one allergy. A study recently published in the Annals of Allergy, Asthma and Immunology clear up this picture for adults with asthma who likely also have allergies. The results were a bit surprising to most professionals in the field.

By studying and comparing data from over 2500 patients in two age groups, 20-40 and 55+, researchers found that for asthmatics, allergic sensitization was present far more often than not. For the first age group, 20-40, those with asthma were also allergic to at least one allergen 75.4% of the time. In the second group, 55 years and older, asthmatics were allergic to at least one allergen 65% of the time. While this type of overlap has been studied and identified in children, most believed that the link between allergies and asthma wasn't as strong with adults.

Within this data, there is some variation between the types of allergens that these age groups showed the most sensitivity to. For the older set of patients, the most common allergen was dust mite. Over one-third of those who were asthmatic and allergic were sensitive to dust mites. Rye grass, cats, dogs and cockroaches followed. For the younger set of patients the allergen sensitivities were similar with dog and the dust mite allergen leading the way.

Allergies and asthma are two very closely related animals. One is like a llama while the other is like an Alpaca. Both are different but fairly closely related, and like llamas/alpacas, sometimes people confuse the two.

In terms of helping people, this stronger correlation can help doctors and allergists better diagnose conditions in older adults. And while asthma and an allergy may be the cause of a particular set of symptoms, some of the same measures to help control your indoor environment will work for both.

To read the article's abstract or access the full article.

Three Ways to Reduce Allergens in Your Bedroom

Author: Kevin Gilmore

I have to say, I always enjoy reading or hearing stories like the one a friend of mine passed me yesterday (thank you Cordelia!). A very similar story was part of the broadcast on NPR this morning as well. The focus of both was controlling asthma, but to me the more interesting part was how it was being done - environmental control.

At AchooAllergy.com, we have been advocating environmental control, as a way to reduce allergic and asthmatic reactions, for over a decade. So, it is always heartening to see doctors, insurers and others recognizing the importance of this preventative style approach to asthma and allergies and actually creating programs to bring these ideas into the homes of people who need it the most.

Environmental control is multifaceted, and something that is often done in stages. Because it can be time intensive and not the most inexpensive process in the world, we have always stressed that people start with the bedroom and work out towards the rest of the home. You spend more time in your bedroom than any other single room in your home, so if there is one place to be a sanctuary, a place where you can provide relief from allergens, it should be there.

Both stories touched on things we have written about and advocated for years.

• Using a HEPA vacuum cleaner
• Installing allergy bedding covers on your mattress and pillow
• Avoiding harsh cleaners like bleach or ammonia based cleaning products as well as "deodorizers" that pollute the indoor air even more
• And, removing carpet, to name a few

These measures all work to do one main thing - reduce allergens and improve the indoor environment. In addition to this, programs like the Community Asthma Initiative actually help people by going into the home, educating, coaching and providing the information and products to go about making these changes. Most importantly, they also measure their results, and in a time when budgets are being literally pushed to their breaking points, the ability to quantify the good that comes from these measures is critical in obtaining the funding to continue and expand this type of program.

On a similar note, over the last year, we have had the benefit of working with a partner who has recognized the benefit of allergy bedding in helping to reduce dust and dust mites in the home. With them we have been able to provide mattress covers, pillow covers, pillows, and other dust mite bedding to hundreds of people who, without this program, would not likely be able to afford it. Sadly these partnerships remain more of a rarity than the norm, and one of the biggest problems remains education - education of those affected as well as education of those who can help and those who can provide funding for these types of programs. Too few people in both of these groups understand the long term benefit that environmental control can offer.

The educational side is where other partners, like the Allergy & Asthma Network Mothers of Asthmatics, is critical. As a non-profit on the front lines of asthma education and advocacy, the AANMA works to not only help to educate those affected by allergies and asthma, but they also act as a voice to raise awareness on these issues at the state and national government levels.

Allergy shots remain one of the closest things to a cure for allergies, and while medication can tamp down many of the reactions that those affected with asthma have, it's really only when the these things are combined with environmental control measures in the home that the most benefit is seen. It is my sincere hope that as research continues, partnerships, like the ones we have, and programs like the Community Asthma Initiative can continue to coalesce and provide health benefits to those who need it most.

For the full article from Pediatrics Journal.
For more information about the Community Asthma Initiative program or to read/listen to the NPR story.

