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FARE Announces Launch of FARE Clinical Network,
Names 22 Centers of Excellence as Inaugural Members
McLEAN, Va. (June 29, 2015) – Food Allergy Research & Education (FARE), the leading nonprofit organization working on behalf of the 15 million Americans with food allergies, is proud to announce the establishment of the FARE Clinical Network. The network is an initiative that aims to accelerate the development of drugs for patients with food allergies as well as improve the quality of care for this serious illness. FARE will initially fund 22 centers of excellence with an investment of over $2 million dollars annually. Under FARE’s leadership and coordination, FARE Clinical Network members will serve as sites for clinical trials for the development of new therapeutics and will develop best practices for the care of patients with food allergies. The FARE Clinical Network will serve as a powerful driver of collaboration to advance the field of food allergy, with member centers contributing to the development of a national food allergy patient registry and biorepositories.

Man convicted of involuntary manslaughter in asthma death BOSTON — A Boston man has been convicted of involuntary manslaughter for the death of a man who had an asthma attack fleeing a street shooting. Michael Stallings had been charged with first-degree murder and could have faced life in prison. He was convicted of a gun charge. His attorney said the murder charge was a stretch and that someone else opened fire first in a gang confrontation. Stallings faces punishment ranging from probation to 20 years in prison at sentencing, which hasn’t been scheduled. Prosecutors said 26-year-old Stallings started shooting at a group of men on a street in January 2012. No one was hit, but 40-year-old Kelvin Rowell had an asthma attack and collapsed. He fell into a coma and died six weeks later.

“Peanut Patch” Gets Fast Track Go Ahead from FDA DBV Technologies is the first company to announce Breakthrough Therapy Designation from FDA in food allergy for its product Viaskin Peanut for the Treatment of Peanut Allergy in Children. The patch is a form of immunotherapy. Breakthrough Therapy Designation was granted following positive Phase IIb trial results emphasizing the need to provide a safe pharmaceutical treatment for patients suffering from life threatening food allergies. Breakthrough Therapy Designation is intended to expedite the development and review of drugs/biological products for serious or life-threatening diseases or conditions, such as peanut allergy. Currently, DBV is actively preparing the launch of its Phase III trial of Viaskin Peanut in Children, suffering from peanut allergy, in close coordination with the US FDA.

Connecticut Legislators Push for Food Allergy Guidelines (Fairfield Sun) The legislation, HB 6975 An Act Establishing a Task Force to Study Life-Threatening Food Allergies in School, would create a task force with the mission of formulating a uniform policy on food allergies for all school districts. The CT Department of Education has guidelines for districts in the development of district-wide management plans for students with life-threatening allergies and glycogen storage disease; however, each school district is creating their own policies — some that are in direct conflict with Centers for Disease Control guidelines.

“My goal with this legislation is to bridge the emotional divide between parents of children with life threatening food allergies and school administrators, staff and parents of students without allergies and find a one consistent policy that address everyone’s concerns,” said Rep. Kupchick, who has worked on this issue since her years serving on the Fairfield Board of Education.

Childhood Asthma Doubles in One Decade in India (Times of India) According to health experts, the cases of asthma among children have increased significantly in the past one decade. “Almost a decade ago, childhood asthma was around 8-10% but it increased to 17-22% now. It is happening because of excessive environment pollution,” Dr Deepak Yaduvanshi, consultant in-charge, department of respiratory and chest medicine of a private hospital said. The health experts claimed mining is rampant in the state, which is one of the leading causes of respiratory diseases as mining enhances particulate matter in the air, which damages lungs. Also, increasing number of diesel vehicles are giving rise to particulate matter, the health experts claimed.

Scientists have discovered 34 genes that predispose people to allergies, which could become targets for new drugs

Asthma affects one in ten children in the UK, and allergies are thought to afflict a third of the population. Professor William Cookson, from the National Heart and Lung Institute at Imperial College London, said: ‘Our pioneering approach allowed us to obtain insights that we weren’t able to get from traditional genetics. ‘It isn’t just the genetic code that can influence disease and DNA sequencing can only take you so far. ‘Our study shows that modifications on top of the DNA that control how genes are read may be even more important.” The research, published in the journal Nature, focused on genes that are altered by an environmentally-triggered process called methylation, which switches them off.

Nasal Flu Virus Save for Egg-Allergic, Asthmatic Kids
Researchers in London have found that the live attenuated influenza vaccine (LAIV) may be perfectly safe for children who suffer from egg allergies or children with well-controlled asthma. LAIV is an intranasal vaccine administered via the nose and licensed for use in children. As part of the SNIFFLE study, researchers administered 433 doses of LAIV to 282 children with egg allergy, two thirds of whom had a physician-diagnosis of asthma/recurrent wheezing. Almost half of these children had severe egg allergies, having previously experienced anaphylactic reactions to egg.

No systemic allergic reactions occurred with the egg-allergic children. Similarly, no increase in significant respiratory symptoms were seen in the children with asthma or a history of recurrent wheezing. Not a single child who participated in the study required medical intervention beyond routine treatments. “The data imply that LAIV is safe for use in children with egg allergy and well-controlled asthma,” first author Paul J. Turner, FRACP, PhD, with the Imperial College London, said.

Half of Adults and Nearly Half of Children Don’t Get Epinephrine for Anaphylaxis Our friends at Allergic Living report: Adults and children who experience anaphylaxis do not always receive live-saving epinephrine, according to findings from a three-year Canadian study.
“In adults, our study indicates that almost 50 percent of severe reactions are not treated with epinephrine in or outside of the hospital,” says Dr. Moshe Ben-Shoshan, a pediatric allergist at Montreal Children’s Hospital and a key researcher behind the Cross-Canada Anaphylaxis Registry.
Started in 2011, the registry, known as C-CARE, has collected data from approximately 1,500 allergic adults and children who visited emergency departments in British Columbia, Ontario and Quebec hospitals. The goal was to gain insights into the triggers and management of anaphylaxis.
In a related research paper from the C-CARE data, the rates of epinephrine use in children having reactions proved to be better than the adult patients, but could still stand improvement. Data collected from the Montreal Children’s Hospital emergency department showed that the most common triggers for reactions were peanut and tree nuts, and that nearly 1 in 3 children experiencing reactions did not receive epinephrine. Almost all of these children had been prescribed auto-injectors.


What is the State of Food Allergy Treatment? Dr. Hugh Sampson, head of the Jaffe Food Allergy Institute at Mount Sinai, gives a round up of research projects they’re working on, along with the strengths and weaknesses of each. More

Sean Parker, of Napster and Facebook Fame, Pledges $24-million to Stanford Food Allergy Research The Sean Parker Institute is the brainchild of our friend and contributor, Dr. Kari Nadeau.

Ten-Year Grant to Study Inner-City Asthma The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has awarded the University of Wisconsin School of Medicine and Public Health (SMPH) a seven-year, $70 million grant for its continuing work on the Inner-City Asthma Consortium (ICAC) – a nationwide clinical research network to evaluate and develop promising new immune-based treatments. “The only thing more staggering than the financial impacts of asthma are the health disparities that exist with this disease,” said Dr. William Busse, principal investigator. “The truth is that you are more likely to suffer from asthma in this country if you are part of a minority, live in the inner city, have high social stress and are socioeconomically disadvantaged. Our research is crucial to reversing this health disparity and helping children, no matter where they live, manage the often-debilitating reality of asthma.” More

UK Asthma Care Poor, Fatality Rates Stubbornly High Eight out of 10 asthma patients are not getting the basic clinical care they need, according to a survey by Asthma UK. Inadequacy varies by region with only 14% of people in London receiving care that meets national standards compared with 35% of people living in Northern Ireland. Asthma killed 1255 people last year in the UK compared to approximately 3500 in the US, which has five times the population. More

Eczema Linked to Bone Injuries, Falling People with eczema, a skin condition marked by itching, irritation and rashes, have another problem to add to the list: A new study suggests that they are more likely to suffer broken bones and other joint-and-bone injuries. Researchers studied a nationally representative sample of 34,500 adults ages 18 to 85, of whom about 7 percent had eczema. After controlling for age, sex, income, education, asthma, hay fever, food allergies and other factors, they found that people with eczema were about 44 percent more likely to have had any injury, and 67 percent more likely to have a bone or joint injury serious enough to limit physical activity, than those without the ailment. More in NY Times

Poorly Managed Allergies Cost Europeans Ten Times More Than Treatment (Science Daily) New research in Europe indicates that avoidable indirect costs per patient insufficiently treated for allergy equal 2,405.00 Euros per year due to absence from work and reduced working capacity. On the other hand, appropriate therapy is available at an average cost of 125 Euros per patient annually, which represents only 5 percent of the cost of untreated disease. More

For Caregivers Whose Auvi-Q Expiration Dates Are Premature, Relief on the Way A West Coast activist reports: “Patients or caregivers who, within the last 31 days, purchased an Auvi-Q that expires in less than 12 months are eligible to receive a savings card with a maximum benefit of $400 off one two-pack of Auvi-Q for each Auvi-Q purchase that meets the terms and conditions. Savings cards are valid for use January 1 – June 30, 2015. Patients or caregivers who purchased an Auvi-Q in the past 31 days with 6 months or less of dating may receive a replacement Auvi-Q or they can opt to receive a savings card. For more information, including terms and conditions, patients or caregivers should call Sanofi Customer Service at 1-800-633-1610. ”

Children with Asthma Who Lack Primary Care Are at High Risk for Hospitalization
According to experts at Children’s Medical Center Dallas, the first line of defense are the primary care physicians who offer “medical homes” for children with asthma, providing ongoing, coordinated care and assistance in the management and control of this disease. However, according to Dr. Ray Tsai, president and chief medical officer of MyChildren’s, almost a third of Texas children with asthma have not had a routine medical checkup in 12 months. “The importance of a medical home for a child with a chronic illness like asthma can’t be overstated, because severe attacks can be avoided when children are under the care of a primary physician, and parents and patients have assistance identifying and minimizing triggers,” said Tsai.

Missouri Takes Innovative Steps to Combat Asthma (USA Today April 16)
Two years ago, the Missouri legislature became the first to allow schools to stock quick-relief asthma medications for emergencies. Missouri also became the first state to permit school nurses and other trained staff to administer that medication to any child suffering an asthmatic attack while at school, whether or not the child has an asthma diagnosis or a prescription at the school.

Now the state is poised to register another advance in its campaign against the respiratory disease. The House passed an appropriations bill late last month that would allow Medicaid reimbursement for specialists to visit the homes of low-income patients with severe asthma to identify asthma triggers in those homes. Medicaid would also provide reimbursement for face-to-face sessions to educate severe asthmatics in the disease and ways to manage it. The Senate is now considering the measure.

One in 4 Asthma Patients Referred to National Jewish Hospital Don’t Have Asthma
Of the patients referred to National Jewish Health in Denver for asthma treatment between 2005 and 2008, however, one in four didn’t have asthma. In addition, 70 percent of those patients suffered from other, undiagnosed ailments for which they weren’t being properly treated. “It’s very logical for general practitioners to assume most breathing problems are asthma, especially in children,” said Tod Olin, a pediatric pulmonologist at National Jewish Health, the nation’s leading respiratory hospital. “But there are a lot of breathing problems out there.”

New York State Asthma Costs Reach $1.3 Billion NEW YORK (CBSNewYork/AP) – Asthma is costing New York’s Medicaid system more than half a billion dollars a year, according to a report released Friday that urges the state to do more to help those affected by the respiratory illness. The study by state Comptroller Thomas DiNapoli found that Medicaid costs related to asthma were $532 million in 2013, an increase of more than 26 percent over five years. When all non-Medicaid hospitalizations and treatment and lost productivity associated with asthma are counted, the overall cost of the illness to New York rises to $1.3 billion a year, according to an estimate from the state’s Department of Health. More

Banning Smoking in Public Places Has Rapid, Dramatic Payoff The ban has helped cut premature births by 10 per cent. The study of data from parts of North America and Europe where smoking bans have been introduced also showed a 10 per cent fall in hospital attendance for childhood asthma attacks. The findings reveal that the impact of anti-smoking laws varies between countries but overall the effect on child health around the world is very positive. Laws that prohibit smoking in public places, such as bars, restaurants and work places, are already proven to protect adults from the health threats associated with passive smoking. This is the first comprehensive study to look at how anti-smoking laws in different countries and areas are affecting the health of children living in those regions. It is published today in the journal The Lancet. More

Cats a Deal Breaker in Relationship? Our favorite advice columnist Dear Prudence advises a woman who doesn’t want to give up her cats of ten years when moving in with boyfriend whose daughter from a first marriage will be an occasional visitor. Prudence counsels prudence in her Slate.com column here.

Swedish Olympian Barred from Gold Medal Game for Pseudoephedrine in Allergy Medicine Center Nicklas Backstrom claims to take Zyrtec-D for allergies. Pseudoephedrine is prohibited when its concentration in an athletes’ urine exceeds150 micrograms per milliliter. Backstrom’s level was 190. When a medicine has a decongestant in it, and carries the letter D in its name, it invariably contains pseudoephedrine, which in large quantities can be used to manufacture crystal meth. More

Polish Allergy Rates Said to Rise Because of Changing Agriculture
Science Daily Dec. 16, 2013 — Poland’s entry into the EU may have had the surprising consequence of increasing allergies in rural villages, according to a new study. Surveys show that the prevalence of atopy, a predisposition towards allergic reactions, jumped from seven per cent to 20 per cent in villages in southwest Poland between 2003 and 2012.
Study author Professor Paul Cullinan, from the National Heart and Lung Institute at Imperial College London, said: “Asthma, hay fever, and other allergic diseases are becoming more common in many countries and there’s growing evidence that they’re linked to modern, clean lifestyles. “We found that rapid changes in farming practices after Poland joined the EU were accompanied by a sharp increase in allergies over a very short period of time. It’s likely that similar changes are occurring in other places in Europe, and we can expect that elsewhere in the world, we may see major increases in allergies, asthma and hay fever over the coming decades as countries become more westernized and less rural.”

Asthma Leading Cause of School Absence in State of Tennessee Volunteer State physician reports: “Here in the Chattanooga area…12.5 percent of our children have asthma, over 50 percent higher than the national average. In fact, Chattanooga is the fifth worst city in the country for asthma according to the Asthma and Allergy Foundation of America. WedMD places Chattanooga second. These poor rankings are due to low air quality and high cigarette smoke exposure.”

New York Times Blog Explores the Question of Peanuts on Planes Read about it here.

Dear Abby Makes Pitch for Food Allergy Respect World’s most famous advice columnist responds to letter from woman urged to eat something unsafe at a Thanksgiving dinner. Read it here.

Midwest Mold Spore Triple Normal Levels
Sep. 20, 2013 — The Midwest is experiencing very dangerous levels of mold in the air which will result in headaches, itchy throats and runny noses for those with sensitive respiratory systems. Gottlieb Allergy Count, the official allergy count for the Midwest, reports the mold count today is 125,000, a high for 2013, and well over the 50,000 threshold that signals a dangerous air quality warning. “The heat, the humidity and the rains have created a dangerous concentration of mold that is a real health hazard for many in the Midwest today,” says Dr. Joseph Leija, allergist, who performs the Gottlieb Allergy Count, the only consistent allergy count for the Midwest. “Today is no TGIF as many will be running to their allergists for relief.”

Asthma App Moves Up in the World, Renames and Expands
Asthmapolis, the Madison-Wisconsin based smart inhaler company, is changing its name as it moves beyond both asthma treatment and GPS mapping. The company’s rebranding as Propeller Health will correspond with a broadening of its offerings to include chronic obstructive pulmonary disease, or COPD, a lung condition similar to asthma except more likely to afflict an older population. (Readers of this website may remember that we were one of the first to report on Asthmapolis and our coverage included this piece about the revolution it promised for the study of rural asthma.)

“From a commercial standpoint, there’s just so much overlap between what we’re doing with asthma and what we need to be doing with COPD that it just has made sense in our customers’ eyes, so in part we’re reacting to that market demand,” David Van Sickle, CEO of Propeller Health, told MobiHealthNews.

EpiPens for All
Novelist Curtis Sittenfeld, food-allergy mother, writes in the Sunday New York Times about the death of a Virginia girl who died because under state law she couldn’t be given epinephrine prescribed for another child.

“I’m the mother of a child with food allergies, and stories like Amarria’s are my worst nightmare. In describing her tragedy, I question the fairness of reducing a 7-year-old girl to a symbol. Nevertheless I repeat the circumstances of Amarria’s death because it appears they directly affected legislation in her state.

“Just a few months after she died, “Amarria’s Law” was in place; the law requires Virginia schools to stock epinephrine and allows school authorities to give it to children without a prescription, and indemnifies those who administer it in a life-threatening situation. There is now an opportunity for similar legislation to be enacted nationally, in the form of the School Access to Emergency Epinephrine Act, and I urge lawmakers to pass it. The House approved the bill in July, and it is likely to go before the Senate this fall.”

Allergist’s 101st Birthday, continued
Frankland qualified as an MD in the 1930s at Oxford, served in WWII in Singapore, spent 3 ½ years in a Japanese prison camp, and returned to London, where among other things, in 1954 he published a double-blind, randomised trial showing how patients given preseason injections of the protein component of pollen had greatly reduced symptoms during hay fever season. This led to the pollen count being introduced into weather forecasting in the UK in 1963.

Frankland also worked with Sir Alexander Fleming, who discovered penicillin. “I liked and respected Fleming enormously”, Frankland recalls. “I saw him at 10am every morning for 2 years, and worked closely with him on penicillin allergy. He hardly ever mentioned clinical work in our discussions, being far more interested in the science than its clinical effect.”
Frankland’s self-experimentation in the 1950s—to investigate desensitisation to insect bites—is legendary. He allowed the South American insect Rhodnius prelixus (a vector of Chagas disease) to bite his arm and suck blood at weekly intervals. Expecting to gradually desensitise to the recurring bites, by week 8, he went into anaphylaxis.”I had a nurse and ward sister on hand just in case”, he remembers. “After the eighth bite I knew I was in anaphylaxis, and would die without intervention. The young nurse came in, and thinking I did not look too well, said she would fetch me a cup of tea. Realising the situation was more serious, the nurse ran for sister, who got me out of anaphylaxis with two shots of adrenaline. That was at 2pm, I recall. By 4pm I saw a patient in clinic, after which I had a delayed reaction to the bite which required a third injection of adrenaline. Later that day I was feeling fine, and drove myself home.”

For the full Lancet article go here

Asthma UK Scotland Warns of Sharp Rise in Emergencies After School Starts
Last year more than three times as many ¬children were hospitalized due to their asthma during the first week of September compared with mid-July. That means more Scots children are rushed to hospital with a potentially fatal asthma attack in early September when they are back at school than any other week during the year.
The charity also says it has been notified of three children who died from an asthma attack in September last year. It further warns that the spike in children’s asthma hospital admissions occurs year after year in the UK and in many other countries, usually two to three weeks into the autumn term. Children aged six to seven years old are the most seriously affected, it says.

Understanding Eczema to Treat It by JANE E. BRODY in the New York Times is an excellent guide to the “itch that rashes.”
Among the highlights:
“Normal skin provides a remarkably effective physical and chemical barrier to substances in the environment. It also prevents substances that should remain in the body from escaping.
“Eczematous skin also lacks normal amounts of a natural antimicrobial agent called cathelicidin, leaving it susceptible to infections that can be hard to control. More than 90 percent of people with eczema have colonies of the bacterium Staphylococcus aureus growing on their skin and contributing to the skin’s allergic sensitivity and inflammation… Scratching the lesions enhances the ability of these bacteria to further disrupt the skin’s barrier function.”

Scientists Develop Allergies to Research Animals Both in Lab and in the Field
As reported in the New York Times, scientists are prone to allergies after working with animals over a protracted period of time. This article recounts the stories of several researchers, including one who became quite reactive to a fungus on the cicadas that emerge on 13-17 year cycles; this was one of those years. Other scientists have trouble with mice and certain plants.

“An estimated 15 to 20 percent of researchers who work with mice and rats, for instance, may eventually become allergic to the animals, said Dr. Karin A. Pacheco, an assistant professor of environmental and occupational health sciences at National Jewish Health in Denver. The real number could be even higher, because some people who become allergic may never report it, valuing their job above their health or comfort, Dr. Pacheco said.”


A. There are several possible explanations for one-sided sensitivity to a substance.

One hypothesis is that the more sensitive side was the one where the substance first provoked a reaction, “and there are immune cells that remain in this area and can respond more rapidly,” said Dr. Donald Belsito, a dermatologist at NewYork-Presbyterian Hospital/Columbia University Medical Center. This is called a recall reaction.

Another suggestion, he said, is that the site that reacts most intensely is the one that experienced the highest level of the chemical causing the initial reaction. It has been shown that the higher the concentration of the chemical that induces the allergy, the lower the concentration needed to bring it back out.

In a one-sided reaction involving the eyes, right-handed people tend to rub the right eye more than the left, making that side react more, said Dr. Marjorie L. Slankard, director of the allergy clinic at NewYork-Presbyterian. The many allergy cells around the eyes, called mast cells, can be physically disrupted so they release chemicals that cause swelling, redness and more itching.

