Friday, April 25, 2014
Inquirer Daily News

Allergies and Asthma

POSTED: Thursday, March 27, 2014, 5:30 AM
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What incredible advances have taken place in world health during the past half century! From the mid-20th century on, discoveries like penicillin, steroids, and other drugs and vaccines have changed the trajectory of human health.  Thanks to these advances, the average human life span has doubled from the mid-40s to the mid-80s in less than a century. Amazing progress!

Yet for all our success in treating polio, malaria, and bacterial infections, many diseases are far more prevalent today than they were in decades past. And despite advances in treatment, they remain hard to control. One such example is asthma. Rates of asthma are increasing every year and we don’t quite know why. Asthma is a complex condition. There seem to be factors in “westernization,” including microbial exposure, lifestyle changes, and obesity that have affected our immune systems, making them function in a different way.

Today, there are an astounding 300 million people with asthma globally. The number of people diagnosed with asthma grew by 4.3 million from 2001 to 2009. During that period, asthma rates rose the most among black children, almost a 50 percent increase, according to the Centers for Disease Control and Prevention. In the United States, about 22 million people have asthma, including 6.5 million children. Among kids, asthma accounts for 13 million school days lost and 200 deaths annually.  Direct health care expenditures for asthma total more than $14 billion a year in this country.  

POSTED: Wednesday, February 12, 2014, 9:50 AM

Childhood obesity and access to health care remain some of the most pressing issues when it comes to children’s health in Bucks, Delaware and Chester counties, according to recently released reports from Public Citizens for Children and Youth, a children’s advocacy non-profit.

The reports found that nearly 20,000 children in Bucks, Chester, Delaware and Montgomery counties are uninsured.  More than a quarter of those kids (5,692) are undocumented and cannot enroll in CHIP or Medical Assistance. 

In the three counties, about 114,000 children are overweight or obese. In addition, disparities persisted between children of different races, ethnicities, insurance statuses and incomes.

POSTED: Tuesday, February 11, 2014, 5:30 AM
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Does your child get tired easily during or after exercise, or coughs after coming inside from being active outdoors? It could be exercise-induced bronchospasm (EIB) or exercise-induced asthma, a condition in which people experience constriction of the airway when they exercise, producing symptoms such as wheezing or coughing.

For some, it can lead to shortness of breath and an inability to continue the exercise. EIB is common in asthmatics, but may also occur in those who do not have asthma. For children with EIB, winter weather poses special concerns. The cold, dry air combined with rapid breathing during exercise are a combination that can trigger attacks of EIB.

The upper airways – the nose and mouth – act as an air conditioner, moisturizing and warming the air as it goes down into the lungs. When you are breathing rapidly, the dry, cold air doesn’t have a chance to warm up. Cold air is, to begin with, drier than warm air, because air at lower temperature has a lesser capacity to hold water. That is why even stepping out into the cold sometimes “takes your breath away.” The effects of cold and exercise are most pronounced with high ventilation sports, such as soccer, running, hockey and skiing.

POSTED: Monday, January 13, 2014, 12:05 AM
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Has your child had a severe rash that couldn't be treated with topical creams and oral antibiotics and steroids? It could be contact with a substance which contains a combination preservative designated as MCI/MI (Methychloroisothiazolinone or Methylisothiazolinone) found in some baby wipes.

An article released today from Pediatrics describes six cases of a stubborn contact dermatitis to what is generally considered to be an innocuous product – baby wipes.The wipes were not immediately suspected to be the culprit, but despite active treatment with multiple topical and oral antibiotics and steroids, the rash only resolved after discontinuation of the wipes. It turned out that these wipes had MCI/MI.

Baby wipes are generally very safe and the presence of MCI/MI in baby wipes had not previously been reported to be an extensive problem in infants. However, all the patients in the article were patch tested and were found to be positive for MCI/MI.

POSTED: Tuesday, November 5, 2013, 5:30 AM
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Lately, it seems like everyone is talking about gluten free products. What is gluten exactly and does it need to be avoided by all?

Gluten refers to a family of proteins found in the grains of wheat, barley, and rye. Celiac disease is a form of gluten intolerance, but strictly speaking, it is not an allergy. It is a rather a complex immune phenomenon involving antibodies that the body produces when someone eats gluten. These antibodies lead to damage of the lining of the small intestine, which can affect absorption of foods and can lead to malnutrition.  

Most kids with celiac disease will have abdominal symptoms when they ingest gluten. Some will also have a rash similar in appearance to eczema. There is a genetic component to celiac disease, it tends to run in families, and is more common among Caucasians than among other racial and ethnic groups. The best way to diagnose celiac disease is by blood test to measure IgA levels against gluten components.  The only real treatment is to remove gluten – primarily wheat – from the diet. People with celiac disease who avoid gluten usually do quite well, but approximately 15 percent of patients will have non-responsive celiac disease.