Author: Kevin Gilmore

People who suffer from COPD (Chronic Obstructive Pulmonary Disorder), sleep apnea or other respiratory conditions have some familiarity with wearing a mask while sleeping. Perhaps not the most comfortable, these masks often help keep airways open or deliver concentrated oxygen to assist breathing when lung functionality or airways are compromised. Sometimes bulky, these masks provide a very real and much needed benefit to ensure oxygen levels remain at levels that keep the body healthy and feeling refreshed after a night's rest. For those who suffer from other respiratory conditions like asthma or allergies, masks serve a different purpose. They block particle allergens like dander and pollen while some also filter out odors, smoke and chemicals. While these types of masks are often worn during the day, there may also be some benefit to wearing them at night.

In the February issue of The Journal of Allergy and Clinical Immunology, a research piece explores the idea of asthma sufferers wearing a mask while sleeping. While allergen avoidance is a commonly recommended course of action for people with allergies or asthma, one type of intervention alone is rarely sufficient. This has long been the reason why we have traditionally recommended an overarching approach that includes allergy bedding covers, air filtration, and regular cleaning to removal of carpet and the use of an allergy mask. It is this last part that these researchers focused on.

This randomized, four week study focused on children with asthma and rhinitis and tested to see how sleeping with a mask (even when they continued on their normal medication) would affect them. What they found was that those who slept with a mask at night to help filter allergens or irritants reported more asthma control days (days where their asthma was under control) and a higher peak expiratory flow than their non-mask wearing counterparts.

While no single measure, wearing a mask, encasing bedding, or regular cleaning, can effectively control allergies and asthma alone, what the study shows is that when added to a regimen, wearing a mask at night may be beneficial to some children in their efforts to control asthma. If wearing an allergy mask at night is something you want to consider for your child, keep in mind a few things - size/fit, effectiveness, and airflow. While even something as simple as a N95 rated mask will help, comfort, correct sizing and adequate airflow can all impact how likely the child is actually to keep the mask on while s/he sleeps. And if it comes off during the night, don't worry! In the study, almost half of the children who did wear masks, woke up with them no longer on but still benefitted.

To read the full published research article.

Author: Kevin Gilmore

Viruses, bacteria, and germs... they seem like a terrifying lot sometimes, particularly when the evening news shows stories of salmonella food poisoning, some ultra rare microbes with devastating effects or a story about how research on the mutating the Avian flu virus to affect people will continue. For all the negatives we hear day in and day out about the microscopic organisms, millions of them are on our skin and even inside of us at any given time. As science focuses more on how they interact with our bodies and effect our health, the picture of a positive relationship is becoming much clearer.

Over the last few months new studies have shown that bacteria in our digestive system play a key role in everything from losing weight and fighting colds to lowering cholesterol and even alleviating asthma. In addition to the longer known relationship between bacteria in our GI tract and digestion, new research is showing a symbiotic relationship on many levels.

The lungs have long been thought to be sterile, devoid of the types of microorganisms that are so commonly found in the digestive system. A recent study by the Cardiff University of Medicine has revealed that not only was that assumption wrong, but that some of the organisms found in the lungs may play a key role in whether or not a person develops asthma.

With over 100 different types of fungi found in sputum samples, the study showed differences in not only the types but also the number of fungal species found in samples from asthmatic and control patients. For asthmatic samples certain fungal species were found that were either not found or found in much lower numbers in the control group - Psathyrella candolleana and Malassezia pachydermatis are just two. The reverse was also true for control patients. Systenostrema alba and Eremothecium sinecaudum were found in healthy patients and were either not found in asthmatics or found in much lower numbers.

While the study of numbers, types and more importantly the role of fungal species in the lungs is still in its infancy, it offers a new avenue of study in terms of the development and treatment of asthma.

To read the full text of the study.

Author: K. Gilmore

As a dog owner, keeping my dog clean and free of ticks and fleas can sometimes seem like a real chore. Over the years I have tried a few different methods in controlling fleas and ticks. Though I never used a flea collar, I have tried the shampoos and the treatments that you apply down the back of the dog. A few years ago, I stopped using both of these things, particularly after actually reading up on some of the chemicals that these products contain, mainly insecticides. (Though when a bottle of shampoo has to have a disclaimer about being toxic to aquatic life, I should have taken that as a bad sign.) Beyond potential issues with your pet's health, they can also have an adverse effect on some people.

The active ingredient in most modern tick and flea shampoos is commonly a pyrethroid, a class of organic compounds related to natural pyrethrins found in some flowers. Most household insecticides stem from this class of chemicals. The problem with many of these is that, quiet bluntly, they are toxic. Most have labels that state as much, particularly with regard to animals and aquatic life. Pyrethroids are considered safe for vertebrates since they have the enzymes and biology in place to break down these chemicals in fairly short order.