Mast cells in the skin may be more common in one area than another, Dr. Slankard said. In rare cases, an arm that shows greater sensitivity to one kind of allergy shot can show a more extreme reaction even to a different kind of shot. C. CLAIBORNE RAY

The Power of Competition–Singulair market share for asthma drug montelukast fell 98% after generics entered the field.  $25 million sales vs. $1.4 billion earlier. More

Big Article on Food Allergy Research in Allergic Living Editor Gwen Smith and Kate Johnson look at the current state of the science in Hunt for a Cure: Where Is It Headed? in the summer issue.  This is must reading for anyone considering embarking on desensitization.  (Incidentally, the article refers to information reported on this website and uses our photograph of Dr. Xiu-Min Li and Dr. Kari Nadeau.)

Dr. Jennifer Kim of Mount Sinai’s Jaffe Institute was interviewed on introducing foods to infants with food allergies in mind. Listen to it here.

NBC News reports on the growing movement to stock injectable epinephrine in schools See the video here.

Wall Street Journal reports: Kids With Asthma Play Hard, Too–
In a Shift in Advice, Doctors Tell Patients to Get as Much Exercise as Their Peers

By Shirley S. Wang
“Children with asthma should play hard in gym class and stop worrying they might have an attack that could leave them struggling to breathe, respiratory specialists are now recommending.Physical activity by people with asthma isn’t harmful and might even be helpful to treating the condition, doctors in the field believe. A report published last year in the Cochrane Database Systems Review, a journal that reviews health-care treatments and decision making, looked at 19 previous studies of exercise and asthma and concluded that people with the respiratory condition fared well with physical activity. The studies’ results ranged from showing no difference in patients’ asthma control to an increase in the number of symptom-free days and a decrease in asthma severity.”

Asthma Plagues Middle Earth
New Zealand, chosen by native Peter Jackson to provide the breathtaking landscape for Lord of the Rings movies, has an annual asthma mortality rate double that of the United States. As reported in The Press, “About 130 Kiwis die from an asthma attack each year…Asthma was believed to cost the country $125 million a year in direct medical costs, and $700m a year indirectly.” With a population more than 60 times New Zealand’s 4.5 million, approximately 3500 Americans die of asthma annually. At the same fatality rate, more than 7000 US residence would die.

Economics and finance researcher Andrea Menclova, links home heating and asthma emergencies. ”If people adjust to higher electricity prices by improving the efficiency of their home heating, allowing them to have increased heating for the same cost, this should improve asthma symptoms and lower the number of asthma admissions.”

Tokyo Choking with Cedar Pollen; Allergies at Epidemic Levels When we think of manmade environmental assaults, we generally think of carbon dioxide and other industrial pollutants. However, Tokyo is suffering from reforestation efforts made after World War 2. Read about it in the urban economics blog new geography.com.

Green Mountain Paradox Vermont women have best diets, worst rates of asthma. Read more here.

World’s biggest study of food allergies gets underway
The €9million project builds on an earlier €14.3 million research study and will involve the worlds leading experts in the UK, Europe, Australia and US. The Manchester team will work with 38 partners including, industrial stakeholders (represented by Unilever and Eurofins), patient groups representing people at risk of severe allergic reactions from Germany, UK and Ireland and a risk manager and assessor group including the UK Food Standards Agency. The project will work loosely with the clinical community, working in collaboration with the European Academy of Allergy and Clinical Immunology.

Professor Clare Mills, from the Allergy and Respiratory Centre of The University of Manchester’s Institute of Inflammation and Repair and based in the Manchester Institute of Biotechnology, will head the study. Professor Mills said: “This is a massive research project which will have far reaching consequences for consumers and food producers. The evidence base and tools that result from this will support more transparent precautionary “may contain” labelling of allergens in foods which will make life easier for allergy sufferers as they try to avoid problem foods.”

Big Insurance Company Now Covering “Asthmapolis” Sees business, public health benefits in using technology for better asthma control
A WellPoint health plan in Florida, called Amerigroup Florida, announced that it will offer Asthmapolis’ FDA-cleared mobile health device and service to its members with asthma.

Asthmapolis’ device is a sensor that sits atop (most) inhalers used by patients who have asthma or COPD. The sensor transmits data to a companion app on the user’s mobile phone every time the inhaler is used. The app can then track the time and location of each medication discharge, which can then be used to help patients and their care givers better understand their asthma triggers. Amerigroup Florida members who use Asthmapolis will receive ongoing education outreach through email, text, mobile apps, and phone support from a certified asthma educator. They also have the option to share the information they collect via the device with their healthcare provider or other care givers. Amerigroup Florida will make the offering available in both English and Spanish.
More here.

UK Health Authority Reverses Position on Xolair for Severe Asthmatics AGAIN
Reuters reports that the National Institute for Health and Clinical Excellence (NICE) has reversed a decision (see item below) not to offer the expensive drug Xolair (omalizumab) “in the light of extra analyses and a move by Novartis to offer a so-called patient access scheme to discount Xolair’s list price.” Xolair works by blocking immunoglobulin E (IgE) antibodies from attaching to allergens. When IgE attaches to an allergen, it sets off a process that eventually leads to an allergic reaction.

“Xolair is the only treatment that works for some people with severe allergic asthma who would otherwise be virtually housebound because of breathlessness and living in constant fear of the next asthma attack,” Samantha Walker of the charity Asthma UK said in a statement.

It is also used off-label to treat intractable cases of urticaria, and as an adjunct to multi-food oral immunotherapy (OIT). Two years ago when NICE originally decided not to cover Xolair for children, had a three-doctor “roundtable” on the decision. The consensus was that while Xolair is very expensive, when it works it saves money in the long run by cutting back on emergency care. More here.

Xolair Back in News in UK–”Anti-IgE” Treatment Facing Budget Ax Again
The Daily Mail reports–Thousands of patients could be denied the drug after the National Institute of Health and Clinical Excellence (NICE) recommended it should no longer be available on the NHS. NICE — which decides treatments the NHS should provide based on cost-effectiveness — is expected to announce its final decision about Xolair (omalizumab) soon, after recommending last November that it no longer be prescribed.

Defending the recommendation, Sir Andrew Dillon of NICE says: New evidence indicates that it is not as clinically or cost effective as was first thought.” This new evidence refers to research that found severe asthma patients taking long-term medication had roughly double the risk of death from all causes, and asthma, compared with other patients — higher than previous estimates. However, no patients in the study took Xolair.

When NICE first deliberated on paying for Xolair, we published a “roundtable” by three US physicians. Read what they said here.

Auvi-Q Hits Market–Mylan Disputes New Competitor’s Claims That Patients Don’t Like to Carry EpiPens The New York Times says, “The product, called the Auvi-Q, boldly challenges the superiority of the EpiPen at a time when food allergies among children and teenagers are on the rise. Sanofi and the Edwards brothers [twins who invented device] clearly hope it will appeal to a gadget-hungry generation with its compact, rectangular design and automated voice instructions that guide a user through the injection process. Both the Auvi-Q and EpiPen contain the drug epinephrine, which can halt a severe allergic reaction, known as anaphylaxis. Evan Edwards said the device was special because it was designed by people who were intimately familiar with patients’ needs. ‘This wasn’t just an invention,’” he said. ‘This was something that I knew I was going to carry with me every single day.’”

UK Pediatric Asthma Hospital Admissions Fall 18% in Three Years After Public Smoking Ban  National Health Service doctors call ban an unqualified public health success.  More

New Test for Condition Associated with Risk of Anaphylaxis
A new FDA-cleared blood test, ImmunoCAP Tryptase, is now available to physicians to help diagnose patients with Systemic Mastocytosis (SM), a rare disease in which there is an over-formation of mast cells in a variety of tissues, including the skin, liver, and bone marrow. Patients with SM are at a higher risk for anaphylaxis, from a variety of triggers, compared to those without the disease.

Actress Discusses Son’s Anaphylaxis
By Jessica P. Ogilvie
Los Angeles Times December 4, 2012
Actress Julie Bowen of “Modern Family” doesn’t want other parents to go through what she and her husband did when their toddler experienced a life-threatening allergic reaction that sent him into anaphylactic shock. Her son recovered completely, but the incident inspired Bowen to become an activist in educating the public about kids’ allergies. Here, she talks about how parents can prepare themselves for the possibility of such an incident and what she’s done to keep her family safe.

Survey Shows Primary Care and Emergency Physicians Drop Ball on Anaphylaxis Treatment, Follow Up
As reported by MedPage Today, a disturbingly high proportion of primary care and emergency physicians don’t know the correct ways to treat anaphylaxis and prevent recurrences, according to a survey presented at the recent American College of Allergy, Asthma, and Immmunology (ACAAI) in Anaheim, California. Myron Zitt, MD, of the State University of New York at Stony Brook said that interviews with 318 physicians showed that many do not always give epinephrine to patients they believe are having anaphylactic reactions, fail to refer anaphylaxis patients for follow-up care, and believe incorrectly that some such patients should not receive epinephrine auto-injectors.

The next speaker, Akhil Chouksey, MD, MBA, of Case Western Reserve University in Cleveland, said a 10-year review there showed that in only 15% did the care include all three of the major recommendations: that epinephrine be administered within 30 minutes of triage, that auto-injectors be prescribed at discharge, and that patients be referred to an allergist or immunologist for follow-up investigations and treatment. The review also found that in 26% of cases in which anaphylaxis was definitively confirmed, the patients never received epinephrine.
{Note: another perspective on this problem was discussed by Dr. Ehrlich in the blogpost “Defining Anaphylaxis—Different Specialties, Different Treatments”}

Pollen Counts to Double by 2040, Making Allergies Worse
ScienceDaily (Nov. 9, 2012) — According to research presented by allergist Leonard Bielory, M.D., at the Annual Scientific Meeting of the American College of Allergy, Asthma and Immunology (ACAAI), pollen counts are expected to more than double by 2040. “Climate changes will increase pollen production considerably in the near future in different parts of the country,” said Dr. Bielory, ACAAI board member and fellow. “Economic growth, global environment sustainability, temperature and human-induced changes, such as increased levels of carbon dioxide, are all responsible for the influx that will continue to be seen.”


In the year 2000, pollen counts averaged 8,455. Fast forward to 2040, and these counts are anticipated to reach 21,735. Researchers at Rutgers predict counts in 20-year increments up to the year 2100, and are incorporating various climatic factors in their models including weather patterns, changes in precipitation and temperature.  The sneezing season will begin earlier every year.

“In 2000, annual pollen production began on April 14, and peaked on May 1,” said Dr. Bielory. “Pollen levels are predicted to peak earlier on April 8, 2040. If allergy sufferers begin long-term treatment such as immunotherapy (allergy shots) now, they will have relief long before 2040 becomes a reality.”  An earlier report by the same researchers demonstrated an increase in ragweed pollen in a section of the country, from Texas to the Canadian border, over the past 25 years. This was associated with an increase of ragweed pollen by two to three weeks as one moves north.

Burning of Crop Stubble by Indian Farmers Causes Asthma Epidemic
Times of India Ludhiana: The burning of stubble by farmers these days has resulted in a spurt in the number of patients suffering from asthma and othernaso-bronchial allergies visiting city hospitals for treatment.

Doctors say smoke due to burning of stubble goes up in the air and increases the concentration of smog which aggravates naso-bronchial allergies including bronchial asthma, chronic obstructive pulmonary disease (COPD) and bronchitis. They add that the huge variation in temperature during the season has also aggravated the condition of patients.

Study Shows Home Visits Effective at Treating Asthma, Point to Big savings on US Health Care Costs
(Cleveland Plain Dealer)“[A] small, grant-supported research study in Cleveland during which asthmatic children were visited in their homes. Hospitalizations for those children dropped 58.6 percent year-over-year….The Cleveland study focused on 29 children who had been hospitalized at University Hospitals Rainbow Babies & Children. Workers from the nonprofit Environmental Health Watch visited the children’s homes to evaluate the environments and talk to the family about risk factors, such as mold, cockroaches and smoking. Smoking in the home was the biggest risk factor for children in the study.

“’The families need assistance in problem-solving,” Stuart Greenburg, senior advisor for Environmental Health Watch told those gathered. “Everybody knows you’re not supposed to smoke inside but how do you negotiate that with other household members?’

“Managing asthma symptoms could save the national health care system $5 billion annually, according to figures the Massachusetts-based Asthma Research Council presented at the meeting. The average emergency visit for asthma cost $691, and the average hospital stay of a child for asthma cost $7,987.”

One-in-four Anaphylaxis Patient have Auto-injectors Reporter Sarah Scott writes in Allergic Living, “…Dr. Estelle Simons and Harvard epidemiologist Dr. Carlos Carmago conducted a survey in 2009 of 1,885 people who had suffered anaphylaxis. The symptoms must have been scary, yet only 27 per cent of the people who experienced anaphylaxis used an auto-injector; 73 percent, or almost 1,400 of the patients, did not.” Read the full report Time to End Food Allergy Tragedies here.

Mylan, Maker of EpiPen, Behind Big Push to Make Auto-injectors Available in Schools for Kids Without Prescriptions in Emergencies

New York Times “After a 7-year-old girl died in January in a similar case in Virginia, the state passed a law that allows any child who needs an emergency shot to get one. Beginning this month, every school district in Virginia is required to keep epinephrine injectors on hand for use in an emergency. Illinois, Georgia and Maryland have passed similar laws, and school nurses are pushing for one in Ohio. A lobbying effort backed by Mylan, which markets the most commonly used injector, the EpiPen, made by Pfizer, led to the introduction last year of a federal bill that would encourage states to pass such laws. Mylan has also lobbied state legislatures around the country directly and is passing out free EpiPens this fall to any qualifying school that wants them.

“‘When a child is having an anaphylactic reaction, the only thing that can save her life is epinephrine,’ said Maria L. Acebal, the chief executive of the Food Allergy and Anaphylaxis Network. ‘911 doesn’t get there fast enough.’”

New York Times Update on Bronchial Thermoplasty for Severe Asthma Reports Limited Adoption

“Although bronchial thermoplasty was approved by the F.D.A. only two years ago, clinical studies on it began in 2000. Since then, about 650 patients across the country have had the procedure.

“During the procedure, a doctor guides a bronchoscope into a patient’s airways. There, it heats the lungs to 149 degrees Fahrenheit — cooler than a cup of coffee, but warm enough to shrink the smooth muscle in the airways, which swells during an asthma attack and restricts breathing. After the procedure, the airways no longer are so prone to constricting, studies show. Asthma patients suffer fewer attacks and need fewer hospital visits.”

Several five-year studies show no long-term safety issues while asthma attacks dropped by a third, emergency room visits by 84 percent, and the number of days they lost from work and school by 66 percent. A spokeswoman for America’s Health Insurance Plans, said insurers are awaiting the results of an additional five-year clinical trial, required by the F.D.A. when it approved bronchial thermoplasty. It will not be completed until at least 2018. Until then, insurers are denying coverage on the grounds the procedure is experimental.
“But three five-year studies have already been completed. Many asthma specialists believe that insurers are taking a shortsighted approach. The one-time cost of $20,000, they say, is dwarfed by the tens of thousands of dollars in hospital bills and medication costs that a severe asthmatic can easily accumulate in a single year.”

For more on bronchial thermoplasty, read this post by NYU pulmonologist Dr. Frank Adams.

New Twist on the Pet-or-Allergy Dilemma
A recent letter to advice columnist Cary Tennis of Salon.com brought the pet-allergy problem to a novel and absurd level. The writer said: “….our friend “Joe” lost one of his part-time jobs and was in a very unsafe, unhealthy living situation. He had just enough money to leave the city and move to where we were. We enthusiastically welcomed him, and he found a job shortly after arriving. He pays rent, washes dishes, and we all got along well. Sounds good, right?
Except … I’m allergic to everything he brought into the house. He has two dogs, one cat, a bird, and a bunch of dusty furniture. I already had cat allergies: he brought the cat but said it would stay in his room. We tried that. Cat dander sticks to EVERYTHING, gets into the heating ducts, and made me miserable. For weeks, it felt like someone was grabbing my lungs in a fist and slowly contracting until I got just enough oxygen to breathe. I got winded walking to the bus stop. My boss expressed concern that I was too sick to do my job. Finally, reluctantly, he moved the cat to the garage, but I didn’t get better. After spending lots of money on allergy and asthma testing, which wasn’t all covered by my insurance, I have learned that I am allergic to cat and dog dander, dust mites, and feathers. My doctor told me to get rid of the animals, rip up the carpet, remove or encase all dust-collecting objects, and install a HEPA filter…In desperation, I set up our camping tent and began sleeping outside — finally, merciful relief! The chest burning stopped. The itching stopped. My brain was finally getting enough oxygen that I was able to get some work done! I feel a thousand times better. All I had to do was move out of my own house and completely avoid everyone in it.”

The desperate woman worries that the animals will be destroyed if they are given to a shelter and that they are all this man has to cling to.

Mr. Tennis counsels: “…This guy has to take his animals and go. It’s sad but true.
Letting him live with you was a big-hearted gesture and a valiant attempt to improve his life but it didn’t work….I don’t know where he will go or what will become of his animals. If he were the one writing to me I would try to figure that out. But he didn’t write to me. You did. I’m concerned about you. This is a terribly stressful situation. You have to take care of yourself. If it were just an inconvenience you could live with it. But this is a serious medical risk. You have to be able to breathe….”

On a recent TV show called “The Doctors” a plastic surgeon suggested that diners tell waiters they are allergic to butter in order to avoid extra fat in their food. Sakina Bajowala, M.D.–who has contributed a piece to this website tears the show to pieces for their unethical recommendation, which is an affront to all those struggling with managing real food allergies, in this video. How about if this plastic surgeon injected it in his patients’ faces when they asked for collagen?

Substantial Numbers of Food-Allergy Reaction from Intentional Exposure, Too Little Use of Epinephrine, Study Shows
(from USA Today)
Unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in Pediatrics.  Surprisingly, non-accidental exposures resulted in 13% of reactions. It’s not clear why caregivers would purposely give a child a known allergen, maybe “to see if (the child) has outgrown an allergy, or how allergic he is,” says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. “The vast majority happened from ingestion.”

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they should. There’s often a “fear of using epinephrine, a concern that there will be side effects,” Fleischer says. “In studies that we’ve done, parents are surprised how quickly and effectively it works.”

Tennessee Senator Votes to Enforce Clean Air Rules; State Has 3 Top-5 Worst Asthma Cities
WASHINGTON – U.S. Senator Lamar Alexander (R-Tenn.) today voted to uphold a clean air rule that would require coal plants to install the same pollution control equipment the Tennessee Valley Authority has already committed to installing, saying, “TVA can’t clean up Tennessee’s air alone, because dirty air blows in from other states.” In a speech delivered on the Senate floor before the vote (Video HERE), Alexander said: “Let me say what upholding this rule will mean to the people of Tennessee: It will hasten the day that Memphis, Chattanooga and Knoxville are not three of the top five worst asthma cities in America and Nashville is not competing to be in the top 10.”

“Upholding this rule means that visitors will soon not even think of calling the Great Smoky Mountains the Great Smoggy Mountains because it is one of the most polluted national parks in America. We want those 9 million visitors to keep coming every year with their dollars and their jobs.” This puts him at odds with neighboring Kentucky Senator Rand Paul who thinks asthma and filthy air are not related.


1.8 million in U.S. allergic to tree nuts
Published: June 22, 2012 at 1:05 AM

SANTA MONICA, Calif., June 22 (UPI) — About 1.8 million Americans are allergic to tree nuts, which are among the leading causes of fatal and near-fatal food reactions, a U.S. expert says. “Tree nuts include walnut, almond, hazelnut, coconut, cashew, pistachio, Brazil nuts and more,” Phil Lempert, a food industry analyst, trend watcher and creator of supermarketguru.com, said in a statement. “Tree nuts are not: Peanuts, which are legumes, or seeds, such as sunflower or sesame seeds.”

The Food Allergy and Anaphylaxis Network advised that people diagnosed with a tree nut allergy must avoid those nuts for life, Lempert said. “However, tree nuts are very versatile ingredients and can sometimes pop up in unexpected places. It is important to stay vigilant and read labels,” Lempert said. “Here are some unexpected foods that may contain tree nuts: salads and dressing, barbecue sauce, breading for chicken, pancakes, meat-free burgers, pasta, fish dishes, pie crust and honey.”

Hygiene Hypothesis on Op-Ed Page of New York Times

“Dirtying Up Our Diets”
By Jeff D. Leach (science and archaeology writer and founder of the Human Food Project)
Published: June 20, 2012
OVER 7,000 strong and growing, community farmers’ markets are being heralded as a panacea for what ails our sick nation. The smell of fresh, earthy goodness is the reason environmentalists approve of them, locavores can’t live without them, and the first lady has hitched her vegetable cart crusade to them. As health-giving as those bundles of mouthwatering leafy greens and crates of plump tomatoes are, the greatest social contribution of the farmers’ market may be its role as a delivery vehicle for putting dirt back into the American diet and in the process, reacquainting the human immune system with some “old friends.

