Updated 10/30/2008

WHY DOES ASTHMA GET WORSE  AROUND LABOR DAY ?
 
This question was answered by Malcolm Sears in Sep  2007  issue of J. Allergy Clinical Immunology.  It is a common observation that right around the time kids get back to school there is an increase in ER visits and hospitalizations for asthma especially in younger children.  It was thought to be related to increase in allergens, although authors feel, since this increase in asthma exacerbations is initially seen  mostly  in younger school going  children, there must be another explanation.  These authors suggested Rhinovirus infection as the reason for this increase.   Rhinivirus infections during fall  are  the most common cause of asthma exacerbations in school age children and these infections are spread in the school environemnt.  Later on an increase is seen in younger children as well as adults and this could be due to these infections being spread to other family members.
 
Authors suggested that since this has been the pattern, pre-emptive steps should be taken in the form of adding or increasing controller medications to the treatment regimen for at risk asthma patients.  Patients should consult their physicians and have a plan to adjust their medications before the school starts.




Updated 9/09/2008

INDOOR NITROGEN DIOXIDE ( NO2 )  LEVELS AND ASTTHMA
 
 
Dr. Kattan and associates reported in Sep 2007 issue of J. of Allergy Clinical Immunology on the adverse effects of indoor NO2 on asthma symptoms in inner city  pediatric population in New York City.    87.8% of these families had gas stoves in the house.  Authors report that the outdoor levels of NO2 were 18 ppb  while in these houses the indoor concentration of NO2 was 29.8 ppb.   Among these patients  not only the relative risk of having increased asthma symptoms was higher, they also had lower peak flow readings especially during colder months.  Higher levels of NO2  have been reported to increase respiratory symptoms in asthmatic as well as non asthmatic individuals.  Indoor NO2 levels are determined by the outdoor NO2 levels as well as from indoor sources of NO2.  Families that use gas stoves   for cooking and heating would be at higher risk of having respiratory problems in asthmatica and as well as  non asthmatic family members. 




Updated 8/29/2008

POLLUTION'S EFFECT ON ASTHMA

Number of studies in healthy as well as asthmatic children have shown adverse effects on lung functions after exposure to pollution including increases in particulate matter and ozone levels.  Studies  looking at the effects of increased levels of Carbon Monoxide, an indicator of vehicle borne air pollution have shown the same adverse effect on lung fuctions.  In a study published in May 2008 issue of J. of Allergy Clinical Immunology, authors Connor and associates studied the effects of Air Pollution on the lung functions. They noticed that on days with higher environmental concentrations  of Sulfur Dioxide, NO2, Particulate matter below the size of 2.5 micron, there were more missed days from school as well as poorer lung function.  Patients should discuss  with their asthma care givers as to how to adjust their medications  during high pollution and poor air quality days.


Updated 8/26/2008

SMOKING AND ASTHMA RISK IN PATIENTS WITH HAY FEVER ( ALLERGIC RHINITIS )

In a  study published in J. Allergy Clinical Immunology, June 2008,  Dr. Polosa and associates studied patients who had history of ALLERGIC RHINITIS ( Hay Fever ) to evaluate the risk smoking imposes on these patients developing asthma.

They studied 325 patients who were seen in  1990 and 1991 for Hay Fever only. At that time these patients did noty asthma.  These patients were recalled ten years later in 2000 - 2001 and were evaluated for presence of asthma and were questioned about the history of smoking.  Authors found that  among these patients those who smoked had increased incidence of asthma compared to those who did not smoke.  The increased incidence was proportionate to the  number of packs they were smoking. Higher the number of packs per year, higher the incidence of asthma.  Those who smoked were compared to those wo did not smoke at all. 

It was also noted that among those who smoked and also had history of hay fever, if they took allergy shots for better management of their hay fever, than the incidence of development of asthma was less than those who did not take allergy shots.  Therefore even though smoking increased the risk of developing asthma in these hay fever sufferers, proper management of hay fever including allergy shots lessened the chances of developing asthma.