Except for cats... Ostensibly, dogs and humans can break down these insecticides in the liver in kidneys without long term effects. Because cats cannot breakdown a common pyrethroid used in flea and tick treatments, phenothrin was pulled by most manufacturers in 2006. Adverse reactions ranging from tremors and hair loss to salivation and death were reported when used with cats.

Cats notwithstanding, most pets and humans are fairly safe when using products that contain pyrethrins. Be even if these products are relatively safe for use around humans and dogs, there are still other compounds found in these can produce adverse reactions in people and pets alike.

D-Limonene (smells like oranges and sound innocuous enough, right?) is assumed to be the culprit in a case where a Pomeranian in Washington recently suffered a severe allergic reaction. The family pet developed edema throughout her body but ultimately recovered. Limonene is also used as a solvent in cleaners, air fresheners, and even glues. While D-Limonene is used commonly used in cosmetics and as an insecticide, the FDA recommends against using this hydrocarbon on cats or dogs, and some with sensitivities may develop contact dermatitis or a general sensitivity to the compound.

In another instance where chemicals in flea and tick repellents more directly impacted a person, a pet shampoo distributed by Sogeval Laboratories, Inc., with an ingredient, phytosphingosine, was associated with the death of one woman who was bathing her dog with the product. An acute asthma attack was the cause of death, and just a few days later, another asthmatic family member suffered a mild asthma attack while bathing the pet with the same product. The belief is that the particular substances used in that formulation of pet shampoo triggered the two asthma attacks in the individuals involved.

This is not to say that all pet shampoos are going to cause problem for you or your pets, but what it does highlight is two things. First, read labels. If there's something you're unfamiliar with, look for a known alternative. When you do come across an unknown compound, check online for the MSDS sheet or visit the manufacturer's website to get as much information as you can. You can then search for these compounds to find out more about them and potential hazards. This may seem like a lot, but it literally takes 10-20 minutes of searching online. Second, some ingredients in flea and tick treatments, as well as cosmetics, cleaners, and other household products, can react differently with different people (particularly those who have an existing allergic or asthmatic condition and those who have shown a sensitivity to chemicals that don't affect most others).

As a side note, for fleas and ticks, I use the Ecology Works pet shampoo. Personally, I like the smell, it lathers well, and I've yet to find a flea or tick on my dog (despite my roommates dog having fleas a couple times since we have lived together.

Author: Kevin G.

In a recent study presented at the European Respiratory Society conference in Vienna, researchers defined the link between the use of a common asthma treatment drug and a child's height. For years it has been believed that budesonide, the primary active drug in Pulmicort, temporarily slowed the growth of children but that as the children grew into adults, their height eventually "caught up." This most recent study finds that the long term effects on adult height, though minimal, are permanent.

When accounting for all factors across multiple age groups, researchers found that prepubescent children who took a twice daily dose of the inhaled glucocorticoid were an average of 1.2 cm (just under half an inch) shorter than those in the placebo group. As the children grew to be adults, the slowing in growth was not cumulative nor was it progressive.

Overall, this is likely a case of not wanting to throw the baby out with the bathwater. While height is minimally effected, particularly with higher doses and with younger children, the overall effect of fewer asthma attacks ultimately outweighs this potential side effect.

For doctors and parents, this study should prompt a discussion about the use budesonide and finding the minimal dose required to control asthma while limiting any potential growth issues.

To read the original articles published in the New England Journal of Medicine.

Author: Kevin Gilmore

Keep an eye out the next three days as this week is VIRUS WEEK!

Like many health issues and conditions, the primary determining factors are genetics and the environment. Both are not weighted equally in any given situation, but both play a role in the development of most medical conditions and diseases. Even when the specific causes of a condition, like allergies, asthma and eczema, are unknown, evidence is strong that these two factors are important. A recent study published in The Journal of Allergy and Clinical Immunology suggests a very strong link between parents with allergic diseases and the chances of their same sex offspring in developing allergic diseases.

Using a combination of IgE blood tests, skin prick tests and close examination of parental history, researchers studied parents and monitored their children for their entire childhood. In collecting and analyzing the data they found that when a mother had asthma or eczema their female children demonstrated a nearly 50% increase in the risk of developing that same condition. The same was not true for male children. However, this a near identical increase in risk was seen when examining paternal conditions and their male offspring. Simply put, if a mother had asthma or eczema, her daughter was 50% more likely to develop the same condition. Her son, saw little to no appreciable increase in risk. If a father had asthma or eczema, his son was 50% more likely to develop the same disease while his daughter was not.