Increasing evidence suggests that the alarming rise in allergic and autoimmune disorders during the past few decades is at least partly attributable to our lack of exposure to microorganisms that once covered our food and us. As nature’s blanket, the potentially pathogenic and benign microorganisms associated with the dirt that once covered every aspect of our preindustrial day guaranteed a time-honored co-evolutionary process that established “normal” background levels and kept our bodies from overreacting to foreign bodies. This research suggests that reintroducing some of the organisms from the mud and water of our natural world would help avoid an overreaction of an otherwise healthy immune responsethat results in such chronic diseases asType 1 diabetes, inflammatory bowel disease, multiple sclerosis and a host of allergic disorders.

Dog or Allergic Boyfriend? Slate.com Advice Columnist “Prudence” on Marriage Ultimatum
Q. I’m Delaying Marriage Because of My Dog. Am I Crazy?: I have a 9-year-old cocker spaniel. I’ve raised him since he was a puppy and I think of him as my four-legged son. However, my boyfriend of 10 months is allergic to dogs. He also dislikes them. He was attacked by one as a child and now won’t go near dogs at all. As such, he almost never comes to my place. We are very committed to each other and wish to get married soon. But the problem is that I can’t allow myself to give my beloved doggy away to another family. He has a few medical problems related to age and the vet has told me he will probably live another two years or so, although of course nobody knows for sure. I’ve asked my boyfriend if we could delay our marriage until my dog dies, and he thinks I’m crazy. We both want to have kids soon, but considering I’m now 34 and he’s 40, my boyfriend doesn’t want to wait another two years. He understands that I love my dog, but he thinks marriage is more important and I should just find another loving family for him. I feel heartbroken at the very idea. Am I really nuts for putting my furry baby ahead of human babies?”
Read what Prudence (aka Emily Yoffe) says here.

European Academy of Allergy and Clinical Immunology (EAACI) Launches Food Allergy Campaign, say life-threatening allergic reactions in children, such as anaphylaxis, increased 7-fold in the last decade.  A third of all allergic shocks in children occur for the first time at school with teachers largely unprepared

The purpose of the campaign is to raise awareness of the sharp increase of anaphylaxis in children, an allergic reaction that is severe and potentially life-threatening. It aims at educating the public to recognise the symptoms and its triggers, and to teach methods of how to react in case of emergency, e.g. by using an adrenaline pen.

More than 17 million people in Europe suffer from food allergies, with 3.5 million younger than 25 years. The sharpest increase is seen in children and young people, especially in the number of life-threatening allergic reactions in children. The number of hospital admissions for severe allergic reactions in children increased 7-fold in the last 10 years.

Live-Fish Cure in India Reflects Desperation of Asthma Patients Thousands of asthma-sufferers thronged a southern Indian stadium on Friday to swallow live sardines coated with a yellow herbal paste to cure their breathing problems. In this annual ritual, the herbs are inserted in the mouth of a live sardine, or murrel fish, and slipped into a patient’s throat.

The therapy was started by the Bathini Goud family, which consists of a secret formula of herbs, handed down by generations only to family members. The Goud family claims that they received the herbal formula from a Hindu saint about 170 years ago. They provide it each year on a day chosen by astrologers without charge and refuse to reveal the mix, as they say that the saint warned them not to disclose the secret of the wonder therapy or else it would lose its potency if commercialised.

After swallowing the live fish, believers are told to avoid fried foods and keep to a strict 45-day diet of 25 different foods, including lamb, rice, white sugar, dried mango, spinach and clarified butter.

U.S. asthma rates at all-time high, CDC says
By Thomas H. Maugh II
Los Angeles Times May 15, 2012

The proportion of Americans with asthma increased from 7.3% in 2001 to 8.4% in 2010, marking the highest level ever, the U.S. Centers for Disease Control and Prevention said Tuesday. In 2010, an estimated 18.7 million adults and 7 million children had the disease — one in every 12 Americans. Overall, about 29.1 million adults have been diagnosed with asthma at some point in their lives, but many of those were misdiagnosed or have apparently recovered, leading to the current figure of 18.7 million.
In 2009, the most recent year for which data are available, asthma accounted for 3,388 deaths in the United States, 479,300 hospitalizations, 1.9 million ER visits and 8.9 million visits to physicians’ offices, the CDC said. The estimated costs to society were $50.1 billion per year due to medical expenses, $3.8 billion resulting from missing work and school, and $2.1 billion from premature deaths.
Children (9.5%) had a higher asthma prevalence than adults (7.7%), suggesting that the disease will become a bigger problem in the future. Females (9.2%) had a higher prevalence than males (7%). People of multiple race had an incidence of 14.1%, while Asians had the lowest (5.2%). Blacks were at 11.2%, while whites were at 7.7%. Hispanics of Puerto Rican descent had the highest prevalence, 16.1%. Death rates were highest for women, blacks and people over the age of 65.

FDA Issues Stern Admonition to EpiPen Manufacturers Over Misleading Advertising Commercial made it sound like life for a food-allergic child could be worry free as long as mom had injector on hand. “The Office of Prescription Drug Promotion (OPDP), Division of Consumer Drug Promotion (DCDP) of the U.S. Food and Drug Administration (FDA) has reviewed a 60-second Direct-to-Consumer broadcast television advertisement (TV ad) distributed by Mylan Specialty, L.P. (Mylan) on behalf of Pfizer, Inc. (Pfizer)1 entitled “Max’s Birthday Party” (EPI12-1003) for EpiPen® and EpiPen® Jr. (epinephrine) Auto-Injectors (EpiPen). The TV ad was submitted as a complaint to the OPDP Bad Ad Program. The TV ad is false and misleading because it overstates the efficacy of the drug product. Thus, the TV ad misbrands the drug in violation of the Federal Food, Drug, and Cosmetic Act (FD&C Act), 21 U.S.C. 352(n), and FDA implementing regulations. 21 CFR 202.1(e)(6)(i). This violation is particularly alarming from a public health perspective because the misleading presentation of the use of EpiPen may result in serious consequences, including death.”

Read the full letter here.

Breathing Smog While Pregnant May Worsen Asthma in Offspring
SUNDAY, May 20 (HealthDay News) — Exposure to air pollution while in the womb might harm the lung-function development of children with asthma, a new study finds. Researchers conducted repeated evaluations of 162 asthmatic children between the ages of 6 and 15 in Fresno, Calif., and used U.S. Environmental Protection Agency data to determine the children’s mothers’ exposure to air pollution during pregnancy. The study showed that exposure to airborne particles and the pollutant nitrogen dioxide during the first and second trimesters was associated with poorer lung function growth in both boys and girls with asthma.

The findings add to existing evidence that a mother’s exposure to air pollution during pregnancy can have long-term effects on lung-function development in children with asthma, said lead author Amy Padula, a postdoctoral fellow at the University of California, Berkeley, in a conference news release. Padula and her colleagues hope to conduct studies examining how genetics might affect a person’s susceptibility to air pollution. This type of information could prove helpful in public health efforts.

Scientific American: Climate Change = Worse Allergies

Money quotes:

In New Jersey, officials observed the highest pollen levels ever recorded in February this year. “I’ve never seen that in 25 years of my work in this area,” said Leonard Bielory, an attending physician and allergist at the Robert Wood Johnson University Hospital and a professor at Rutgers University’s Center for Environmental Prediction. “I told people before the year began that it’s going to be a horrendous year.

Jeffrey Demain, director of the Allergy, Asthma & Immunology Center of Alaska, noted that America’s northernmost state saw a 46 percent increase in insect stings, with some parts of the state suffering increases as high as 626 percent…This comes largely from warmer winter temperatures leading to more snowfall, since Alaskan winters often reach the point where it’s too cold to snow. The snow helped insulate insect dwellings, and as a result, more stinging insects survived the winter and expanded their ranges.

In addition, allergens are now so ubiquitous, it’s hard to find a safe place for sensitive eyes, skin and throats. “There is almost nowhere you can really go to get away from this,” said Stephen Apaliski, (allergist and author of “Beating Asthma: 7 Simple Principles.) He noted that physicians in the past recommended that people with allergies move to drier climates, but even those areas are increasingly dusted with pollen.

British Doctor Calls Attention to “Non-Sexy” Diseases Like Asthma
Dr. Max Pemberton writes:
If ever there was a disease that needed a PR makeover, asthma would be a contender. It affects breathing, and there’s not much that’s more boring than breathing – everyone’s at it, even when we’re asleep. Any condition you can have a “bit of” is unlikely to be exciting. You can’t have a “bit of” a heart attack or a “bit of” cancer. For many people, asthma still hasn’t shaken off its image as one of those things schoolgirls used as an excuse to get off PE. Yet the fact that asthma is a serious, potentially life-threatening condition is missed by the public – and by many in the medical profession. I’ve lost count of the times I’ve heard a doctor give me a patient’s medical history and then add, almost as an afterthought: “Oh, and I think they might have asthma.”

According to a survey published this month, almost one in five people with asthma have not visited their doctor for a check-up for more than a year. Half admitted to using a friend’s inhaler in an emergency, and a third had been forced to use an out-of-date device. Even more shocking is that each year there are more than 1,000 deaths from asthma. The charity Asthma UK estimates that 90 per cent of these are preventable. That’s nearly four unnecessary deaths a day. They die because not enough people – including health-care professionals – think that asthma is that serious.
More here.

Oil Spills and Asthma
A Huffington Post article about aftereffects from the BP disaster in the Gulf of Mexico says this about oil and asthma:

“Crude oil contains some 1,000 chemicals, including cancer-causing benzene. When released into the air by high winds and high seas, some chemicals from the oil can increase ozone levels and the corresponding haze, according to the U.S. Environmental Protection Agency. These volatile organic compounds, as well as the small particles created during the controlled burning of crude oil, are notorious asthma aggravators. A two-year follow-up of children exposed to the 2007 Hebei Spirit tanker oil spill in South Korea estimated an approximate doubling of asthma in areas of high contamination, compared with low contamination.”

Asthma treatment still inadequate in Australia
The treatment of asthma in Australians remains inadequate, and could be improved by tailoring individuals’ asthma treatment and educating patients on inhaler technique, a leading asthma expert has warned.

Writing in the latest edition of Australian Prescriber, Associate Professor Helen Reddel,research leader at the Woolcock Institute of Medical Research says many people are prescribed higher doses than necessary. Most people do not use their inhalers correctly, leading to poor clinical outcomes and wasted medicines.

“Deaths from asthma have dramatically fallen in recent years, so it is often perceived as a commonplace and rarely serious condition. However, treatment of asthma in Australia is not optimal,” says Dr Reddel.

“Many patients are still under-treated. More than half of people with asthma aged 15–34 years are dispensed preventive medications only once in a year, which indicates many people are not taking enough of these medicines to reduce the risk of asthma flare-ups…On the other hand, many patients are being over-treated. The majority of preventer prescriptions for asthma in Australian adults are for the highest potency combination of an inhaled corticosteroid and long-acting beta2 agonist rather than a low-dose inhaled corticosteroid which alone should be sufficient for most patients. People with asthma should have their asthma control and risk factors reviewed once or twice a year, and have their treatment adjusted if necessary. Patients may also make short term adjustments for worsening asthma in accordance with their written action plan.”

Doubts cast on food intolerance testing
By Julie Deardorff, Chicago Tribune reporter
April 11, 2012

According to one lab that tests for “toxic food syndrome,” eating green peppers may cause bloating or lethargy. Lemons might trigger headaches. Other common foods like corn, soy, egg whites, whey and chicken “may act like a poison in your body,” the website warns.

This company and others promise to detect such hidden problems with blood tests that can range in cost from hundreds to thousands of dollars, depending on how many foods are tested for.

Other health practitioners may say they can diagnose food sensitivities by assessing muscle strength, by analyzing hair, gastric juice or body tissue, or by reading the body’s “energy pathways.” Consumers are told that dietary triggers can cause gastrointestinal complaints such as heartburn or irritable bowel syndrome as well as fatigue, attention deficit problems, autoimmune diseases and arthritis.

But allergists and gastroenterologists say that although food intolerance does occur — most of it involving specific food sugars like lactose or fructose — the tests being marketed to consumers have no scientific basis. Blood tests for food sensitivities are prone to false positives that can lead people to eliminate harmless foods from their diets, they say.

The best way to test for the problem is to eliminate various foods from the diet until the symptoms clear, then reintroduce them one at a time, experts say. None of the other tests is recommended by U.S. or European allergy or immunology societies or the National Institutes of Health.

iSonea Launches U.S. Pediatric Asthma Study
iSonea has begun its first large U.S. post-market study of its WheezoMeter™ monitoring device in pediatric patients with a range of asthma symptom severity. The study will include patients who are too young to be tested with spirometry, a traditional measuring technique used in older children and adults.

Medical director Jonathan Freudman says, “In the pediatric asthma population, it is challenging to accurately monitor and manage asthma symptoms in patients using conventional techniques. The WheezoMeter™ has the potential to meet a critical unmet need for better, easy to use monitoring tools for young asthma patients.” The study is planned for two West Coast locations and iSonea has begun enrolment at the site in Folsom California. The WheezoMeter™ device is based on iSonea’s Acoustic Respiratory Monitoring™ technology platform, which uses acoustic sensors and novel signal processing software to establish the presence, frequency and severity of wheeze. The portable device records and analyses sounds caused by inflammation or narrowing of the airways, to quantify the rate of wheezing, a hallmark symptom of asthma. The technology correlates to traditional lung function tests, but is more patient friendly, enabling frequent monitoring in real-life settings. The device requires no physical exertion and can be used to interpret respiratory symptoms by all asthma patients, including young children or the elderly.

Other methods for monitoring asthma in small children include the signs-based evaluation created by Dr. Thomas Plaut, which was launched on this website, and NIOX MINO, from Aerocrine, which measures exhaled nitric oxide, an inflammation marker. More

World’s Oldest Active Doctor is an Allergist 100-year-old British physician Bill Frankland “persuaded Britain’s media to include the pollen count in weather forecasts back in 1961. And, some 60 years ago, he worked alongside Sir Alexander Fleming, the Nobel Prize- winning discoverer of penicillin.”

“It was Frankland who championed the view that an allergic reaction is due to a malfunctioning immune system. In doing so, he and his colleagues opened up the possibility of radical new treatments for lifelong sufferers by using small doses of an allergen to, in effect, retrain the errant immune system.”

He recalled: “I got a call [in 1979] to see the new president of Iraq, Saddam Hussein. They told me he had an allergy and he was being treated with various desensitising injections. But he wasn’t allergic at all; his problem was that he was smoking 40 cigarettes a day. I told him to stop and if he wouldn’t I would refuse to come and see him again. I don’t think anyone had spoken to him like that before. I heard some time later that he had had a disagreement with his secretary of state for health, so he took him outside and shot him. Maybe I was lucky.”

From the Daily Telegraph. More

Company Develops Training Device to Help Raise Shockingly Low Correct Inhaler Usage More than 50 healthy participants, aged 18-60, took part in a recent study conducted by Cambridge Consultants to test the efficacy of T-Haler. Before using the training system, the average success rate of the group in using an inhaler correctly was in the low 20 percent range — in line with numerous other studies carried out. The participants had no prior experience with asthma or inhalers and were given no human instruction beyond being handed the T-Haler and told to begin. The on-screen interface walked the group through the process, which takes just three minutes to complete.

“What was remarkable about the T-Haler in our own study was how quickly the participants learned, and how well that knowledge stayed with them,” said Kate Farrell, senior design engineer, medical technology at Cambridge Consultants. “Without any human direction beyond the word ‘go,’ participants went from around a 20 percent success rate without training to a success rate of more than 60 percent after only three minutes with the T-Haler device. This is more than twice the compliance rate we have seen in other studies with trained participants. Interestingly, a week later, 55 percent were still correctly using the device — showing that they retained what they learned.”

Nasal Allergies on Rise in Middle East In a survey by Nycomed—makers of the nasal spray Omnaris–called Allergies in the Middle East, “more than half of the employed patients said that allergic rhinitis has affected their job productivity by 25 per cent. This first-of-its-kind survey interviewed 501 patients from five countries in the Middle East, including the UAE, Saudi Arabia, Lebanon, and Egypt.

“During times of allergy attacks, four in 10 patients said they experience fatigue while seven out of 10 reported feeling ‘miserable during the worst month of their allergy symptoms.’”

Minnesota Schools Asthma Management Toolkit Web-based program (developed by Southeast Minnesota Beacon Community Program) includes: Written action plan for every student with asthma, policies and processes for parental consent, specific actions staff members can perform, policies and procedures for administering medications, including protocols for emergency response to a severe asthma episode, education for staff and students about asthma. “This asthma management toolkit will help districts promote school environments where children with asthma can feel safe, be healthy, and remain active,” says Barbara Yawn, M.D., a Beacon co-investigator and pioneer of the Community Collaborative Asthma Project in Olmsted County. “We are very pleased that Beacon gives us the opportunity to develop reliable ways to share asthma-related information between physicians, parents, school nursing and other staff. It is so important that schools and parents have up-to-date and accurate information immediately available to deal with changes in symptoms or asthma attacks.” More here.

Childhood Asthma On The Rise As Political Battles Threaten EPA’s Air Pollution Rules
Lynne Peeples environment and public health reporter at The Huffington Post reports on the battle here.


“Some members of the fossil fuel industry and their supporters, however, continue to stall stricter regulations with dozens of letters and lawsuits. Two weeks ago, Sen. Jim Inhofe (R-Okla.), an outspoken climate change skeptic, sent a letter to EPA’s Jacksonthat criticized a newly proposed greenhouse gas rule that would raise new automobile fuel economy requirements and cut carbon emissions from those vehicles in half by 2025. He noted that in addition to being a detriment to the nation’s energy security, the standards would add an average of $2,000 to the cost of new cars in 2016, and would actually increase soot pollution from vehicles because people would simply drive more.

“According to EPA estimates, the rule would reduce overall soot emissions, but only if the resulting reductions in fuel refining and distribution are also factored in. And when the improved gas mileage is taken into account, consumers would net a savings of $4,400 over the life of a new vehicle.”

New York Times tackles French pine bark supplements for asthma, among other conditions Finds claims unproven and unconvincing. More here.

“A dangerous allergy to change”
In the Financial Times, journalist Gillian Tett gives her take on why access to EpiPen is tightly restricted although its efficacy and safety for emergency anaphylaxis treatment are indisputable. She gives her reasoning on why injectable epinephrine could be provided in public settings on the same “good Samaritan” basis that makes emergency defibrillators so widely available.

However, the article contains a questionable statistic: “around 1,500 people are thought to die in America each year from similar allergic reactions which could have been reversed with an EpiPen.” The American Academy of Allergy, Asthma and Immunology (AAAAI) says “It is estimated that food allergies cause approximately 150 to 200 fatalities per year, based on data from a five year study of anaphylaxis in Minnesota from the Mayo Clinic.” An additional estimated 40 deaths from insect stings could be added to that figure.
Note: After an exchange of emails with this website, the Financial Times has now altered the figures on fatalities.

Wall Street Journal Publishes Major Article on Food Allergies

“Many parents of children with life-threatening allergies say they are seeing changes at schools, day-care centers and restaurants. This comes after years of being dismissed as overbearing or overprotective in their efforts to insure school lunches and play-date snacks didn’t expose their kids to danger. Parents used to address this issue preschool by preschool and classroom by classroom. Now school districts and state legislatures are stepping in as the general public has become more aware of the issue.”
Reported by Liz Rappaport


Colorado School Expels Girl Who Used Classmate’s Inhaler
The high school girl who complained of trouble breathing and used a friend’s inhaler at her suggestion was expelled after the two of them sat out ten-day suspensions. This was considered a violation of a drug policy.

What Are People Doing Without Primatene? The Los Angeles Times reports here.

UK to Investigate Reducing Asthma Deaths

Not a moment too soon. As we have pointed out in the last few weeks, asthma fatalities are far higher per capita in the UK than in the US. Now the government has commissioned the National Review of Asthma Deaths (NRAD), which will be led by the Royal College of Physicians.

Dr Mark Levy, clinical lead of the NRAD, told WebMD that for nearly 50 years research has shown that most asthma deaths are potentially preventable. However, he hopes this large scale review will provide new information: “We’re going into these deaths in much more detail than has been done before, in terms of looking at the process of care that’s been provided and also by interviewing a hundred of the families we will hope to get information that hasn’t been gleaned before.”

Asthma UK is launching a simple new online test called Triple A: “Avoid Asthma Attacks”, to help people assess their risk of a severe asthma attack and enable them to take steps to avoid it. The test asks eight questions about factors that have all been linked to an increased risk of a serious asthma attack. The three most important questions are about inhaler use, steroids and recent hospital admissions. Depending on the answers, participants will fall into one of three categories color coded like traffic lights, with red at highly increased risk down to green at no increased risk. Each category gives health advice with links to web pages on how to control symptoms, avoid an attack and what to do when having an asthma attack.

Eat My Dust (Mites): Danish Pill Containing Droppings Shows Promise for Asthma Patients

A daily tablet developed by Danish firm ALK Abello, contains extracts of proteins found in dust mite droppings and exposes the immune system to tiny amounts of the allergenic protein, like other forms of allergy immunotherapy. The tablet is dissolved under the tongue—so-called sub-lingual immunotherapy, or SLIT.