Updated  8/22/08

OBESITY AND ASTHMA RISK

Link between asthma and obesity is being recognized more and more.  In a recent study  published in J. Allergy Clinical Immunology, May 2008, it was reported that infants who were obese or overweight had incrased risk of wheezing by the time they were three years of age. 




Updated 8/01/08   

MENOPAUSE AND ITS EFFECT ON RESPIRATORY SYMPTOMS


In study published in j of Allergy clinical Immunology  vol 121, issue 1, Jan 2008

Francisco Gomez Real and associates studied 4259 women from 21 different centers. These women ranged in age from 45 - 56 years of age.  They found that women who were in menopause and who were lean body weight had a higher incidence of respiratory symptoms and lower lung volumes compared with women who were in menopause but were medium body weight.  Women with  allergic asthma had similarly increased  asthma problem if they were of lean body weight and were in menopause. These menopausal women were compared with women of same age who were still menstruating regularly and did not fit in the definition of menopause.  Therefore if you are a woman of lean body weight and are in menopause and have lung problems, you should be extra vigilant and take better care of yourself and follow up with your doctor regularly.


Updated 7/28/2008

FOOD ADDITIVES AND BEHAVIOUR


In a study published in Journal Lancet, authors studied the effect of food colors and additives on behavior in children ages 3 and 8-9 year olds.  It was observed that not only children who had been diagnosed with hyperactivity, even in normal children food colors and additives caused  hyperactivity. 



updated 7/21/2008

OBESITY AND ASTHMA



In May 2008 issue of J. of allergy Clinical Immunology Stephanie Shore PhD  has convincingly shown how obesity can have a major impact on asthma.  Obesity can
 
increase the likelihood of developing asthma 

increase the incidence of exacerbations

increase the severity of exacerbations.

Therefore it is very important that  as we treat asthma with directed therapies, we do not overlook the role of obesity in making asthma worse.  Patients with asthma who are overweight should discuss with their asthma specialist and or Primary Care Physician, as to how to bring their weight to normal levels.

Last update 7/20/08

FOOD ALLERGY AND ANTIULCER MEDICATIONS

June 2008 issue of Journal of Allergy Clinical Immunology it has been reported that Antiulcer medications may potentiate the development or worsening of food allergy.  Antiulcer medications  by raising the pH in the stomach interfere with the breakdown and digestion of food protiens allowing these to cause or aggravate allergic reactions to food allergens.  Reactions may occur at lower threshold or become more severe. Patients who have known allergies to foods may keep this in mind when they start antiulcer medications.



Updated 7/17/2008

Hydrolyzed infant formulas cut children's allergy risk


Hydrolyzed infant formulas, made with proteins that are already broken down, may help lower the long-term risk of allergic disease among children who are genetically predisposed to developing allergies, according to a study in the Journal of Allergy & Clinical Immunology. Previous studies have shown that, compared with whole-protein formulas, hydrolyzed versions lower the risk of allergic disease during infancy and early childhood. This study suggests the benefits may last until age 6 or longer. Researchers from Marien-Hospital Wesel, Germany, studied 2,252 children born between 1995 and 1998 who all had at least one parent with allergies. All parents were encouraged to breastfeed. But if breast milk was supplemented, they were randomly assigned to use one of four options: standard formula, partially hydrolyzed whey formula, extensively hydrolyzed whey formula or extensively hydrolyzed casein formula. Those given a hydrolyzed formula were up to 29 percent less likely to develop eczema by age 6, depending on the type of hydrolyzed formula.

editorial comment:  Children born in families with high incidence of allergies should be on Hydrolyzed formula  especially if they are not breast fed. 



ACE INHIBITORS CAUSE 30% OF ALL ANGIOEDEMA.

30% of all the cases of ANGIOEDEMA presenting to the emergency room are due to ACE INHIBITORS.   Angioedema is a condition characterized by episodes of swelling of the lips, tongue, throat, or other areas of the soft tissues, especially on and around the facial and throat area.  Could be life threatening.  Patients who start on ACE INHIBITORS should be aware of this potentially life threatening side effect.   IF YOU ARE ON ONE OF THESE AGENTS DO NOT STOP ANY MEDICINE WITHOUT CONSULTING YOUR PHYSICIAN