This is important for two reasons. In the more long term, it more clearly defines the genetic link between parents and children when it comes to allergic diseases. The genetics behind conditions like eczema will ultimately be key in preventing them. In the short term, because this link has been more readily defined, it could make it easier in the future to diagnose allergies and eczema. Patient history is a critical factor in determining asthma but even more so for allergies. Blood and skin prick tests can show sensitivities but it is not until a doctor sees the full picture of the patient's medical and family history that a most accurate diagnosis can be given.

To read an abstract of the study.

To view eczema friendly personal care products.

Author: Kevin Gilmore

So maybe the title is a bit deceptive since there will be no mention of the famous movie by the same title that starred Marilyn Monroe and Tony Curtis, except for this one. What I am referring to, however, is the intense heat that is EZ-Baking the middle of the US and slowly marching east. From Denver to DC, Atlanta to Chicago, temperatures surpassing the century mark have set records in over a dozen cities this week. While a lot of us really enjoy the sun and being outdoors, +100° temps are a time when some caution should be used. Here's just a quick list of things to keep in mind while you worry about if you used enough deodorant today.

• Avoid the Heat, Avoid Ozone - Record temperatures are almost synonymous with ground level ozone and air quality warnings. A look at the national map reveals a lot of code orange dots scattered throughout the eastern part of the country. Heat mixes with emissions to create a stew of pollutants that can adversely effect everyone but specifically the elderly, children and anyone suffering from a heart condition or respiratory issue. This means asthmatics and those with COPD, among others, should take precautions to limit to their time outdoors to early mornings when ozone is at its lowest levels. If you must go out, use a mask that features carbon or charcoal in the filter.
  
  
• Sunscreen + Water = Win! - If you are going to enjoy the sunshine, make sure to use a little sunscreen and drink plenty of water. With almost no chance of rain, not a cloud to be found and temperatures so high, it's important to protect your skin from UVA and UVB rays. Vanicream offers a healthier sunscreen is healthier alternative to traditional sun blockers that can be laden with harmful chemicals and fragrance. Water is very important in replacing what you lose through perspiring and preventing dehydration. It's a great way to avoid looking like a sun-dried raisin!
  
  
• Put Off Yard Work - Much to the chagrin of your significant other, you officially have a legitimate reason for putting this off. If there is work to be done in the yard, aim to complete it by 9-11am, at the latest. Depending on local conditions, there may be no dew on the ground even earlier than this, but typically dew "burns off" by the midmorning hours. You can either wait a few days until the extreme temperatures subside or use the early hours to get your outdoor chores completed (and earn brownie points for not putting it off!).
  
  
• Take a Break - If you are outside for very long or doing physical activity, take a break! Find some shade, a cool drink and give you body some time to recover. Extreme sun and heat saps your strength, so short periods of rest can help recharge your batteries. And don't forget about eating. When the temperatures are warm and I am outside, I can be guilty of this. Heavier foods are not going to be helpful, light snacks and fruit provide the energy you need to keep going.
  
  
• Don't Forget the Pets - Have outdoors pets? Bring them inside. If they're anything like my dog, after a hot day at work, he loves to just flop on the cool tile in our downstairs and soak up the cool. At the very least, keep an eye on outdoor pets and ensure they have plenty of fresh water and shade. Alone inside a parked car with the windows cracked? Unless you have the vehicle running, and your AC cranked, it's like a blast furnace in your car or truck. In this case, it is actually better if they are outdoors, or best still, leave them home.
  
  
• Take a Moment for Tomatoes - If you have a garden or just a few tomato plants and landscaping like I do, the heat can wilt and damage them in fairly short order. Vulnerable, potted plants should be moved to areas where exposure to sunlight is less than normal. Water them in the early hours or after the sun has gone down to reduce the amount that is lost by evaporation. Some plants, even when not exposed to direct sunlight, will wilt simply due to the extremely high temperatures.
  
  
• Your Excuse To.... - On a lighter note, use the heat as an excuse to stay indoors in the air conditioning. If this means spending time with the family or visiting/checking on an elderly relative, perfect! If it just means you staying inside and catching a movie you've been wanting to see, that's fine too!

This list isn't comprehensive, but it does give you a few things to keep in mind as these high temperatures steam roll across the midwest, south and east coast. If you are feeling dizzy or lightheaded at any point, stop what you are doing and rest for a few minutes. If conditions like this do no subside quickly, please visit your local hospital, clinic or health care provider. Heat stroke and dehydration, though common during times of high heat, are completely preventable and usually, easily treated. Stay safe!

Author: Kevin Gilmore