Around 5.2 million people in Britain have asthma and the mortality rate is much higher than in the US.
In a trial involving 600 asthma sufferers allergic to house dust mites, one in three on the pill were able to stop using their inhaled steroids.

The same company also makes the anti-hay fever pill Grazax from grass pollen.

Asthma Mom, Foundation Organizer, Secretary, Spy

The Sydney Morning-Herald ran a fascinating obituary for Mickie Hardie, nee Broun 1918-2011, who, after World War 2, helped found the Asthma Foundation of Australia because of her experience with her own asthmatic child.  The obit reads:

“Mickie Broun, as she was in 1939, relieving switchboard operator in Sydney for a Dutch company, Phillips Lamps, was astonished when she put a call through to the general manager and forgot to close it off, instead hearing him greet the caller with the words: ‘Heil Hitler’.

“Two weeks later, two men clad in black went into the general manager’s office, clicked their heels and gave the Nazi salute, confirming in her mind that all was not quite right with her boss, who had recently arrived from Germany.

“She confided to her mother what had happened. That got to the Premier, Bertram Stevens, who in turn alerted army intelligence. Two intelligence officers visited Broun and recruited her as a spy, telling her to listen to conversations, watch comings and goings at the man’s office and keep a special ear out for the words ‘Messerschmitt’, ‘Luftwaffe’ and ‘Panzer’.”

The boss was arrested when Australia entered the war, and she spent the duration working for the country’s intelligence service. In 1986, Hardie was awarded the Medal of the Order of Australia for establishing the Asthma Foundation.

Asthma, Allergies, Children in Spain

– Prevalence of asthma — 7-15%
– Prevalence of rhinitis — 23-36%
– Prevalence of atopic dermatitis — 4-8%
– Prevalence of food allergy — 3%

All children in Spain have the right to be evaluated in their National Health System. Primary care is provided by pediatricians, who go through a 4-year medical residency training program.

There are currently 112 certified pediatric allergists in Spain accreditated by the European Union of Medical Specialists. Future specialists in pediatric allergy will obtain their titles through a specific education program to be developed in one of the 4 accredited training units on pediatric allergy, after pediatric residency.

The web site of Spanish Society of Pediatric Allergy and Clinical Immunology (SEICAP) SEICAP, http://www.seicap.es, open since 2004, received 750 daily visits during 2011.

The pediatric allergy units perform immunotherapy and induction of oral “tolerance” in food allergy.

Information from http://allergynotes.blogspot.com/


Huge rise in potentially fatal allergies in UK; new guidelines published

The number of people admitted to hospital with life-threatening anaphylactic shock – involving sudden swelling, breathlessness and low blood pressure – has increased by at least 700 per cent in the last two decades.

The first guidelines for treating the condition, published today by the National Institute for Clinical Excellence (Nice), say doctors should record the circumstances immediately before the reaction to help identify the cause and ensure an adrenaline injector is given to patients after emergency treatment before they are referred to a specialist. Patients can then give themselves a shot of adrenaline, which may be life saving in the event of another attack.

Quebec Parents Fighting for Food Allergy Emergency Training in Schools

MONTREAL – Following the death of a 6-year-old Montreal schoolgirl, parents of children with food allergies and support groups are calling on Quebec to make it law for all schools to institute training programs and emergency measures to deal with the potentially fatal allergic reaction known as anaphylaxis.
It’s estimated there are 72,000 students in the province who are potentially at risk.

First-grader Megann Ayotte Lefort was in the care of daycare staff at Saint-Germain Cousin elementary school in Montreal North while her parents were at an information session with her teacher in September 2010. Megann started showing signs of distress at 6:20 p.m., crying and asking for her father soon after taking small bite from a store-bought sandwich her mother gave her, but it was 25 minutes before staff gave her two puffs from her asthma inhaler when she had trouble breathing, a coroner’s report revealed. It was 40 minutes before staff came to get the parents to say their daughter wasn’t breathing. When they got to Megann, the parents demanded the staff call 911. Paramedics managed to revive her and rush her to the hospital, but she was declared dead at 8:20 p.m.

“The school was well aware of Megann’s allergies and her asthma. … Everything about that night was wrong. Everything,” Megann’s father Sylvain Lefort told Allergic Living magazine.


Petless Homes Have Pet Allergens

By Mary Elizabeth Dallas
SUNDAY, Nov. 6 (HealthDay News) — Pet allergens are found in more than 90 percent of U.S. homes, even though only 52 percent have a pet, said Dr. Dana Wallace, president of the American College of Allergy, Asthma and Immunology, in a college news release. That can pose a problem for pet-allergic children at schools, when classmates introduce allergens via their clothes and backpacks.
“Studies show that when asthmatic children who are allergic to cats attend classes with many cat owners, they have increased asthma symptoms,” Wallace said. “We usually see a spike in asthma episodes at the beginning of the school year when students are reintroduced to the allergen after being away from it over the summer.”

There are a number of steps pet owners can take to limit the amount of pet dander in their homes, noted Wallace, including:
• Limit where the animal can roam, particularly the bedroom, to establish an “allergy free zone.”
• Wash clothing and bedding with bleach.
• Cover mattresses and pillows with tightly woven microfiber fabric.
• Use room air cleaners and vacuums with a HEPA (High-Efficiency Particulate Air) filter.
• Use central heat and air; a MERV 12 filter is also recommended. (MERV is a rating system that signifies the size of particles a filter can capture)
• Opt for wood or tile floor over carpeting.
• Replace fabric upholstery with leather furniture.
• Give pets regular baths.
These steps can also help pet owners who find out they’re allergic to their own dog or cat, Wallace said. Pet owners can also consider immunotherapy, or allergy shots, advised Wallace.

For more on pet allergies, read Asthma Allergies Children: a parent’s guide, including how cat dander is transmitted via children’s clothing, and what happens to people who must choose between their marriage and their pets.

Rising allergies, asthma triggered by ‘the things we love’

By Anita Manning, Special for USA TODAY

Allergists speaking at a meeting of the American College of Allergy, Asthma and Immunology warned of the potential for some of life’s sweetest pleasures — a glass of wine, a beautifully scented room, the unconditional love of a pet — to set off fits of sneezing, coughing, hives and even serious asthma attacks.
•Air fresheners and scented candles: Sometimes, the allergy trigger is right under your nose, says Atlanta allergist Stanley Fineman, president-elect of the allergists group. “I’ve been seeing more and more adults who are having problems with air fresheners,” he says. “They’re coming in with all kinds of symptoms,” from sneezing and congestion to headache, coughing, fatigue and asthma.
Candles and air fresheners may emit volatile organic compounds, or VOCs, such as formaldehyde, petroleum distillates, limonene and other substances that increase asthma risk in children and can trigger eye and respiratory irritation and other health problems.
•Alcoholic beverages: Reactions to wine or other alcohol-containing drinks are rare, but symptoms can range from rash to severe asthma attacks, says allergist Sami Bahna, chief of allergy and immunology at Louisiana State University Medical School in Shreveport.
Potential allergens that occur naturally in beer and wine include hops, barley, ethanol, grapes, tryptamine, tyramine, wheat and histamine, and there may be added ingredients such as egg whites or sulfites, he says. “About a third of asthmatics can have difficulty with alcohol,” possibly in reaction to sulfites or other preservatives, he says.
In some cases, a mild allergy to a wine ingredient pairs up with a mild allergy to something in food, such as cheese, and the combination can cause an allergic reaction.
•Pets: More than 90% of homes have “measurable dog and cat allergens,” even those that don’t have a resident pet, says Fort Lauderdale allergist Dana Wallace, president of the allergists group.

Wales Experiment Shifts Asthmatic Children to New Housing, Shows Significant Improvement

Housing authorities in Wrexham County Borough, Wales, UK compared the health of severely asthmatic children in homes modified to improve ventilation and household heating with a control group. A total of 177 children aged between 5 and 14 years, identified from general practice registers, were studied, and their parents reported on the quality of life of their children over a 12-month period. Health-service resources used by those children, and their asthma-related prescriptions were monitored over the same period.

Seventeen percent of children in the intervention group were shifted from `severe’ to `moderate’ asthma, compared with a 3% shift in the control group. The mean cost of these modifications was £1718 per child treated or £12300 per child shifted from `severe’ to `moderate’.

The researchers concluded: “This novel and pragmatic trial, with integrated economic evaluation, reported that tailored improvement of the housing of children with moderate to severe asthma is likely to be a cost-effective use of public resources. This is a rare example of evidence for collaboration between local government and the NHS (National Health Service).”

Why are supermarkets offering allergy tests? Read about the latest wrinkle in the misuse of testing and over-diagnosis of food allergies in “Attention Shoppers: Free Allergy Testing in Aisle Five” by medical writer Kevin Lomangino. Also read what Dr. Ehrlich has said on the subject here and in other blog posts.

Allergies, Asthma Exploding in India
A study by the World Allergy Organisation (WAO) has warned that 20 to 30 per cent of people in India have one or more allergic diseases and their prevalence is rising dramatically. The prevalence of asthma and rhinitis was one and 10 percent respectively in 1964 in the country, but, new data shows that about 14 per cent people now have asthma, while over 20 per cent are suffering from allergic rhinitis (AR).

“This increase is especially affecting children, who are bearing the greatest burden of the rising trend which has occurred over the last two decades,” said Dr Ruby Pawankar, the President Elect of WAO. She attributes the increases to growing industrialisation and fast changing biodiversity coupled with sedentary lifestyles are causing a surge in allergic diseases, especially among children. “The way these are occurring, we believe by 2050, about 50 percent of all children will have some sort of allergies,” Dr Pawankar, an Indian doctor who is currently associated with Nippon Medical School in Tokyo.

According to Pwankar, the WAO paper indicates that allergy poses a major global health issue. It has also provided some high level recommendations to governments and health authorities. “It has asked governments to institute environmental control measures by lowering indoor and outdoor air pollution, tobacco smoking and allergen and drug exposures,” she said. “It also calls for developing national allergy action plan to promote the prevention of allergic diseases and immune tolerance, aiming to decrease the burden of allergic diseases.”

Unlucky Numbers: Dismal Canadian Asthma Statistics Paint Picture of Poor Control

(These statistics are taken from Allergic Living Magazine. Read full article “Running on Empty: The Crisis in Asthma Control” by Claire Gagné here.)
“Research shows 28 per cent of Canadians with asthma have symptoms of their disease every day, while 67 per cent have symptoms every week.” — Dr. Louis-Philippe Boulet, a respirologist and asthma researcher at Laval University in Quebec City. In Ontario alone, hospital statistics show that asthmatics made more than 73,000 emergency room visits in the past year. All asthma patients are supposed to have an action plan. Yet, only between 3 and 15 percent do.

In Canada, more than eight million work days are lost each year due to asthma-triggered absenteeism. Respiratory disease as a whole costs the Canadian economy an estimated $15 billion a year. Worldwide, the economic costs associated with asthma are thought to be greater than tuberculosis and HIV/AIDS combined.

Preventing deaths from food allergy
Scott H. Sicherer Chief of the Division on Allergy and Immunology in the Department of Pediatrics, Mount Sinai Medical Center, New York City recently summarized the best current information on food allergies and the incidence of fatalities at KevinMD.

Among the most important points:
According the Centers for Disease Control (CDC), about 4% of children have food allergies, up 18% in ten years. Studies at Mount Sinai’s Jaffe Food Allergy Institute, in collaboration with the Food Allergy & Anaphylaxis Network and funded by the Food Allergy Initiative, showed that reported peanut allergy among children has tripled from one in 250 in 1997 to 1 in 70 in 2008.

Fatalities are uncommon, but occur mostly among teenagers or young adults “those who are at an age of risk-taking and prone to ingest possibly unsafe foods to ‘fit in’ with peers and avoid discussing their allergy because of embarrassment.” Other common risk factors: delayed treatment with epinephrine and poorly controlled asthma.

Because of these common risk factors, Sicherer recommends carrying epinephrine at all times, better asthma control, and better information and peer education for patients. He also recommends the National Institutes of Allergy and Infectious Diseases (NIAID) of the NIH Guidelines for the Diagnosis and Management of Food Allergy in the United States, and provides links to other resources. There’s also good news about current research. You can read more about studies and clinical trials by visiting the Mount Sinai Jaffe Food Allergy Institute, or search “food allergy” here.

Do We Need Food Regulation? Some Politicians Don’t Think So
(This is from a USDA press release)
WASHINGTON, Sept 20, 2011 – M & P Food Production Ltd., a Brooklyn, N.Y. establishment, is recalling approximately 11,000 lbs. of chicken, beef, veal, and pork dumpling products because they may contain an undeclared allergen, milk, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today. The milk is a sub-ingredient contained in sour cream used to make the dough.

The products subject to recall include:
14 oz. pouches of “Bapehuku Beef Dumplings”
16 oz. pouches of “Babushka Brand Beef and Pork Dumplings”
16 oz. pouches of “Babushka Brand Veal Dumplings”
16 oz. pouches of “Babushka Brand Chicken Dumplings”
16 oz. pouches of “Russian Brand Veal Dumplings”
16 oz. pouches of “Russian Brand Chicken Dumplings”
16 oz. pouches of “Siberian Brand Pork Dumplings”
16 oz. pouches of “Siberian Style Dumplings”

The problem was discovered by an FSIS inspector while conducting a routine label review. The inspector noticed the use of sour cream in making dough for the products, but no indication of milk as an ingredient on the label. FSIS and the company have received no reports of adverse reactions due to consumption of these products. Anyone concerned about a reaction should contact a healthcare provider. When available, the retail distribution list(s) will be posted on FSIS’ website at: www.fsis.usda.gov/FSIS_Recalls/

Canadian Prime Minister Won’t Act on Air Pollution Despite Asthma

“[W]hat’s remarkable to me is that the prime minister has asthma, and I would have thought anyone with asthma would understand that the (things) that trigger an asthmatic episode have to do with the fact that we are treating the air like it’s a garbage can.

“It’s not the atmosphere or the economy, it’s not jobs or spotted owls. The reality is that our home is a thin layer of air, water and soil around that planet: That’s a biosphere, it’s what keeps us alive. Ecologists try to tell us how we can do that sustainably … [but] we don’t do it that way, and that’s getting us in a great deal of trouble.”

— David Suzuki, environmentalist and host of Canadian science program, The Nature of Things, now in its 51st season. More

Asthma and New Orleans’ Children After Katrina
(This is excerpted from Huffington Post and is available in full here)
Floyd J. Malveaux, M.D., Ph.D. Executive director, Merck Childhood Asthma Network, Inc.

The disappearance of reliable healthcare services in New Orleans left many children with asthma no choice but to seek out treatment in emergency rooms across town — if they seek care at all. And while there have been strides to restore services for this very vulnerable population, work to rebuild hospitals and medical practices has been moving slowly. But that doesn’t mean healthcare needs have slowed — particularly for children burdened by asthma. It does mean that innovative ways to provide asthma management directly to where they live and go to school is necessary. And while we don’t know everything about childhood asthma, we know enough to do better in controlling its symptoms and effects.

A report from The George Washington University found that asthma adds about 50 cents to every health care dollar spent on children with asthma compared to children without asthma. And those most at risk — low income, medically underserved, and African-American and Hispanic children — have the least access to preventive care and the most visits to the emergency room. Access to quality, affordable care plus healthier communities can control costs and improve health.

Regular access to health care can also help families better manage the disease, get on a schedule of taking medication and establish a routine of care for their child. Results from the Head-Off Environmental Asthma in Louisiana (HEAL) program is proof. The program was launched in the months following Hurricane Katrina to provide education and counseling to caregivers on how to manage their child’s asthma in a transformed environment. It provided in-home surveys for asthma triggers and community-based asthma services that led to fewer children being rushed to the hospital, a reduction in symptoms and fewer days of school missed.

Another outcome of the program is that more parents felt confident that they could better manage their child’s asthma. This is a large feat considering too many families in New Orleans and across the country seek care in the ER only when their child’s asthma symptoms occur rather than attempt to prevent them before they happen. So access and innovation in healthcare delivery will go a long way to helping alleviate the burden of childhood asthma and bring more peace of mind to the families of these children.

Sloane Miller reacts to recent food allergy tragedies in this piece on CNN.

Q & A
Peanut Problems
Published: August 22, 2011
Q. When I observe student teachers in a school auto shop, there is almost always an engine retrofitted to run on biofuels like used peanut oil. Is it safe for students with a severe peanut allergy to be around it or work on it?
A. The processing of the fuel minimizes or eliminates such a risk, in the opinion of Dr. William Reisacher, an ear, nose and throat specialist and the director of the Allergy Center at NewYork-Presbyterian/Weill Cornell hospital.
In the manufacturing process used to produce peanut oil for cooking, “essentially all of the peanut protein is filtered out,” Dr. Reisacher said. “However, some products that are labeled as organic, cold-pressed, expelled or extruded may still have enough protein present to cause an allergic reaction is a person who is peanut-allergic.”
“However, I don’t think you or your students have anything to worry about” when the oil is recycled as fuel, Dr. Reisacher said. “First of all, you are probably using oil that has no viable peanut protein to begin with. Even if there are trace amounts of protein present, the processing of the fuel, including a pass through an internal combustion engine, will certainly degrade any traces of peanut protein.”
“If you want to add an extra layer of safety,” Dr. Reisacher said, “consider having peanut-allergic students use a barrier mask or respirator when the engine is running.” C. CLAIBORNE RAY


Mom sues Denver, three workers over child’s death

By Allison Sherry
The Denver Post

A Denver mother whose son died after she was unable to fill his multiple prescriptions because pharmacists kept telling her he was not eligible for Medicaid — even though records proved he was — has filed a lawsuit against the city and county of Denver.
Zuton Lucero-Mills said she called Denver County Human Services several times a week in the spring and summer of 2009 after she tried to get 9-year-old son Zumante’s asthma medications at Walgreens and was told he wasn’t eligible for Medicaid.
No one resolved the computer glitch. Most of Lucero-Mills’ calls weren’t returned.
Her son’s asthma worsened after several months of being off the anti-inflammatory drug Advair, which kept the disease manageable.

The boy died in July 2009. He fainted at his home after telling his mother he couldn’t breathe and then died a few days later at Children’s Hospital when he was taken off a ventilator. State investigators later found the boy died of complications from his condition, which was covered by a state health plan that should have paid for the prescription medication he needed.


Effort to Get Earlier Care for Asthma Patients
By Barbara Peters Smith
Sarasota Herald-Tribune
With asthma-related emergency room visits — and costs — climbing in Florida by 14 percent over a two-year period, the Florida Asthma Coalition met Thursday to plot a statewide coordination of prevention and care efforts. While Florida has a relatively low rate of asthma in adults, the prevalence in children is much higher than average. The majority of ER visits occur in children from birth to 4 years old, and they are disproportionately high among blacks and people in Florida’s rural counties.
Jamie Forrest, an epidemiologist with the Department of Health, said the state’s average cost of emergency treatment for asthma was more than $2,000 in 2009, for a total of $183 million. Leslie Hendeles, a University of Florida pharmacy professor who specializes in children’s asthma, said these trips to the hospital account for 24 percent of all U.S. asthma care costs.
Getting health care providers on the same page is a primary need, said Kristen Rogers, chair of the Suncoast Pediatric Asthma Coalition in St. Petersburg and the mother of three children with severe asthma. Her first indication that she had the disease came when she was a teenager.
“Probably the most frustrating thing is the lack of consistency of care,” she said. “On a given day, you are going to get a different message from every doctor out there. Not just small differences — wide-ranging, head-spinning differences.”
{Note: This otherwise informative article overstates the death rate from asthma in Florida by about 300%.}

61-Year Old Swimmer Abandons Cuba-Florida Swim After Asthma Attack

An asthma attack, a painful shoulder and battering wind and waves forced 61-year-old swimmer Diana Nyad to abandon early on Tuesday her bid to become the first person to swim from Cuba to Florida without a shark cage. The American, who tried and failed the 103-mile (166 km) swim more than three decades ago when she was 28, gave up after enduring nearly 30 hours of a crossing expected to last 60, exhausted by her body’s limits and the force of the elements.
She told CNN that she suffered an unexpected bout of asthma that left her gasping for oxygen. “Last night at midnight, I was trembling, the 11 hours of asthma had taken so much from my body … I just knew that it wasn’t mind over matter anymore, I was absolutely spent.” She said that toward the end she was “limping” and “slapping around” in the water and even resorted to breast stroke instead of her usual crawl. Her doctor joined her in the water at one point to try to give her relief with an inhaler.
More from Reuters

Risk Factors for Asthma Related Death

Pat, the editor of Guide Asthma at About.com said recently:
“Importantly, 80 to 85% who die from asthma develop progressive symptoms anywhere from 12 hours to several weeks before death. Only 15 to 20% die in less than 6 hours after developing symptoms. Thus, the vast majority of patients dying from asthma developed symptoms in a time frame that would have allowed them to seek appropriate medical care.”
He then gave these risk factors:
• Previous history of a near-fatal asthma event
• Recent poorly controlled asthma with increased shortness of breath, nocturnal awakenings, and rescue inhaler use
• Prior severe asthma exacerbation where you were intubated or admitted to an intensive care unit.
• Two or more asthma-related hospital admissions or three or more visits to the emergency room for asthma
• Using 2 or more canisters of your short acting bronchodilator like albuterol in a month
• If you have trouble identifying when your asthma symptoms are worsening or you are having an asthma attack
• Being poor and from the inner city
• Substance abuse
• Significant psychiatric disease
• Other significant medical problems like a heart attack and other lung diseases

Poorly controlled asthma doubles costs
According to researchers at National Jewish Health in Denver, poorly controlled asthma in children more than doubles the cost of treatment and hurts their school performance. As reported by UPI, the researchers evaluated direct medical costs — medications, unscheduled office and emergency visits, and hospital admissions — and indirect costs such as school days lost. Very poorly controlled asthma patients incurred costs at baseline an average of $7,846, compared with $3,526 for not-well-controlled asthma patients and $3,766 for well-controlled asthma.