POSTED: Thursday, August 8, 2013, 6:00 AM
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The term contact dermatitis may not be familiar, but you or your child have experienced it before if you’ve had an allergic reaction to poison ivy or oak. Contact dermatitis involves more of a delayed response, unlike nasal allergies and hives that are mediated by an antibody.

The best examples of allergic contact dermatitis are poison ivy and poison oak. About 70 percent of us are sensitive to the allergen contained in these plants’ oils. The plants like to grow in temperate climates and are native to Africa and North America.  Poison ivy, a climbing plant, is more prevalent on the East Coast. While poison oak, a shrub, seems to be found more in the western part of the United States. It is easy to come in contact with poison ivy or oak while hiking in a wooded area or even weeding your garden. Remember to tell your children this old adage, “Leaves of three, let it be” to avoid exposure to this potentially harmful plant.

Poison ivy can cause symptoms that are quite irritating and stubborn, lasting for a week or two. Contrary to common belief, there is no way to desensitize a person to poison ivy or poison oak, and there is no preventative treatment other than avoidance. The contact allergen in these plants that is responsible for the symptoms is called “Urushiol”.  Other common culprits of allergic contact dermatitis include nickel (found in jewelry, watches, belt buckles), latex, medicines, perfumes and makeup products. In the latter categories, an aromatic substance known as balsam of Peru is often the offending ingredient.

POSTED: Monday, August 5, 2013, 5:00 AM
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Recently, a 13-year-old girl in Sacramento, CA, died of anaphylaxis after ingesting a rice krispies treat coated with peanut butter, to which she was extremely allergic. In this tragic case, even though everything possible was done to save her, including the swift administration of epinephrine (Epi-pen), she went into cardiac arrest and was pronounced dead later at the hospital. Her heartbroken parents, one of whom is a physician, issued a statement imploring people to stay ever vigilant and never let their guard down when it comes to known food allergies.

Although such deadly consequences are rare, this sad story exemplifies that they do indeed occur. The victim was at a church camp, her mother was present. Food was being shared in a festive and communal atmosphere. It was dusk and visibility was low. The girl picked up a treat without realizing that it had been coated with chocolate and peanut butter. As soon as she took a bite, she recognized the taste and spit it out. But just that minimal exposure was enough to trigger anaphylaxis.

The Epi-pen (one of several available epinephrine autoinjectors on the market) is a very effective rescue medication, especially if used right away. Unfortunately in this case, it did not work. The reasons for this are purely speculative. The point is to never be cavalier about food allergies, particularly with nut and shellfish allergies. ALWAYS read labels. ALWAYS ask questions at restaurants. NEVER eat home-prepared foods unless you are certain they contain none of the potentially lethal substance. The sad truth is that the best medicine that we have failed to help this girl, the only effective “treatment” would have been avoidance.

POSTED: Tuesday, June 25, 2013, 6:00 AM
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Hives – red, splotchy, itchy, raised patches or welts that seem to “bloom” suddenly on the skin – are quite common in both children and adults. About 10 to 25 percent of people will get them at least once during their lives. The welts typically move from place to place on the body. Hives usually itch, but they also can burn or sting. 

Hives, also known as urticaria, can happen at any time in life and can be triggered by an allergic reaction to foods, medications, pets, or insect bites. Other causes include viral infections, illnesses, and hormonal changes. Stress is also thought to be a factor, although stress is very hard to measure, so there are no definitive studies on the effect of stress on hives.

No matter what the cause, a case of hives can last for a few minutes, a few hours, or even days. Hives can manifest as acute flare-ups or occur on a chronic basis. Chronic daily hives, defined as lasting longer than six weeks, are much more common in adults, although they do occur in children. Unless children experience prolonged hives, we usually don’t test for an underlying cause. It’s simply more expedient to treat them, since the testing is usually not very helpful.

About this blog
The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

If you have questions about your child's health, ask them here.

Anna Nguyen Healthy Kids blog Editor
Stephen Aronoff, M.D., M.B.A. Temple University Hospital
Christopher C. Chang, M.D., Ph.D Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Mario Cruz, M.D St. Christopher’s Hospital for Children, Drexel University College of Medicine
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist - The Anxiety Behaviors Clinic, CHOP
Gary A. Emmett, M.D. Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Lauren Falini Bariatric exercise physiologist, Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Crozer-Keystone Health System
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, RD Children's Hospital of Philadelphia
W. Douglas Tynan, Ph.D. Nemours/Alfred I. duPont Hospital for Children, Jefferson Medical Colg
Flaura Koplin Winston, MD, PhD Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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