Two years later, costs for very poorly controlled asthma patients increased to $8,880 while costs for those with well-controlled asthma dropped to $1,861. All costs are in 2002 dollars and costs in 2011 dollars would be about 25 percent greater.

The study, published in The Archives of Allergy, Asthma & Immunology, finds children with very poorly controlled asthma finds missed an average of 18 days of school each year, compared with two or less for other asthma patients.

*Take these figures with a grain of salt and call your doctor in the morning
Thomson Reuters-NPR Health Poll: One-in-Five US Households Have Food Allergies
One in five Americans reports having at least one household member with a food allergy or intolerance.

Thomson Reuters and NPR developed the monthly poll to gauge attitudes and opinions on a wide range of health issues.

The latest survey in the series finds that among the 20 percent of U.S. households where someone has a food allergy or intolerance, milk and milk products were the most commonly cited problem (36 percent), followed by fruits (19 percent), vegetables (9 percent), peanuts (9 percent), shellfish (8 percent), gluten (7 percent) and wheat (6 percent). Food allergies were far more prevalent among respondents under 35 years of age (24 percent) than those in the 65+ age group (15 percent). Approximately-two thirds of households reporting food allergies said they had been diagnosed by a physician.

Among all respondents, a 59-percent majority said they support bans on common food allergens (such as peanuts) in public places such as airplanes and lunchrooms. Conversely, 49 percent of respondents said they felt food allergy fears have been blow out of proportion.

*Note: The data in this poll are skewed by several factors. First of all, they combine food allergy and food intolerance, which are not the same thing. Second, only two-thirds have been diagnosed by a physician. Self-diagnosis is really unreliable, as are many allergy tests. For better statistics on the extent of food allergy, see this article in Pediatrics. For excellent analysis of the Pediatrics numbers, see Kathy Franklin’s Food Allergy Corner piece here.

Phadia recombinant ImmunoCAP Allergen Components receive FDA approval

Phadia, a provider of allergy, asthma and autoimmunity diagnostics, has received the US Food and Drug Administration (FDA) 510(k) approval for its recombinant ImmunoCAP Allergen Components. The FDA clearance covers 13 components (9 recombinants and 4 natives) including peanut, cat dander, dust mite, bermuda grass, ragweed and the mold Alternaria alternata.

Hugh Sampson, Jaffe Food Allergy Institute director and Mount Sinai School of Medicine Pediatrics professor, said recent studies suggest that component testing will help allergy and immunology specialists assess the risk of clinical reactions. Phadia president and general manager David Esposito said by identifying the specific molecule within the allergen causing the allergic reaction, clinicians have information to enhance patient care. “Allergen component test results have the potential to assess risk for reaction, explain symptoms due to cross reactivity, and identify a more targeted approach for patients requiring immunotherapy,” Esposito said.
Phadia has plans to accelerate its ongoing commitment to educate clinicians and patients on the use of ImmunoCAP test results to support improved patient care.

“Prayin’ for the End of Time” Not to Be Taken Literally
Singer Meat Loaf was performing a concert in Pittsburgh on Thursday when he fainted on stage for 10 minutes during an asthma attack. Here’s the kicker. He got right back up and finished the show. That’s right. According to the Pittsburgh Post-Gazette, the 63-year-old had just finished singing his 1992 hit “I’d Do Anything for Love (But I Won’t Do That)” when he collapsed on the stage. You know you’d pass out too singing that epic 12-minute opus, but let’s just assume he sang the 5-minute radio edit.

Staffers were all around Meat Loaf on the stage floor and the band stopped playing the song before, about 10 minutes later, Meat Loaf was breathing again and was well enough to continue the show. Right before performing his 1977 hit “Paradise by the Dashboard Light,” he explained to this fans what happened.
“I f—-ing fainted. I have asthma … I can’t breathe … and then … oh wait, I forgot … I got poked by a pin and bled half to death … and then I got slapped in the face and my tooth is loose,” Meat Loaf said.


Can I Use My Inhaler while Fasting for Ramadan?

From the Canadian organization National Asthma Patient Alliance
The Islamic holy month of Ramadan begins early next week.

Although Islamic rules state that people with chronic conditions are permitted not to fast, some Muslims choose to do so and confusion exists about whether using an inhaler constitutes breaking the fast.

From Islam Online, Sheikh Ahmad Kutty, senior lecturer and Islamic scholar at the Islamic Institute of Toronto, says:
According to the preferred view of scholars, using inhalers by asthma patients does not break their fast. The drug inside an inhaler, we are told, goes straight into the airways; while the airways are treated, very little of the drug itself gets into the rest of the body. This being the case, it is perfectly comparable to rinsing the mouth with water or gargling, brushing the teeth, or using eye or ear drops; such actions should never be reckoned as consumption of foods or drinks.

Therefore, you may use them if need be. Rules of Islam, we may do well to remember, are not at all intended to make life hard for people. Almighty Allah says in the Qur’an, [He [Allah] has imposed no difficulties on you in religion] (Al-Hajj 22:78).

If It Quacks Like a Lizard….. Another BS Folk Asthma Treatment
Here at asthmaallergieschildren.com, we are always trying to provide perspectives on allergies and asthma from around the world. Thus we noted that the government of the Philippines warned Friday against using geckos to treat a variety of maladies including not just asthma, but AIDS and impotence. This is not a cheap treatment. Prices for these wall-climbers start at 50,000 pesos ($1,160 U.S.). They are also exported to Malaysia, China and South Korea, where they are used as aphrodisiacs and as traditional medicine for asthma, AIDS, cancer, tuberculosis and impotence.
A health department statement warns that the use of geckos has no scientific basis and could be dangerous because patients might not seek proper treatment for their diseases. Trading geckos without permit can be punishable by up to four years in jail and a fine of up to 300,000 pesos. A healthy population of geckos is needed to regulate pests and maintain the fragile ecosystem. Geckos feed on insects and worms. Larger species hunt small birds and rodents.

Really? The Claim: Allergies Reduce the Risk of Cancer
“Allergies are generally considered more of a nuisance than a blessing. But for some people there may be a silver lining.
“Researchers have long speculated that one of the benefits of having allergies is a vigilant immune system, which not only overreacts to common triggers, like pollen and dander, but also protects against serious threats like nascent cancer cells. Numerous studies dating back at least two decades have explored the idea of a link. Most have found that compared with the general population, people with common allergies like hay fever, asthma and eczema do have a slightly decreased risk of some cancers, though it is not clear why.”
The article cites a study in the journal BMJ Open, about Danish researchers tracking nearly 17,000 adults over many years for contact allergies — that is, contact with metals, poison ivy, hair dyes or other chemicals caused them to develop skin irritation. The scientists found that people with contact skin allergies had lower rates of breast and skin cancer after checking them against health registries.

The theory is that hyper-vigilant allergic immune systems fight cancer.

Can Text Messaging Improve Medication Adherence?
“Text messaging and adolescents don’t always mix well, but researchers at National Jewish Health hope text messages can spur teenagers to take their asthma medications more reliably. The study is testing whether health information and medication reminders via text message will boost adolescent’s adherence to asthma medication regimens.
“’We know that the combination of hectic schedules and less parental supervision can lead many teens to lack consistency in taking their daily asthma medications,’ said Daniel Searing, MD, Assistant Professor of Pediatrics at National Jewish Health. ‘We also know that most teens text frequently. We want to see if providing them with asthma information and reminders helps with their medication adherence.’”

How Michelle Obama Copes With Asthma
According to First Lady Michelle Obama, in a piece she wrote for the book Healthy Child Healthy World, when her daughter Malia was about three years old, they took a family outing to the circus where Malia’s breathing became more and more strained. The Obamas rushed her to the emergency room where the doctor diagnosed her with asthma.??
It’s all too common of a story these days. In fact, asthma is the most common chronic disorder of childhood impacting nine million children under the age of 18 —a more than 200% increase over the last 30 years.
Everyone who’s been through it knows that an asthma diagnosis begins a complete shift in lifestyle. For the Obama family, it was no different. How have they coped? “Since then, we’ve worked to stay ahead of it,” writes First Lady Obama. “We take Malia to the pediatrician regularly to ensure she has whatever treatment she requires. We keep our house dust- and dander-free, and don’t bring in anything that will disrupt her.”

Perspective on Asthma from the Guy You Don’t Want to Meet—the ER Doc
(From NY Daily News)

As director of pediatric emergency medicine at Mount Sinai, Dr. Adam Vella treats patients under the age of 22 for everything from cardiac emergencies to ear infections and broken arms. Every day, as many as 10 kids come through his ER as a as a result of severe asthma attacks.

Who’s at risk

Summer can be a dangerous time for children with asthma, as humidity, temperatures, air pollution and pollen counts all rise. “Asthma is an allergy specific to the lungs, where the airways are hyper-reactive and respond to allergens by shutting down,” says Vella. “Though millions of adults have asthma, too, it’s even more common in kids, many of whom will grow out of it.”

About one in 10 American children is living with asthma. “It’s a genetic predisposition that responds to an environmental trigger,” says Vella. “For these kids, an asthma attack can be triggered by a simple cold or an airborne allergen like pollen.”


EPA Grant Powers Green Locomotive in Upstate New York
(New York, N.Y. – June 30, 2011) The U.S. Environmental Protection Agency unveiled upstate New York’s first ultra-low emission locomotive at a railroad yard in Selkirk, N.Y. Locomotives are a source of pollutants in the outdoor air, including asthma triggers such as fine particles (soot) and ozone (smog). The new engines will reduce emissions of nitrogen oxide and particulate matter from the locomotive by 80 percent using technologies that monitor engine idling and switch to “sleep” mode after a period of inactivity. “Trains produce diesel pollution that is linked to asthma, decreased lung function, and heart attacks,” said Judith A. Enck, EPA Regional Administrator.

Is Your House Giving You Asthma?
By Alison Rogers (in Time)

More than 17 million American adults and 7.5 million children currently have asthma, and the rates are rising. According to the Centers for Disease Control and Prevention, 4.3 million more people were diagnosed with asthma between 2001 and 2009, and eight percent of the population now has the respiratory illness. That increase includes a 50 percent rise in rates among black children. (Asthma is thought to kick in when environmental triggers hit people who are already genetically sensitive, and rates for non-Hispanic black children are a woeful one in six.)

Really? Pets Can Raise a Child’s Risk of Developing Allergies
By ANAHAD O’CONNOR, writing in the NY Times, 6/21

In the latest study, appearing this month in the journal Clinical & Experimental Allergy, researchers at the Henry Ford Hospital in Detroit followed 566 boys and girls from birth until age 18, regularly collecting data from the children’s families about exposure to indoor pets. At the end of the study, the researchers took blood samples and tested the subjects for their allergic sensitization to dogs and cats. The children who had shared a home with a cat in their first year of life were about half as likely to be allergic to cats as those who had not. A decreased risk also was found in boys who lived with a dog as infants, though for some reason the effect was not as strong in girls. The researchers also concluded that exposure at later ages did not make much of a difference — it was exposure in infancy that mattered. “The first year of life is the critical period during childhood when indoor exposure to dogs or cats influences sensitization to these animals,” the study’s authors concluded.

The Wall Street Journal reports on the growing acceptance of bronchhial thermoplasty, the heat treatment for very severe asthma. Read about it here. We published our own report on this expensive, but effective treatment by the eminent pulmonologist, Dr. Frank Adams, here.

Irish Asthma Society Tips on Treat-Not-Trigger Gardening
1. Choose plants that are pollinated by bees, the pollen is heavier and sticky and therefore stays on the bees rather than floating around the garden.
2. Avoid wind pollinated plants, which disperse copious amounts of pollen into the air.
3. Avoid plants, which are intensely fragrant as they can be a trigger for allergies and asthma.
4. Choose female plants, as they produce no pollen. Sterile male plants are also a good choice.
5. Grass is a major pollen producer so mow your lawn regularly, before it flowers.
6. Wear a mask when mowing lawn or trimming hedge.
7. If possible replace your lawn with gravel
8. Replace organic mulches with inorganic mulches
9. Avoid ornamental grasses in your planting schemes.
10. Remove hedges, which harbour dust, pollen grains and mould spores which can trigger asthma and allergy symptoms.
11. Planting female and thus fruiting trees will attract birds to feed on insects
12. If space is limited place bird feeders will attract birds to keep insect dander out of your breathable atmosphere.
Asthma Society CEO, Dr Jean Holohan, says , “The ‘Treat not Trigger’ garden is lush and florally abundant, tackling the misconception that people with asthma or allergies cannot enjoy gardening, when in fact they can. We want to show visitors that they can improve their asthma control by taking simple steps to avoid triggers, such as planting low allergy rated flowers. “

New Legislation to Provide Support for Better Asthma Control; Hawaii Representative Takes Lead, Along With AANMA

WASHINGTON, May 11, 2011 /PRNewswire-USNewswire/ — New legislation introduced by Rep. Mazie Hirono (D-HI) would provide grants for asthma management programs in schools across the U.S. in a step to ensure the nation’s 7.1 million children with asthma have access to care that could save their lives. Hirono announced the bill, H.R. 1692, The Asthma Management Plans in School Act, at the Allergy & Asthma Network Mothers of Asthmatics (AANMA) 14th annual Asthma Awareness Day Capitol Hill.
“Early access to medication can be a matter of life or death for students with asthma or anaphylaxis,” says Nancy Sander, president and founder of AANMA, the nation’s leading family-founded nonprofit organization for people with asthma, allergies and related conditions. “Just like some schools have defibrillators in case a student goes into cardiac arrest, this bill would prepare schools for breathing emergencies such as asthma and anaphylaxis episodes.”

Respiratory agent spending was $19.3Bn in 2010. Spending growth slowed to $1.1Bn in 2010 from $2.2Bn in 2009, mostly due to slowing growth from B2- stimulants – often referred to as rescue inhalers – which saw spending growth slow to $1Mn in 2010 from $417Mn in 2009.

Anti-asthmatics contributed 61% of the spending growth within respiratory in 2010 with $730Mn in new spending. Anti-asthmatic products include Advair Diskus®(fluticasone/salmeterol) and

The Use of Medicines in the United States: Review of 2010
Report by the IMS Institute for Healthcare Informatics


Asthma Rate Rises Sharply in U.S., Government Says
NYT Published: May 3, 2011
Americans are suffering from asthma in record numbers, according to a study released Tuesday by the Centers for Disease Control and Prevention. Nearly one in 10 children and almost one in 12 Americans of all ages now has asthma, government researchers said.
The report found that the overall prevalence of asthma increased to 8.2 percent in 2009, when 24.6 million cases were diagnosed, from 7.3 percent in 2001, when 20.1 million cases were diagnosed — a 12.3 percent increase. Among the most affected were children, 9.6 percent of whom had asthma, and especially poor children, of whom 13.5 percent had it.
While 7.7 percent of adults were found to have asthma, the rate was higher among women (9.7 percent) and among poor adults of both sexes (10.6 percent).
Asthma costs grew to about $56 billion in 2007, up from about $53 billion in 2002, the report said, though annual deaths attributed to asthma declined to about 3,500 in 2007, from a peak of about 5,500 deaths in 1996.

State funding cut latest hurdle for school nurses
By Misty Williams
The Atlanta Journal-Constitution

In 2009, Georgia ranked 45th in the nation with one registered nurse for every 2,317 students, according to the National Association of School Nurses. The group recommends one registered nurse for every 750 students. The top-ranked state, Vermont, has one nurse for every 311 students.
Nationwide, 45 percent of schools have a full-time nurse, 30 percent have part-time nurses and 25 percent don’t have a nurse at all, said Martha Bergren, director of research for the association.
State funding for school nurses in Georgia has steadily dropped from an initial $30 million in 2001 to $26.4 million for fiscal year 2012.

Rural kids have more asthma, get less medicine
By Amy Norton
NEW YORK | Thu Apr 28, 2011 3:23pm EDT

NEW YORK (Reuters Health) – Asthma is known to be a major health issue for children in inner cities, but a new study suggests that it may be an even bigger problem for poor rural children.
Looking at data on 117,000 Tennessee children on Medicaid, researchers found that 13 percent of children in rural areas had asthma — higher than the rate in urban areas, which stood at 11 percent.

What’s more, children in rural areas were somewhat less likely to be on inhaled corticosteroids — though use was generally low among all children in the study.

Inhaled corticosteroids help control asthma and prevent attacks of wheezing and breathlessness, so low rates of use are a concern.
Roughly one-third of asthmatic children in this study were prescribed an inhaled steroid, but those prescriptions were typically filled only one or two months out of the year.

“We think the important message of our (study) is, we know that asthma is a problem among poor urban children in the U.S., but it turns out it is also a problem among poor rural children,” said lead researcher Dr. Robert S. Valet, of Vanderbilt University School of Medicine in Nashville.

The low use of inhaled-steroid prescriptions, regardless of where children lived, was surprising, Valet told Reuters Health in an email.

“Improving adherence to inhaled corticosteroid medications is likely a major opportunity to improve asthma control in both our urban and rural Medicaid populations,” he said.

Advice on spring cleaning in Woman’s Day. Click here. “A thorough once-over of your home helps control both indoor and seasonal allergens,” says Sakina Bajowala, MD, Board-Certified Allergist & Immunologist with DuKane Allergy Asthma Associates in St. Charles, Illinois. “You won’t completely eliminate allergens, but there are many ways to reduce exposure for you and your family.”

American College of Allergy, Asthma and Immunology (ACAAI) is conducting its 15th annual Nationwide Asthma Screening Program in May during National Asthma Awareness Month. Free screenings will be available at more than 200 locations across the country.

More than 24 million Americans, including 7.1 million children, have asthma. The disease is responsible for almost 4,000 deaths a year. Allergists, working with other physicians and allied health professionals, conduct the free asthma screenings at shopping malls, civic centers, health fairs and other locations throughout the country. The screenings also offer people already diagnosed with asthma the chance to see if their condition is under control and can direct people who may be suffering from other breathing conditions such as chronic obstructive pulmonary disease (COPD) to seek professional diagnosis.

During a screening, adults complete a 20-question Life Quality (LQ) Test developed by the ACAAI. Children under age 15 take a special test called the Kids’ Asthma Check that allows them to answer questions themselves about any breathing problems. Another version of the Check is available for parents of children up to 8 years of age to complete on their child’s behalf.
Participants take a lung function test that involves blowing into a tube, and meet with an allergist to determine if they should seek a thorough examination and diagnosis.

For a list of asthma screening locations and dates or to take online versions of the LQ Test and Kids’ Asthma Check, visit www.AllergyAndAsthmaRelief.org

AAFA Rankings of Asthma Capitals
Knoxville TN, is the #1 city at the top of AAFA’s annual “Spring Allergy Capitals” rankings for the second year in a row. But the final scores for all 100 cities studied were very close this year.
• Knoxville’s ranking this year is due primarily higher-than-average use of allergy medications per patient, and higher-than-average pollen counts.
• Knoxville has been within the top-10 on this report for 6 of the past 9 years.
See the report for all 100 major metropolitan areas, including detailed data for each city, the research methodology and more by clicking the links below. The top 5 on the spring list this year are:
1. Knoxville, TN
2. Louisville, KY
3. Charlotte, NC
4. Jackson, MS
5. Chattanooga, TN
Tn. is #1

OTC Med Use on Rise
AAFA also reports: For the first time in this 9-year report, the average number of allergy medications-per-patient is less than 1.0 (actual national average this year is 0.94 medications used per patient). The Spring Allergy Capitals report mostly measures prescription (RX) medication purchases and refills, so this decline is most likely an indication that patients are relying more and more on over-the-counter allergy medications since the scope, variety and strength of over-the-counter medications today is much larger than in the past.

Groups say asthma cases will rise if EPA rules blocked

Wednesday, April 06, 2011
By David Templeton, Pittsburgh Post-Gazette
A study released today says asthma cases nationwide will accelerate along with health-care costs if Congress blocks the U.S. Environmental Protection Agency from implementing new air-pollution rules.
The study issued by Health Care Without Harm, the Alliance of Nurses for Healthy Environments, and the National Association of School Nurses said the already staggering human and financial toll of asthma in the United States “is likely to increase if Congress acts to stop important updates to the Clear Air Act.”
More than 24 million Americans, including 7 million children, have asthma, with direct and indirect costs of treating the nation’s worsening epidemic already exceeding $53 billion a year, including $8 billion in out-of-pocket expenses for families.
The U.S. House is scheduled to vote on Energy and Commerce Chairman Fred Upton’s bill to block the EPA from reducing carbon pollution, while the Senate may vote on one or more amendments that would block or delay EPA efforts.
“Congress is negotiating with the White House to continue funding the federal government with a new spending measure, onto which some members of Congress hope to attach EPA-blocking ‘riders’ that would also prevent the agency from reducing pollution,” the release states.
Air pollution, including smog, ozone and particulate pollution, can cause asthma and trigger attacks. Already asthma has major health impacts on Americans, with a particular impact on children:
• More than 688,000 children visited emergency rooms because of asthma in 2008.
• Lost school days from asthma in 2008 totaled 10.5 million, with lost work days for adults totaling more than 14 million days.
• Asthma was responsible for nearly 2 million emergency room visits in 2007, with 3,400 people dying from asthma in 2007.
The release said current EPA rules prevent 1.7 million cases of asthma exacerbation and by 2020 would prevent 2.4 million cases.
“By blocking the EPA from making additional needed updates today, federal lawmakers would be allowing increases in soot, smog, carbon, and other air pollution that would cause asthma incidence to increase,” the study concludes. “The cost of these additional cases would also increase the taxpayer bill and could lead to an increase in private insurance costs as well as increases out-of-pocket expenses.”

MedPage Today’s Blogger KevinMD published an excellent piece by Juliet K. Mavromatis, MD that included these lessons she learned from here own asthma therapy:

1. People with chronic illness may feel guilty about the social effects of their illness.
2. People with chronic illness may feel that they are to blame for their illness.
3. Our current culture of personal responsibility may not be helping those with chronic illness with these perceptions, and may lead to increased depression and social isolation in those who have chronic illness.
4. Difficult patients should be listened to and usually bring up valid points.
5. Allergies are not volitional.
6. Patients with chronic illness frequently understand their health conditions better than doctors do.
7. Chronic illness care is more effective in the context of a long term collaborative relationship with one’s personal physician.
8. Family pets are hard to get rid of.
Juliet K. Mavromatis is an internal medicine physician who blogs at Dr Dialogue.com.

Severe Eczema Linked to Lasting Milk, Egg Allergy in Kids

According to research presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI), in San Francisco, hildren with more severe cases of the skin condition known as eczema are less likely than others to outgrow their milk or egg allergy.
The study included more than 500 children, aged 3 months to 15 months, with egg or milk allergy. They were assessed for eczema and categorized as “none-mild” or “moderate-severe.” During two years of follow-up, 46 percent of children with no eczema or mild eczema at enrollment outgrew their milk allergy, compared with 25 percent of those with moderate-severe eczema. The study also found that 39 percent of children with none-mild eczema outgrew their egg allergy, compared with 21 percent of those with moderate-severe eczema.

Extensive Survey Shines Spotlight on Severity of Asthma, Allergies and Impact on Patients and Their Families
Newswise — Washington, D.C., March 17, 2011 – Today Allergy & Asthma Network Mothers of Asthmatics (AANMA) released results of a first-of-its-kind survey detailing the impact of asthma and allergies on the people who cope with it every day. The survey confirms what many already know: asthma and allergies disrupt daily lives, not only for patients but their families as well. AANMA published the Impact of Asthma Survey results in the spring issue of its award-winning magazine, Allergy & Asthma Today, and on their website, www.aanma.org.

Nancy Sander, President and Founder of AANMA, says, “Survey results show we have a long way to go to transform asthma care and create a better future for generations of people with asthma. Proven best practices such as completion of a proactive asthma action plan are still not widely adopted, and uncertainty is a major force in the lives of patients and their families.”
• Life on the Edge. 43 percent made at least one trip to the emergency department; 19 percent had one or more hospitalizations; 15 percent experienced a near-fatal asthma episode over the past year.
• Allergy Testing. NIH Asthma Guidelines recommend finding the root cause of symptoms; 80 percent have had allergy testing.
• Asthma Action Plan. The Guidelines say all patients with asthma should have a written Asthma Action Plan; 37 percent don’t have one.
• Not One-Size-Fits-All. Respondents’ challenges differ from one to the next. Some face multiple challenges while others listed only one: inability to pay for medications; problems getting prescriptions filled with the drug prescribed by the physician; too many missed school and work days; and frustration that family, teachers or co-workers often don’t understand that asthma is serious or what their family is going through.


Medical Mystery
Dr. Lisa Sanders’ Diagnosis column in the NY Times discusses a mysterious rash. It also does a great job of describing the difference between an allergy and a toxic reaction.

” ‘Whoa! That is definitely not poison oak,’ Dr. Walter Larsen blurted as he entered the exam room in his Portland, Ore., office. The patient smiled ruefully. “I told you,” she said to the doctor. The 56-year-old woman had seen Larsen that Tuesday, two days earlier. Then she was concerned; now she was scared. She looked down at her hands and arms. Her fair skin was nearly hidden by vicious-looking streaks of red. “And it’s everywhere.” She lowered the office gown to reveal scarlet lines crisscrossing up her arms, across her neck, down her back, chest and abdomen. Larsen leaned in close to get a better look at the patient’s red-streaked skin. He didn’t know what this rash was, but it sure had become a lot uglier in just a couple of days.”

NHS warns against complementary therapies for children’s food allergies
National Institute for Clinical Excellence says no proof alternative diagnostic tests work as immune disorders grow
Owen Bowcott
The Guardian, Wednesday 23 February 2011
Alternative tests for children’s food allergies – such as hair analysis or muscle weakness – must be avoided because there is little evidence they work, according to NHS guidance.
But general practitioners must do more to identify those suffering from the rapid increase in immune disorders, which now affect one in 20 young people in Britain, the National Institute for Clinical Excellence (Nice) warns.
The vogue for complementary cures may be a consequence of the NHS’s inadequate response to the problem, Nice believes. Hospital admissions for food allergies have risen by 500% since 1990 and the UK appears to be one of the most severely affected countries.

Salon.com columnist tears apart “The Office” for distorting the hygiene hypothesis

Dr. Rahul Parikh has a new column called PopRx that “uses pop culture as a jumping-off point to better understand our health.” His first piece goes after a sit-com for misrepresenting the hygiene hypothesis, a key theory for the explosive growth of allergic disease. Dr. Parikh is a pediatrician in the Bay Area.

“The first problem with Dwight’s take on the hygiene hypothesis is that he is confusing immunity against infection with protection against allergies. The second is that by the time you’re old enough to eat phlegm-drenched toast for breakfast, it’s too late to confer ironclad immunity against infection or allergy, because you need to develop it in early childhood. (Perhaps, in his toilet-side collection of medical journals, Dwight confused the hygiene hypothesis with a recent study showing that infants and toddlers in daycare who get sick a lot tend not to get sick as often once they hit kindergarten and beyond. Details, Dwight. Details!).”

A Hospital Prevents Readmissions, but Threatens Revenue
Cheryl Clark, for HealthLeaders Media, February 10, 2011

An asthma prevention program at Children’s Hospital Boston has drastically reduced emergency room visits and hospitalizations. But the program underscores the tension between a hospital’s quest for quality and its bottom line.

Now five years into the program, 626 low-income asthmatic children who used to have expensive, frequent episodes of hospital care have been enrolled. Families receive case management home visits, environmental assessments to detect household mold and moisture. In rare cases, city inspectors are nudged to pressure landlords to repair or seal areas with obvious mold or water leaks.
So far, the program is a quality success, reducing emergency room visits by 62%. Hospitalizations are down 82%. It costs about $2,600 per child, but avoids $3,900 in hospitalization costs over a two-year period, hospital officials say. Elizabeth Woods, MD, who directs the hospital’s initiative, says cost analyses point to a 1.46 return on investment. So, where’s the problem?

“That’s a saving to society, not to the hospital,” Woods says.
“The hospital does it because it’s the right thing to do for kids and families for asthma care and provide it as a model. But it’s primarily a saver to the payers….who are reducing their expenses (but) they’re not paying us currently for the services,” says Woods. “What we’ve been advocating for is that there be a more sustainable way of funding this, that also takes into account the money upfront to prevent the hospitalizations.”

New device can predict asthma attacks
Published: Thursday, Feb 10, 2011
Place: London | Agency: ANI
Researchers have developed a new device that can tell if an asthma sufferer is close to having an attack hours in advance.
The handheld sensor could give patients vital time to take anti-inflammatory medicines and prevent a serious episode that may otherwise land them in hospital.
The Siemens device is the size of a mobile phone and works by analysing a patient’s breath and measuring the amount of nitrogen monoxide (NO) {aka nitric oxide}.

{Note: Exhaled nitric oxide is known as a byproduct of asthmatic inflammation, and measuring it is widely accepted as a way to ascertain whether asthma is controlled.}

Dutch schools too close to highways, roads, endangering asthmatic children
Tuesday 08 February 2011
Around 60,000 children attend schools that are less than 300 metres from a motorway or 50 metres from a provincial road and that must change, according to the Asthma Fund and reported by news agency ANP.
Within these distances, there is a high risk of pollution from soot particles, says the Fund, which is presenting a petition to parliament on Tuesday. It wants no new schools to be built so close to roads.
According to the Fund, 275 primary schools are too close to a motorway and 72 to a provincial road.

British scientists produce postcode map of geographical link to allergies
Researchers hope work will reveal environmental causes of severe allergic reactions that affect one in three in the UK
Amelia Hill
The Guardian, Monday 7 February 2011

A postcode map of allergies has been produced for the first time, bringing scientists one step closer to uncovering the environmental causes of the severe reactions that affect one in three of the UK population.
By examining almost 6,000 referrals from 672 GPs in Devon and Cornwall over 11 years, as well as consultants’ letters, population data and morbidity statistics, researchers have been able to trace how allergy hotspots develop over time.
The audit revealed that people are more likely to suffer particular allergies depending on where they live. Airborne allergies, particularly pollen, were clustered in north Dartmoor and Exmoor. Food allergies, particularly nut allergies, were most commonly found in the South Hams. Seafood allergies tended to be found in the far south-west of Cornwall and in the Padstow area.
The UK is poorly equipped for diagnosis and treatment. In 2007, the House of Lords science and technology committee claimed Britain was “the laughing stock of Europe”.
GPs get little or no training about allergies and, the committee found, many patients go untreated.
Misdiagnosis or nondiagnosis are also thought to be responsible for the increase in admissions to English hospitals for anaphylaxis – severe allergic reactions – from 2,821 in 2004–05, to 3,595 in 2008-09.

Keeping dinner conversation free from TV, disruptions linked to better health
FRIDAY, Feb. 4 (HealthDay News) — The quality of family mealtimes can affect the health of children with asthma, new research suggests.
In the study, U.S. researchers observed the mealtime interactions of members of 200 families with children aged 5 to 12 with persistent asthma.
While children with asthma generally take medicine before exercise or in a particular season, children with persistent asthma need medication more often, need to avoid different allergens, and usually maintain regular schedules to control the disease.
The new study found that mealtimes lasted an average of only 18 minutes but that the quality of interaction between family members was directly related to the children’s health, including how their lungs worked, their asthma symptoms, and their quality of life.

Study challenges high rate of peanut allergies
By Genevra Pittman
NEW YORK | Tue Feb 1, 2011 3:21pm EST
NEW YORK (Reuters Health) — Peanut allergies may be less common than previously believed, according to a new study based on allergy diagnoses in England.
However, the study also found that while the proportion of the population that’s affected by peanut allergies — that is, the prevalence — is small, it has grown over time.
In recent years, parents and researchers alike have become more concerned about peanut allergies. Previous studies have shown that in some parts of the world, as many as two out of every 100 kids might have peanut allergies. The current study, however, found rates only a tenth of that, even in age groups most likely to have allergies. Part of the difference between this study and previous ones may be in the way rates of allergy were calculated.
“Overall, the ‘true’ prevalence of peanut allergy is likely to lie somewhere between these various estimates,” Dr. Aziz Sheikh, one of the paper’s authors from the University of Edinburgh in Scotland, told Reuters Health by email….

It’s possible that the figures underestimate the true prevalence of peanut allergies, the authors write, because some allergies are never recorded by a general practitioner. Dr. Ruchi Gupta, a pediatrician at Northwestern University’s Feinberg School of Medicine in Chicago, agrees with that assessment.
“Allergies are something that, although the generalist physicians should know about it, often times patients go straight to a specialist,” Gupta, who was not involved in the study, told Reuters Health. A pediatrician or family doctor may not end up recording the allergy, she said, if it’s mentioned in passing at a later appointment.


Hold the Chips!
Salty snacks affect children with asthma

ATHENS, Greece, Jan. 25 (UPI) — What a child eats may affect asthma symptoms, Greek nutrition experts confirm.
Study leader Demosthenes Panagiotakos of Harokopio University in Athens and Dr. Kostas Priftis of the University of Athens found a 4.8 times higher risk of having asthma symptoms when children ate salty snacks more than three times a week.
This association, the researchers said, was even more prominent in children who watched TV or played video games more than 2 hours per day.
“Future interventions and public health messages should be focused on changing these behaviors from the early stages of life, by informing parents, guardians, teachers and any other person that could teach children a healthier lifestyle,” Panagiotakos and Priftis say in a statement.
The same study, published in the Journal of the American Dietetic Association, confirmed children eating a Mediterranean diet were less likely to have asthma symptoms.
The researchers describe the antioxidant rich Mediterranean diet as one high in vegetables, fresh fruits, whole grains and olive oil.
Panagiotakos, Priftis and colleagues used data from a cross-sectional study of 700 children — ages 10-12 — in the Athens area.

EU considers raising air quality standards
Europe is considering tightening air quality standards following the latest analysis of the impact of air pollution on people’s health, it emerged yesterday.
Boris Johnson, London’s mayor, revealed last year that pollution causes more than 4,300 premature deaths a year in London at an annual cost of up to £2bn.

Bedroom chemicals ‘raise child’s allergy risk by up to 180%’
Children are up to three times more likely to develop conditions like asthma and hay fever due to chemicals found in some wall paints and cleansers.
Researchers from Karlstad University in Sweden found youngsters had up to 180 per cent greater risk of developing allergies if they were exposed to chemicals known as PGEs in their bedrooms.
Study leader Professor Carl-Gustaf Bornehag, said: ‘The study shows for the first time that the concentration of PGEs, propylene glycol and glycol ethers, in bedroom air was linked to an increased risk of developing asthma, rhinitis and eczema in children.
‘The increase in risk varied between 50 and 180 per cent. It was also found that a higher concentration of PGEs in indoor air was associated with children evincing antibodies (IgE) against allergens such as cats, dogs, pollen.
‘Our analyses also revealed that the use of water-based paint in the dwelling, as well as water-based cleansers, was linked to a higher concentration of PGEs in bedroom air.’
The chemicals can also be found in some plastic toys and packaging.

Recruiting Doctors to Study Asthma Treatment in Black Patients
The AAFP National Research Network, or AAFP NRN, is seeking to recruit as many as 20 family medicine practices for a study that will compare the effectiveness of two different bronchodilating agents — each in combination with inhaled corticosteroids, or ICSs — in delaying the time to exacerbation in black patients with asthma.

Compared with other racial and ethnic groups, blacks with asthma have been shown to have poorer control of their asthma. The addition of long-acting beta agonists, or LABAs, to therapy with ICSs (74-page PDF; About PDFs) in patients whose asthma is inadequately controlled on low-dose ICSs alone has been shown to be effective in reducing asthma symptoms and exacerbations in the general population. However, these agents also have been associated with an increased risk of asthma-related morbidity and mortality, particularly in blacks.

{Note: As Dr. Larry Chiaramonte has commented previously in these pages, two studies presented at the recent meeting of the American College of Allergy, Asthma and Immunology have already cleared these drugs for black patients. for Dr. Chiaramonte’s comments, go here.}

FDA Grants OTC Sale for Allegra
Allegra, another second-generation, non-sedating antihistamine, has been approved for over-the-counter sale, starting in March.
The antihistamines to be available without prescription include:
• Allegra 24-Hour and 12-Hour Tablets for patients ages 12 and older
• Children’s Allegra 12-Hour Tablets and Orally Disintegrating Tablets for patients ages 6 and older
• Children’s Allegra 12-Hour Liquid for patients ages 2 and older
• Allegra-D 24-Hour and 12-Hour Allergy and Congestion Extended Release Tablets with decongestant for patients ages 12 and older
NOTE: Avid readers of this website will recall Dr. Ehrlich’s provocative post in which he recounted going more than a month without prescribing an antihistamine. Read it here.

Asthma Costs Australians More than 63,000 Years of Healthy Life; Children Suffer Most

A report presented by an Australian Institute of Health and Welfare (AIHW) revealed that asthma takes more than 63,000 years of healthy life from Australians.
Fatalities account for more than 4000 years are lost due to deaths because of asthma while 59,054 years are lost from diminished quality of life. Asthma is on number 11 in the table of contributors to total years lost. It accounts for 2.4 percent loss. The report claimed that asthma was the leading cause of “burden of disease” for children aged up to 14—more than anxiety and depression.
It was found that children aged zero to 14 years bear around 61 per cent of the total burden of asthma in the community. More

Asthma Kills 500 Annually in Canada; Canadian National Health Care System No Answer to Better Treatment
Toronto Globe & Mail

“Research shows that only about 40 per cent of asthmatics have their condition under control. Most sufferers simply accept that symptoms and occasional attacks are normal.”

“[One patient] had to discontinue the treatment when she was fired and no longer had a drug plan. (She cannot discuss the details except to say the dismissal was related to her asthma and there was an out-of-court settlement to her human rights complaint.)
“Since then, she has tried to get Xolair through government programs. But the drug is not on the provincial formulary, which determines what drugs are covered for seniors and those with low incomes. She also applied to Ontario’s special access drug program, which considers requests on a case-by-case basis to cover drugs not on the formulary.
“Last month, just days before Christmas, she received the devastating news that her request had been denied because government officials did not feel the treatment was necessary. This despite a letter from her physician saying her asthma had deteriorated markedly since she discontinued Xolair, including that life-threatening attack in 2008.”

Food Allergy and Anaphylaxis Management Act Becomes Law
Much Needed National School Food Allergy Guidelines Will Be Created

FAIRFAX, Va. (Jan. 5, 2011) – The Food Allergy and Anaphylaxis Management Act (FAAMA), legislation that will result in the creation of national food allergy management guidelines for schools, was finally signed into law after spending five years pending in the U.S. Congress.

Sneeze Free Zones NYTimes reports that more hotels are catering to needs of allergic travelers here

Have a Food Allergy? It’s Time to Recheck [NY times personal health column summarizes the New NIAID food allergy guidelines]
—a new analysis of the best available evidence finds that many children and adults who think they have food allergies are mistaken.
According to a definitive report compiled for the National Institute of Allergy and Infectious Diseases by a 25-member panel of experts, a big part of the problem is misdiagnosis, from overreliance on two tests — a skin-prick test and a blood test for antibodies — that can produce misleading results.
The mere presence of antibodies to a particular substance in food does not mean that someone would have an allergic reaction after eating that food. in And a skin-prick test can remain positive long after an allergy is gone.
Sometimes a diagnosis is based on no test at all, solely on a patient’s or parent’s report of a bad reaction after a particular food was eaten. People often mistake food intolerance, like difficulty digesting the lactose in milk, for an allergy. (Allergies involve the immune system; lactose intolerance results from deficiency of an enzyme.)
—According to the panel’s detailed and well-documented report, about one child in 20 and one adult in 25 have a food allergy, nowhere near popular estimates that up to 30 percent of Americans are afflicted.

For whole article, click here

Housing laws are breath of fresh air for city’s children at risk for asthma
Albor Ruiz
NY Daily News
The New York City Council has passed an expansion of the 2007 Safe Housing Act, Intro 436-A, that will crack down on dangerous housing conditions, including asthma triggers that put families at risk, such as mold, rats and rodents. Under this law, every year the city targets for repairs the 200 worst buildings in terms of housing code violations. Landlords must clear their buildings of violations – such as peeling walls, moldy ceilings and rodent infestation – themselves, or the city will do it for them – and bill them for the work. Asthma affects more than 500,000 New Yorkers – more than half of them children – asthma is three times more prevalent in poor city neighborhoods where rodent and cockroach infestation is more common. It is the main cause of school absenteeism and the most common cause of hospitalization for children 14 years and younger in our city. A report by the American Lung Association concludes that with the progressive worsening of the city’s air quality, asthma is bound to become even more prevalent.

Secondhand smoke and asthma.
Albor Ruiz
NY Daily News

The South Bronx has one of the highest rates of smoking in the city. It also has one of the highest rates of children with asthma.

Coincidence? Hardly.

The Asthma and Allergy Foundation of America points out that smoking is a risk factor for asthma in children and a common trigger of asthma for all ages.

That’s why the work of the Highbridge Community Life Center in the South Bronx, is so important.

The Life Center, according to program assistant Juan Ramón Ríos, is a community based group that works to “empower our impoverished, low-income, and working families to make changes for their lives and our community as a whole.”

Read more

Australian scientists make videos showing how gasses move through lungs; particle accelerator may be breakthrough for asthma research
A team of scientists from the Monash Institute of Medical Research is using a synchrotron – a type of particle accelerator – to observe how gases travel through each part of the lung. ”We can track the movement of the lung and each little part of the lung … and we can precisely define how each little region of the lung is behaving,” said lead researcher Stuart Hooper.
This method is the first of its kind internationally, allowing researchers to know which specific areas of the lungs are affected by asthma. The motion imaging will also allow researchers to see whether Ventolin and other asthma medications are reaching the diseased parts of the lung, or circulating in the unaffected areas. Although in its early stages, the project is expected to allow drug companies to review the effectiveness of asthma drugs and determine the most effective dosage and frequency of treatment for patients.

Girl dies of food allergy at school
A 13-year-old Chicago Public School student died Friday after she suffered a severe allergic reaction to food she ate at her Northwest Side school.
Katelyn Carlson, 13, was hospitalized just after 1:30 p.m. Friday after she suffered an allergic reaction to food.
Emergency crews initially took the girl to Swedish Covenant Hospital in serious-to-critical condition, a fire department spokesman said. However, she was later transferred to Children’s Memorial Hospital where she was pronounced dead at 5:40 p.m.
A Saturday autopsy found that Carlson died from anaphylaxis. She reportedly had a peanut allergy, police said, and the autopsy ruled her death an accident.
Crisis counselors have been dispatched to the school while officials continue to investigate her death. The district has no formal policy on the use of EpiPens, emergency injections used to treat life-threatening allergic reactions. When an allergy-related medical emergency arises, school district staff rely on 504 plans — individual student health profiles that contain information about a student’s vulnerabilities and risks — in deciding how to respond.
The death comes less than a month before all Illinois schools are required to implement food-allergy policies based on guidelines developed and released by the state Board of Education, in conjunction with the Illinois Department of Public Health, according to the the board’s website.
The 78-page document recommends specific food allergy-related guidelines for schools to follow when creating policies on everything from classroom parties to food service and emergency situations. Each school board is required to implement a policy based on the guidelines by January 1, according to the board’s website.
CPS has already been working on a policy that addresses food allergies as required by the guidelines.
Note: For appalling reaction of some school board members to the idea of new guidelines as reported by a blogger, click here.

Puerto Rico Asthma Rates Much Higher Than Continental U.S.
Puerto Rico is a U.S. Caribbean territory where children are nearly 300 percent more likely to have the respiratory ailment than white non-Hispanic children in the continental United States. And this year, Puerto Rico has seen a jump in asthma cases, which health officials suspect might be linked to the heavy rains that have unleashed millions of spores.
The island, with a population of 4 million, already has 2.5 times the death rate stemming from asthma as the mainland, according to the U.S. Centers for Disease Control and Prevention. Puerto Ricans in the U.S. also have been hit hard by asthma, with an asthma attack rate 2.5 times higher than for whites.
Adding to the problem is that Puerto Rican children do not respond as well as those from other ethnic groups to the number one medication prescribed to asthmatics: Albuterol, which comes in an inhaler used to relieve sudden attacks. As a result, several major pharmaceutical companies are working to create another medication, but they are still years away from doing so.
“What’s a challenge is that Puerto Ricans are not all the same,” said Dr. Esteban Gonzalez Burchard, director of the Center for Genes, Environments & Health at the University of California, San Francisco. “(They) are racially mixed.”
Those with European ancestry are likely most at risk of developing asthma, he said.
Why are allergies increasing? Gwen Smith and Dory Cerny tackle that big question in Allergic Living Magazine.

Improve Medicaid partnership, don’t abandon it
By Robert Rogers, M.D., of Fort Worth and Hurst resident Sandy Lutz, a managing partner with PwC, are co-chairs of the Tarrant County CHIP Coalition.

“I love Medicaid.”
Have you ever heard that phrase before? We haven’t, either. It’s really no wonder. From the patient’s standpoint, applying for coverage is cumbersome, finding a physician who accepts Medicaid is often difficult, and navigating the re-application process every six months is a headache.
Physicians and hospitals bemoan low reimbursement rates, complicated rules and regulations and denials of coverage. Nursing home operators struggle to provide adequate care with limited funds. Legislators and taxpayers are threatened by the ever-increasing budgetary demands of the Medicaid system at the state and federal levels.
It’s a hard system to like, much less love.
With all of its problems, and with the looming state budget shortfall, it is easy to understand why Medicaid is facing intense scrutiny. Gov. Rick Perry and some legislators recently have suggested that Texas should consider dropping out of the Medicaid system. However, because Texas is responsible for less than 30 cents of every dollar spent on Medicaid, with the remainder covered by federal funds, it is hard to understand how the state will be able to protect its most vulnerable citizens if it turns its back on this enormous federal contribution.
This is all such a shame, because we should be celebrating the existence of Medicaid. As a society, we have decided that it is important to protect children in families unable to afford private insurance, people with disabilities and the elderly who are not able to care for themselves. As a simple example, in my (RJR) practice as an asthma specialist, I am always relieved when a family without insurance obtains Medicaid coverage for the children, despite the poor reimbursement rates for my services.

Asthma From Passive Smoking Kills 36,900 Annually Worldwide; 50,000 U.S. Deaths From All Second-hand Smoking Illnesses
By David Liu
World Health Organization researchers have recently reported that passive smoking or secondhand smoke kills about 600,000 people worldwide each year, including 36,900 deaths from asthma.
Both passive smoking and active smoking have been known to boost death risk from heart disease, stroke, infections, asthma, and lung cancer among other things in smokers and passive smokers.
of the deaths from heart disease, according to a report published in Circulation.
Rebbecca E Schane MD and Stanton A Glantz Ph.D of University of California in San Francisco cited a report in the Oct 13, 2009 issue of Circulation saying passive smoking causes about 50,000 deaths annually in the United States with the vast majority of the deaths from heart disease.
The authors said the effects of secondhand smoke on many pathophysiological mediators of coronary artery disease are as detrimental as active smoking.
According to the Centers for Disease Control and Prevention, 438,000 people in the United States died prematurely from cigarette smoking and exposure to tobacco smoke annually during the period of 1997 to 2001. Passive smoking kills 60,000 Chinese people each year
Gan Q. and colleagues of University of California in Berkeley California published a study in Tobacco deaths in 2002 in China. They estimated that passive smoking led to loss of nearly 230,000 years of healthy life from lung cancer.

Cost of work-related asthma met by NHS not employer: researchers
By Rebecca Smith
More than 3,000 people develop asthma because of their work conditions but the NHS not the employer ends up footing the cost of treatment, researchers have said.
The thousands of new cases of occupational asthma diagnosed every year in Britain are mostly in people working with insulation, paints, flour, foam, carpentry and adhesives.
The NHS and the patient themselves bear the brunt of the cost of treating them, the researchers said in the journal Thorax.
The team, which included experts from the University of Birmingham, said: “The cost to society of occupational asthma in the UK is high.
“Given that the number of newly-diagnosed cases is likely to be underestimated by at least one-third, these costs may be as large as £95-£135 million.
“Each year a new stream of lifetime costs will be added as newly diagnosed cohort is identified.
“Approaches to reduce the burden of occupational asthma have a strong economic justification.
“However, the economic burden falls on the state and the individual, not on the employer.
“The incentive for employers to act is thus weak.”

Global Asthma-Drug Market Expected to Reach $14 Billion by 2017

GlobalData, the industry analysis specialist, has released its new report, “Asthma – Pipeline Assessment and Market Forecasts to 2017” It estimates the global asthma market was $12.4 billion in 2009 and is expected to grow with a Compound Annual Growth Rate (CAGR) of approximately 1.5% from $12.4 billion in 2009 to $14 billion by 2017.

Return of the Nickel Phone Call: Prolonged Cell Use Can Trigger Allergic Reaction, as Can Body Piercing, Tattoos and Cosmetics
ScienceDaily (Nov. 21, 2010) — Chatting endlessly on your cell phone can lead to an allergic reaction to the nickel in your phone, according to allergists at the annual meeting of the American College of Allergy, Asthma and Immunology (ACAAI) in Phoenix, Nov. 11-16. From cosmetics to jewelry, body piercings to tattoos, allergies can lurk in unlikely places, allergists say.
“Increased use of cell phones with unlimited usage plans has led to more prolonged exposure to the nickel in phones,” said allergist Luz Fonacier, MD, ACAAI Fellow. “Patients come in with dry, itchy patches on their cheeks, jaw lines and ears and have no idea what is causing their allergic reaction.”
Nickel is one of the most common contact allergens, and affects up to 17 percent of women and 3 percent of men. Contact with objects containing nickel, such as keys, coins and paper clips are generally brief, so the nickel allergy may not occur on the area of contact. However, even in these brief encounters, nickel can be transferred from fingers to the face and cause eyelid irritation. The risk is increased by frequent, prolonged exposure to nickel-containing objects, such as cell phones, jewelry, watches, and eyeglass frames.
You can also have an allergic reaction to your body art (piercing and tattoos) as well as cosmetics.

Twenty-four percent of people 18 to 50 years old have tattoos and 14 percent have body piercings.
For more on nickel and contact dermatitis, see chapter 6, Asthma Allergies Children: a parent’s guide.

Blame Canada: Asthma Has Greater Impact On Canadian Children Than Kids in Other Countries
Thursday November 18, 2010
Asthma has greater impact on Canadian children according to research presented at the 76th annual meeting of the American College of Chest Physicians. Canadian children with asthma were more likely to feel left out, sad, and different from their peers. They also felt unable to participate in sports in greater numbers compared to children in other countries.
“The data suggest that Canadian children with asthma may be missing out on being involved in sports because they feel excluded…It’s also possible that sports involving cold air, such as ice hockey, which is popular in Canada, are more difficult for those with asthma,” according to lead researcher, Dr. William Carroll
Additionally, 10% of children worldwide with asthma felt they were bullied because of their disease. Dr. Carroll went on to say “Better social integration and sports participation can only be achieved by educating teachers, classmates, parents, and coaches.”


Asthma Care Called Suboptimal
Michael Smith, North American Correspondent, MedPage Today
Published: November 16, 2010
PHOENIX – In research presented at the American College of Allergy, Asthma and Immunology meetings, overall asthma care in the U.S. was described as suboptimal — despite the increasing availability of effective treatments.
“In a survey encompassing almost 4,000 asthma patients, doctors, and members of the general population, 71% of the asthma patients had disease that was either not well or very poorly controlled based on current guidelines, according to Michael Blaiss, MD, of the University of Tennessee Health Science Center in Memphis, and colleagues.
“On the other hand, the majority of asthma patients — some 64% — said they thought their disease was well controlled…The findings suggest that many patients don’t understand the meaning of the term adequate asthma control, Blaiss and colleagues argued.”
A big part of the problem is that medical professionals have to communicate better with their patients.

Foundation Teams with Pediatricians in Ohio for “High-Impact” Children’s Asthma Project

Dayton, OH (Vocus) November 9, 2010
The CareSource Foundation, part of CareSource, a non-profit, public-sector managed care company, recently announced a $75,000 Signature Grant to the Ohio Chapter of the American Academy of Pediatrics for a high-impact, statewide children’s asthma pilot project.
The Ohio Chapter of the American Academy of Pediatrics represents more than 2,900 pediatricians, residents, pediatric surgeons and specialists. As a result of the CareSource grant, 13 practices in Ohio, including community health centers, hospital-based systems and private practices, will form a medical collaborative to address issues of asthmatic children from birth through 18 years old. Goals of the grant are to decrease hospitalizations, identify treatment options and form strategic asthma control plans to improve health outcomes for all children.
Ohio ranks seventh in pediatric asthma incidences with nearly 10 percent of children suffering from asthma. For children living in poverty and certain races, that number nearly doubles.

Sneezing summer in
By Dita De Boni
In our household, there are a few signs that alert the occupants to the close arrival of summer, and warm weather is just one of them.
Others include mosquito bites, Wetas turning up in the most unexpected places (on my finger when I put my hand into my purse to pay for coffee the other day was one; by my leg on the bedsheets was another); and daily fights to put sun screen on the 4.5-year-old (who has, to give at least his consistency credit, been fighting sunscreen with a murderous passion since he was about one year old).
All these things pale into insignificance when we look outside the window and see the beautiful summer sun and lush green garden, of course.
However, Ali and I are looking out the window through red, weepy eyes for the most part, because we spend most of spring and early summer almost incapacitated with hayfever.
Endless sneezing, puffy irritated faces, and scratchy throats are our spring “look”. And a good “look”, it ain’t – unless you like looking like weepy-eyed chipmunks.
Every few months we dutifully trudge along to the chemist to buy some $100 worth of generic anti-histamines aimed at keeping our allergies in check. They work, to a degree, and they need to: with hayfever as severe as ours, daily life is almost impossible without it. More

Korea has more than 2.4 million asthmatics
Doctor corrects many misconceptions about nature of asthma here.

Fire crackers expose people to respiratory diseases
P.T.Jyothi Datta
Mumbai, Nov. 4
In the morning after Diwali, [the Hindu festival of lights, celebrated as a religious holiday throughout India in mid-November] the smog permeates and there is no escape from the pollution, except to stay indoors, says Dr Sundeep Salvi, Director of Chest Research Foundation.
But the alarming fact is that at least 26 per cent of people with no prior history of respiratory illness, are seen to develop symptoms of coughing, wheezing and breathlessness on exposure to fireworks, he points out, citing a study done by the foundation.
Sulphur dioxide level
He says lighting firecrackers increases the sulphur dioxide level 200-fold, above the safety levels prescribed by the World Health Organisation.
The country is estimated to have between 30 to 50 million people with asthma and another 30 to 40 million people with Chronic Obstructive Pulmonary Disease (COPD). Also vulnerable are children and the elderly, he adds.

EPA Awards $160,000 to Boston Public Health Commission to Aid Asthma Project

By LouiseRoys
EPA has awarded the Boston Public Health Commission a $160,000 grant to demonstrate the effectiveness of a citywide asthma intervention, providing home-based asthma education and environmental services by trained health workers. These services adhere to the National Heart, Lung Blood Institute guidance regarding the diagnosis and treatment of asthma and address multiple home environmental contributors to asthma through an online and follow-up system accessible to both clinicians and public health officials.
This grant is one of seventeen cooperative agreements to nonprofit organizations and a university, totaling approximately $2.4 million dedicated to the improvement of indoor air quality nationwide. Americans spend about 90 percent of their time indoors where levels of air pollution may be two to five times higher than outdoor levels.

69 Health And Other Groups Urge EPA To Save Thousands Of Lives With Stronger Smog Standards
Sixty-nine organizations representing health, environmental, Latino and faith constituencies are urging the U.S. Environmental Protection Agency (EPA) to protect public health by issuing strong standards for smog (ground-level ozone). Polluters and their allies are pushing heavily to block the standards, which would save as many as 12,000 lives and prevent tens of thousands of asthma attacks and heart attacks each year.


‘Fun Size’ Raisinets Recalled Over Allergy Risk
GLENDALE– Nestle is recalling some packages of ‘Raisinets’ chocolate covered raisins over a potential peanut allergy risk, the company announced.

The recall only affects ‘fun size’ mini-bags of the treats, which are typically handed out to trick-or-treating kids.

The 10 ounce bags, which could possibly contain peanuts and put people with allergies at risk, were sold to Target, Shop Rite and Don Quixote stores in the U.S.

According to Nestle USA, the recall only applies to candy with the 02015748 production code and UPC number of 2800010255.
So far, the company has received three complaints from consumers.

It is unclear how many packages of Raisinets are affected, but the company says no other candies are involved in the recall.

People with peanut allergies are advised not to eat the recalled candy and anyone who bought any can call Nestle at 1-800-478-5670 for a refund.

Bronchial thermoplasty can help chronic asthma
Erin Allday, Chronicle Staff Writer
Saturday, October 23, 2010
Two months ago, Maggie Bausola couldn’t make her bed or do a load of laundry without risking an asthma attack. Just getting dressed in the morning left her breathless and weak.
She was on more than a dozen medications, including a strong daily steroid, and still her asthma raged out of control. So when a pulmonologist suggested she try a recently approved new treatment, she jumped at the chance – even if just thinking about the treatment made her nervous. Bronchial thermoplasty, developed by a Sunnyvale firm and approved by the Food and Drug Administration in April, involves burning away the thick muscles that line the airways in people with severe asthma. The procedure seems to carry few risks, and at least for Bausola, so far it’s been life-changing.
For severe sufferers
Asthma experts are quick to point out that bronchial thermoplasty is no miracle cure, and is really only useful for people with severe, chronic asthma that can’t be controlled with current drugs. The vast majority of asthma patients are able to manage their symptoms by taking the appropriate drugs and keeping their environment free of triggers like pet dander and cigarette smoke.
In clinical trials of bronchial thermoplasty, patients reported improved quality of life in a questionnaire they took before and after treatment. Compared with patients in a control group, they had fewer severe asthma attacks, emergency room visits and missed days of work.
Those are important results for people with severe, chronic asthma, even though all of those patients still need drugs to control their disease and they still have severe symptoms from time to time, said Dr. Thomas Dailey, chief of pulmonary medicine at Kaiser Permanente Santa Clara, who serves on the board of directors of Breathe California.
Cost of treatment
Bronchial thermoplasty isn’t yet covered by most insurance providers, and it costs about $1,500 per treatment; most people require three treatments, each about three weeks apart.


Note: Thermoplasty is also discussed in chapter 3, Asthma Allergies Children: a parent’s guide.

Flu Shots OK for People With Egg Allergy
October 18, 2010 — For years, people with egg allergy were told to avoid the flu vaccine because it contains egg protein and could trigger a reaction, but this advice no longer stands. People with egg allergies can — and should — get the flu shot this year, according to a new report by the American Academy of Allergy, Asthma & Immunology.
About 1.5% of young children have an egg allergy, but most will outgrow it over time, according to the Food Allergy and Anaphylaxis Network in Fairfax, Va.
Why the change?
“We now know with confidence that most people with egg allergy can receive the flu shot without reaction,” says the report’s author, James T. Li, MD, PhD, an allergist at the Mayo Clinic in Rochester, Minn.
There is a “detectable, but very low” amount of egg protein in the H1N1 and seasonal flu vaccines, and studies have shown that the majority of people with egg allergy do not have an allergic reaction to the flu shot, he says.
“The number of reactions wasn’t zero, but it was low, and most reactions were not serious,” Li tells WebMD.


Palm Beach County schools wage never-ending battle against mold

A Sun Sentinel/Orlando Sentinel investigation reviewed thousands of cases involving moldy classrooms, health-related complaints from teachers and students, and responses and actions by school officials. While the school district has received national recognition for a pro-active measures in addressing mold issues, some problems persist.
In Palm Beach County, reports from July 2007 to June 2010 point to a never-ending battle being waged against mold that infests classrooms, bathrooms, offices and and even school clinics. Among the findings:
Clifford O. Taylor/Kirklane Elementary in Palm Springs: A summer 2007 inspection validated years of complaints by parents and teachers about repeated flooding, roof failures and mold. The school, built in 1970, is improved now thanks to a $40.7 million modernization last year.
Olympic Heights High west of Boca Raton: Surface mold in nine classrooms was reported after school started in Aug. 2008.
Coral Sunset Elementary west of Boca Raton: In June 2009, a district carpenter was called in to remove 48-foot-long moldy cabinets from two walls in the school’s clinic.
Okeeheelee Middle in Greenacres: Surface mold in four classrooms was reported in Oct. 2009.
Independence Middle in Jupiter: In April, a staff member’s illness resulted in the discovery of “very dirty & moldy” parts of the air conditioning system for the physical education office.
(For more on mold and other environmental allergens, see chapter 12, Asthma Allergies Children: a parent’s guide)

Delhi police deny ambulance for asthma patient

A 32-year-old woman, an asthma patient, landed in a hospital’s intensive care unit after the police refused to give her an ambulance saying they were meant for VIPs. The woman, who works as a radio jockey with a private FM channel, started having trouble breathing because of the fireworks display
during the concluding session at the Jawaharlal Nehru Stadium.
After much pleading, she was taken to AIIMS in a DCP’s vehicle, which had the mandatory sticker. The incident was reported around 10pm on Thursday from gate number 6.
“I asked a policeman to help but he said the ambulance was for the VIPs. It was only when the crowd gathered and protested that they took me to hospital. As no vehicle is allowed on that stretch, I had to walk a lot. I lost consciousness after that,” said the woman, who did not wish to disclose her identity.
Delhi Police, however, said deploying ambulances was not their job but they never denied permission for any ambulance to be parked there. “She was taken to the hospital in a policeman’s car. There was no delay in providing her help,” said Rajan Bhagat, Delhi Police spokesperson.

Innovative décor may prevent allergies and asthma
On September 21, design blogs are abuzz about Saratech Permasorb, an air-cleaning wallpaper to prevent “sick building syndrome” and air pollution-related illnesses including asthma and allergies.
The World Health Organization’s (WHO) regional office for Europe noted that the March 5 Ministerial Conference on Environment and Health concluded, “respiratory disease kills one in every two thousand babies in Europe” with the “highest rates in the east.”
The culprit is both outdoor and indoor air pollution.
Design blogs (PSFK, 3rings, Core77, Trendhunter) are noting their excitement over the German company Blücher Technologies’ solution and new patent for Saratech Permasorb Wallpaper to keep lungs healthy especially for young children and those working in building construction.
The wallpaper material is made with tons of “tiny spherical absorbers, which are themselves filled with thousands of branching passages that resemble the interior of lungs. These open passages within the spheroids absorb and store pollutants, making this the first wallpaper that actually cleans the air,” according to a Core77 post.


Pets and the Nation’s Asthma Bill
Providence, RI (PRWEB) October 11, 2010
Asthma costs related to pet ownership in the US has been estimated to be as much as $1 Billion according to a study published this month in Allergy & Asthma Proceedings, the scientific journal representing both the American Association of Certified Allergists, as well as the Regional, State and Local Allergy Societies.
Key findings of the study :
• Approximately 50% of homes have either a cat or dog.
• 17% of the US population is cat allergic
• 7.8% of all persons in the United States have experienced asthma in the preceding 12 months.
• The 2010 estimated cost of asthma in the US is $15.6 billion in direct health care costs.
• Sensitivity to a pet and the relatively constant exposure from having a pet in the home substantially increase asthma morbidity and cost.
• Those with a dog in the home and dog sensitivity had a 49% increase in the risk of needing acute asthma each year of care
• The cost of asthma attributable to indoor pet dander is estimated to be $0.5 to $1 Billion
• $1 Billion in extra asthma health care costs is equal to approximately 0.1% of the total projected health care budget of the United States for 2010.
• Reducing these excess costs would require that all individuals with asthma should be evaluated for allergic sensitivity to thier indoor pets and those allergic, convinced to keep the pet outside of their home.

Black Male Children Have Highest Rates of Food Allergies
Study finds they are 4.4 times more likely to have issues

TUESDAY, Oct. 5 (HealthDay News) — Children, males and blacks have the highest rates of food allergies in the United States, and the risk is 4.4 times higher among male black children than in the general population, a new study finds.

The study, which appears in the November issue of the Journal of Allergy and Clinical Immunology, was funded by the U.S. National Institute of Environmental Health Sciences.

“This study is very comprehensive in its scope. It is the first study to use specific blood serum levels and look at food allergies across the whole spectrum, from young children aged 1 to 5, to adults 60 and older,” senior study author Dr. Darryl Zeldin, acting clinical director at the institute, said in an agency news release.

The authors comment in the paper that food allergies may be under-recognized in blacks, males and children, because previous studies relied on self-reporting.

They also found that food allergies were twice as likely among people with asthma than among those without asthma and that the likelihood of having food allergies grew with increasing asthma severity.

No Asthma Improvement For Decade Has Cost NHS 100m Pounds – Asthma UK Scotland
The number of people being rushed to hospital because of their asthma is the same as it was in 2000 – and at an annual cost of £10m, Asthma UK Scotland has said new approaches are urgently needed for both health and economic benefits. Asthma UK Scotland has been collecting the total number of admissions for asthma over the last forty years. Over the last ten years, rates of adult admissions have hovered around 4,000 per year and rates of child admissions (14 and under) have hovered around 2,000 per year.

ISD Scotland estimated the cost to the NHS in Scotland for treating patients admitted to hospital as emergency admissions with asthma in the financial year 2008/09 as £10,491,000. Asthma UK Scotland estimate that 75% of admissions are avoidable and that an emergency admission is about 3.5 times the cost of treating someone effectively in primary care.


New Study Says Children Raised Around Dogs May Be Less Prone to Eczema (Not So for Cats)
Children who tested positive for dog allergies were less likely to develop eczema by age 4 if they had lived with a dog before their first birthday, according to a study by the University of Cincinnati, but those who didn’t have dogs while they were infants were four times more likely to develop it.
Cat ownership didn’t offer any protection against eczema, the researchers found. In fact, children with cat allergies who lived with cats before their first birthday were 13 times more likely to develop eczema by age 4 than allergic children who didn’t have cats.

New Law Makes It Easier for Kids to Take Asthma Inhalers to School

A new law in Illinois makes it possible for students to carry their inhalers with only a note from a parent or guardian, and a copy of their prescription. Previously, they were also required to get written permission from a physician.

“Over the years, many of the students would carry their asthma inhaler, but they would have to hide it,” said state Rep. Esther Golar, a Chicago Democrat who spearheaded the legislation on behalf of the Respiratory Health Association of Metropolitan Chicago. Golar’s district includes predominantly black Englewood, where one in five children has asthma, among the highest rates in Chicago and far above the national average.


CNN Ignites Firestorm With Report on Food Allergy Bullying in Schools

The report by correspondent Elizabeth Landau had emotive first-hand accounts.

“According to a new study published in the Annals of Allergy, Asthma & Immunology, about 35 percent of children over age 5 with food allergies have experienced bullying, teasing or harassment. The study, which mostly surveys the parents of these children, said those negative social experiences, which included physical and verbal incidents, happened because of food allergies.

“The school has to really address it. It’s not the child’s job to take care of this problem, because there’s already an imbalance of power,” said study author Dr. Scott Sicherer, pediatric allergist at Mount Sinai School of Medicine in New York.
. For more on testing, see chapter 8. For a case study on the misuse of tests for food allergy, see this item in Dr. Paul’s Blog.}

Paris Hilton Arrested with cocaine, albuterol for asthma.

One in 13 Canadians has food allergy
André Picard—Toronto Globe and Mail

Research published in the Journal of Allergy and Clinical Immunology found that about 7.5 per cent of children and adults have at least one food allergy.
“It’s a significant number,” said Ann Clarke, an allergist at the McGill University Health Centre in Montreal and co-author of the study.
She said it is not clear whether the number of people with allergies is on the rise or there is just more awareness, but research like this will help establish a base for comparison in the future.
Dr. Clarke said what is more important than the number is the fact that “many people with food allergy are not properly diagnosed and experience repeated exposure that places them at risk of anaphylaxis.” (Anaphylaxis is a potentially life-threatening allergic reaction.)


Quality of care up at US hospitals, report says
By LINDSEY TANNER, AP Medical Writer
A report says treatment has improved substantially at U.S. hospitals for several ailments including heart attacks, pneumonia and children’s asthma.
The report released Wednesday is based on more than 3,000 hospitals accredited by the Joint Commission, an independent regulatory group (that operates accreditation programs for a fee to over 17,000 subscriber hospitals and other health care organizations. ).
“[F]or asthma care in children, it was 88 percent versus 71 percent in 2007, the first year the commission included that in its annual report.

{Note: To find out why this “good” news is a scandal, see Dr. Ehrlich’s comment here.}

Do ‘Hypoallergenic’ Products Really Cause Fewer Allergies?
Mother Jones writer Kiera Butler says that cosmetics industry standards for claims about allergens in their products and claims of dermatologist approval are fluid and misleading. New legislation, “the Safe Cosmetics Act of 2010, introduced in July by Reps. Jan Schakowsky (D-Ill.), Ed Markey (D-Mass.), and Tammy Baldwin (D-Wis.), would require companies to disclose all the chemicals in their products—including fragrance, about which companies are notoriously secretive. It would also require safety assesments and the phasing out of ingredients suspected of causing cancer and reproductive harm.”

Kathy Franklin wrote about cosmetics in the Waiting Room here.

Study Shows That Spiriva as Effective for Controlling Asthma Bronchoconstriction as Serevent More “Researchers tested three inhaled treatments: doubling the steroid dose, adding Glaxo’s Serevent or adding Boehringer Ingelheim’s Spiriva, which is approved for emphysema and other chronic lung conditions, but not asthma.

“The study involved 210 people whose asthma was not well controlled. They took each drug for 14 weeks with two-week breaks in between treatment.

“Researchers found Spiriva worked better than a double steroid dose and was as effective as Serevent. When the study first began, patients on average had 77 asthma-free days a year — days in which they had no symptoms and did not have to use their rescue inhaler.

Doubling the steroid medicine gave patients an extra 19 asthma-free days; taking Spiriva gave them an additional 48 days with no symptoms, and taking Serevent gave them an extra 51 days.”

British Red Cross says teenagers need first aid training for asthma, other problems One in four has witnessed severe asthma attack; one in seven, overdose of alcohol.

25% of all pediatric emergency room visits in British Columbia in September will be for asthma attacks. “There are several causes for the flare-up, including stress, exposure to animal dander, the onset of cold and flu season and triggers inside the classroom, according to the association’s Menn Biagtan.

“‘With classrooms closed all summer long, there are the possibilities of moulds growing in, some bacteria growing in,’ she said, and they can cause symptoms that range from mild to life-threatening. Chemicals used to battle the moulds and bacteria also play a role.”

Read more: http://www.cbc.ca/canada/british-columbia/story/2010/09/04/bc-asthma-school-year-begins.html?ref=rss#ixzz0yuE02eNu

Are Asthma and Other Inflammatory Diseases By-Products of City Growth?
Drawing on research at UCLA and USC, an article entitled “A Pill for Los Angeles” at the urban economics website newgeography.com says that they are:
“First: Inflammation, the chronic-over-firing of the body’s immune system, now sits at the core of almost all scientific discussion of chronic diseases, diseases that persist despite thirty years of lifestyle advice, medication and surgical intervention.
“Second: Urban environments today are physiologically inflammatory beyond belief, their brew of fumes, crowding, germs and bad food wreaking all kinds of internal damage and prompting no end of lifelong medical problems. As Dr Marc Reidl, a specialist in respiratory disease at UCLA puts it, ‘Mega city life is an unprecedented insult to the immune system.’”

Stanford Program Brings “Extreme Affordability” to Asthma Treatment Aid

The design school at Stanford University is working with doctors to find ways to help large populations around the world at much lower cost. Traditional vendors have historically made products that serve “a tiny fraction of the world’s population.” Early designs include a prosthesis that costs $25 to make, a $20 portable infant incubator that functions like a sleeping bag, and an asthma spacer to enhance the effectiveness of inhaled medication as thin as a piece of paper at a fraction of the cost of ordinary spacers. (An online search shows a low price of $19.)

Allergic to Red Meat? Probably Not.
Cause and effect are often misleading to people experiencing allergic symptoms. As the authors of Asthma Allergies Children: a parent’s guide stress over and over, a good medical history is essential, and it must be interpreted by people who know what to look for. This story in Allergic Living recounts an epidemic of “red meat allergy” and shows how good doctors, in the best spirit of Sherlock Holmes, can find the real villain.

Low-Cost Asthma Spacer Developed by Stanford “Extreme Affordability” Program

Doctors, designers, and business school students at Stanford have a program called “extreme affordability” to transfer medical innovations at very low cost to poor countries. Their accomplishments now include an inexpensive prosthetic limb, a portable incubator, and a paper-thin asthma spacer, which enhances the effectiveness of inhaled asthma medications.


Ozone and cigarette smoke worse for asthma than smoke alone
Ozone generators—also sold as ion air filters–are often used in hotel rooms, cars and private homes to get rid of the smell of cigarette smoke, but new evidence suggests that this cure may be worse than the disease. Researchers at the University of California’s Lawrence Berkeley National Laboratory have found that ozone combines with nicotine and other components of cigarette smoke to produce chemicals that are a greater asthma hazard than the original smoke. In particular, the chemicals combine to form ultrafine aerosols that can carry dangerous chemicals deep into the lungs, where they trigger the development of asthma.
{Note: We had a letter from a mother asking if ion air filters were an acceptable alternative to HEPA-approved machines.}

The Claim: Dark Cats Cause More Allergies Than Light Ones
New York Times August 24, 2010
THE FACTS Cats, love them or hate them, are among the most common causes of allergies, affecting twice as many Americans as dogs do.
The sources of these allergies are proteins found in feline dander, urine and saliva, making all cats capable of provoking reactions. But some scientists suspect that the darker a cat’s coat, the greater the likelihood of it inducing allergic reactions.
Scientists showed this in a small study in 2000, involving 300 patients with allergies. They found that people with dark-colored cats were two to four times as likely to have moderate to severe symptoms as those who either owned cats with lighter coats or did not own a cat. Additional studies found that female cats produce less animal allergen than male cats.
But the color association is not conclusive, said Dr. Clifford W. Bassett of Allergy and Asthma Care of New York, an author of the study. A later study in The Journal of Allergy and Clinical Immunology found that the color of a cat’s coat had no effect on how much allergen it produced. And Dr. Bassett said he and a colleague were planning a larger study to see if the earlier findings bear out.
He advises patients who are allergic and want to keep their cats to take several measures. If avoiding contact is not possible, allergy shots are effective, along with medication. He also advises using HEPA air filters, keeping the pet out of the bedroom and bathing it often.
THE BOTTOM LINE Male cats produce more allergens than females, but it’s not clear that fur color plays a role.

New England Has Highest Asthma Rates in U.S.

New England has the nation’s highest rate of asthma in the country and the disease is poorly controlled in most patients — routinely causing trips to the hospital and lost days at school and work. According to the Asthma Regional Council of New England, an independent agency underwritten by the federal government and foundations, roughly two-thirds of New England’s 1.3 million people who have asthma regularly forfeit sleep, wind up in the emergency room, and rely routinely on inhalers intended as drugs of last resort.
A Boston Globe article says, “Asthma is in many ways a metaphor for the nation’s health system, a chronic illness that should be relatively easy to tame in most patients. Instead, economic, social, and environmental forces combine to make it a persistent hardship for many.”

Risks: A Warning on Asthma and Acetaminophen
Published New York Times: August 16, 2010
Young teenagers who use acetaminophen even once a month develop asthma symptoms more than twice as often as those who never take it, a large international study has found. And frequent users also had more
Other studies have linked acetaminophen (often sold as Tylenol and in other over-the-counter remedies for pain, colds, fever and allergies) with an increased risk of asthma. But the new study’s authors cautioned that the findings did not mean children should stop using it.
“Acetaminophen remains the preferred drug to relieve pain and fever in children,” said the study’s lead author, Dr. Richard W. Beasley, a professor of medicine at the Medical Research Institute of New Zealand. He noted that aspirin and ibuprofen should not be used in children with asthma, since they can bring on an attack.
Although the study does not prove that acetaminophen actually causes asthma, the authors speculated that the drug might have systemic inflammatory effects and result in greater allergic immune response.
The report, from the International Study of Asthma and Allergies in Childhood, or Isaac, was based on data from more than 322,000 children age 13 and 14 from 50 countries.
{Note: The study referred to above is published in the American Journal of Repriratory Medicine and Critical Care Medicine.}
Dr. Ehrlich comments: I for one feel that in spite of the study Tylenol is still good for fever. I will still use it.

Elite Athletes in UK Have More Asthma Than General Population
According to research, asthma rates are nearly seven times higher among elite athletes than in the UK general population where the asthma rates are around 8 per cent.

The figures were based on a review of scores of published studies between 1989 and 2006 on respiratory problems and asthma caused by exercise. This analysis showed that up to 54 per cent of elite athletes are affected.

Those most at risk are swimmers, endurance athletes and those who practice winter sports.

“Athletes appear to develop a special kind of asthma which involves injury to the airways,” the Daily Express quoted Professor Connie Katelaris from the University of Western Sydney, a specialist in the exercise-induced asthma, as saying.

“Athletes need to be screened properly for this problem and those who experience breathing problems need to be seen by specialists in this area to get proper treatment,” Katelaris added.

The figures were revealed at a recent conference of the European Academy of Allergy and Clinical Immunology in London. (For more on exercise-induced asthma and how to manage it, see chapters 8 and 11 Asthma Allergies Children: a parent’s guide.)

From Times of India

Time Magazine Writer Learns Truth About Food Allergies the Hard Way

Columnist Joel Stein writes in the August 9 issue of Time:
“At the beginning of last year, I wrote a column that questioned whether the increase in food allergies among children was a matter of overreporting. It began with this carefully calibrated thought: “Your kid doesn’t have an allergy to nuts. Your kid has a parent who needs to feel special.” After that, I got a little harsh.
“The column was not the first thing that came to mind after my 1-year-old son Laszlo started sneezing, then breaking out in hives, then rubbing his eyes, then crying through welded-shut eyes, then screaming and, finally, vomiting copiously at the entrance of the Childrens Hospital emergency room an hour after eating his first batch of blended mixed nuts. But it was the second thing. Because after my nut-allergy column came out, many parents wrote me furious e-mails saying they hoped that one day I would have a child with life-threatening allergies. I realized I was learning a terrible but valuable lesson: it’s really mean to wish food allergies on a kid who isn’t even born yet.”

{For much more on food allergies and helping your family cope with them both at home and outside, see chapters 5 and 14 of Asthma Allergies Children: a parent’s guide}. Also, read the Waiting Room column on this website, which is dedicated to parents like Joel Stein, who have learned about food allergies the hard way as well.

What do food allergy labels really mean?
By Genevra Pittman
NEW YORK | Wed Aug 11, 2010
NEW YORK (Reuters Health) – While you might be tempted to ignore those “made in a facility that processes” (something you’re allergic to) labels in the supermarket, new research suggests products with these labels are in fact more likely to be contaminated with peanuts, milk or eggs than unlabeled foods…
“It’s kind of their own individual perception about what level of risk warrants the warning,” Dr. Lara Ford, the study’s lead author and an allergist at the Mount Sinai School of Medicine in New York, told Reuters Health. “It may not even enter the consciousness at some companies.”
Products from smaller companies were also about seven times more likely to be contaminated with allergens than products made by larger companies. Small manufacturers, Ford said, “probably are using the same equipment for multiple different products,” which increases the chance of contamination. They also might have fewer resources to devote to cleaning products, she said.
{Note: In her first Waiting Room column Kathy Franklin sounded the warning about smaller companies here.}

iPhone App to Help Monitor Asthma Med Compliance, Reduce Emergencies
Asthmapolis, developed by Reciprocal Sciences, uses a special GPS-enabled device that attaches to an inhaler and automatically records the time and location when asthma patients use their inhalers. This data is automatically transmitted to the patient’s doctor, while aggregate data is available to asthma researchers and public health agencies. David Van Sickle, president and CEO of Reciprocal Sciences, says, “What we’re aiming to do is expand the amount of surveillance data that we have about asthma by an order of magnitude. Even at the national and state level, the focus has primarily been on the really small number of asthma attacks that cause emergency room visits. There are many more asthma attacks that result in doctors’ office visits, missed school and missed work.”

{Note: We’re for anything that increases compliance with a good medication and behavioral regime if treatment for asthma. Non-compliance costs the country billions of dollars, and millions of lost school days and work days. As we say in Asthma Allergies Children: a parent’s guide, compliance is a running theme of the book.

Asthma rises as children return to school
Last September the number of children aged 16 and under admitted [to hospitals] for asthma across England was 58 per cent higher than the average monthly figure over the year as a whole. The previous September the corresponding figure was 102 per cent, according to the NHS Information Center.

British National Health Service issues food allergy guidelines to GPs as hospital cases soar

As hospital admissions for food allergy related events have multiplied, the NHS has noted with alarm that internet sales of at-home testing kits are booming. “In response to the growing problem, the National Institute for Health and Clinical Excellence (Nice) has issued its first guidelines on food allergies in children to help GPs to spot the signs and symptoms. While acknowledging the rise of food allergies the draft guidance warns against do-it-yourself tests sold on the internet and offered by alternative practitioners. Tests including hair analysis and kinesiology can wrongly diagnose food allergies, leading to children being put on damaging diets lacking in nutrients, it says. The guidance advises GPs on when to consider the possibility of a food allergy and when to carry out further testing.”
{Note: for more on food allergy and “pseudo food allergy” see chapter 5 Asthma Allergies Children: a parent’s guide.}

World Record Breaking British Swimmer Overcomes Asthma
Diagnosed with asthma ten years ago, 23-year old Jo Jackson suddenly found, “I’d forgotten how to breathe, basically.” Her asthma got “so bad that her inability to breathe properly forced her ribs to continually pop out of place, she faced a crisis which threatened her future.” More

{Note: Swimming is among the best forms of exercise for asthmatics because the air is very moist from continuous evaporation. For more on exercise and asthma, see chapter 3 Asthma Allergies Children: a parent’s guide.}

Quackery by Phone
A Japanese firm that developed “a dog-bark translation machine” has a new spring-time offering — a mobile phone application to cure hayfever. The gadget maker promises its newest cellphone ringtone can bring relief when users hold the handsets under their noses. According to the developer, Dr Matsumi Suzuki, who says on his website that he studies acoustics and analyzes voiceprints, the ring tone unleashes waves that will shake out pollen stuck in the user’s nose.

For more information about allergy and asthma cures that are too good to be true, see chapter 10 of Asthma Allergies Children: a parent’s guide.

Asthma Leading Cause of Death Among Women in India

MUMBAI: Difficult as it may be to believe, asthma, which is relatively easier to manage than several other diseases like cancer, is the leading cause of death among women in Maharashtra.

According to the Maharashtra State Health Family Welfare Bureau, the lung ailment which can be controlled with daily puffs of inhalers accounted for 8% of all deaths in the 15-to-49 age group of Maharashtra’s women in 2008.

In 2007, it accounted for 5.7% of all deaths, said the report which was a part of the state Economic Survey presented a few days ago.

The other top causes of death are suicides, accidents, cardiac arrest and accidental burns.

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