Weekly News & Insights

Allergic Rhinitis a Significant Burden

on April 26, 2018

Allergic rhinitis continues to exact a high toll on the quality of life of Americans, according to a survey presented here at the American Academy of Allergy, Asthma and Immunology (AAAAI) 2011 Annual Meeting.

"The data are timely, as they were collected from patients who have allergies in surveys less than 1 year ago," study presenter Gary Gross, MD, from the Dallas Allergy and Asthma Center, Texas, told Medscape Medical News. "The results are more of a stimulus to try to improve the care for these patients whose lives are so dramatically influenced by allergies."

Reached for comment, Neeta Ogden, MD, an adult and pediatric allergist at Englewood Hospital and Medical Center in New Jersey, and member of the AAAAI, noted that "the quality-of-life impact can be overlooked in clinical practice."

"People may think allergies are not as 'life-threatening' as other medical problems like diabetes or high blood pressure, etc. However, untreated allergies, especially during the peak pollen months, can lead to daily impairment that affects work/school and quality of life," Dr. Ogden said.

Comparative Look at NASL 2010 and AIA 2006

At the AAAAI's annual gathering, Dr. Gross presented results of the 2010 Nasal Allergy Survey Assessing Limitations (NASL) Survey, looking at the effect allergic rhinitis currently has on the quality of life of Americans.

As part of the survey, 400 people aged 18 years and older who had been diagnosed with allergic rhinitis and who had experienced nasal allergy symptoms or taken medication for their condition in the past 12 months were interviewed. The findings were compared with 2500 respondents from the 2006 Allergies in America Survey (AIA) to determine the degree to which allergic rhinitis still affects patient quality of life.

A look at the 2 data sets suggests no apparent easing of the emotional toll of allergic rhinitis, the researchers say.

Table. Comparison Between NASL 2010 and AIA 2006

table

"The survey reminds us all that these patients suffer far beyond the congestion, runny nose, and sneezing that are characteristic symptoms of allergic rhinitis, and that they need more effective treatment to be productive and to improve their quality of life," Dr. Gross told Medscape Medical News.

He advised clinicians to "question patients who have allergic rhinitis more thoroughly regarding how allergic rhinitis impacts the quality of the patients' lives, and then try to determine the best approach to treatment."

The NASL 2010 survey also confirms that allergic rhinitis limits peoples' ability to participate in social activities (29%), to have or play with pets (34%), and to participate in outdoor (52%) and indoor (13%) activities.

Mirroring the AIA 2006 survey, 33% of respondents in NASL 2010 reported their symptoms affected them "a lot" or a "moderate" amount during the month when nasal symptoms were at their worst. In NASL 2010, work productivity was roughly 71% when nasal symptoms were at their worst; the figure was nearly the same (72%) among AIA 2006 respondents.

Nasal symptoms of allergic rhinitis also contribute to "substantial" sleep disturbances, including trouble falling to sleep and staying asleep, according to other data from the NASL 2010 Survey reported separately at the meeting.

New Data "Not Surprising"

In Dr. Ogden's view, the NASL 2010 findings are "not surprising, especially since allergy symptoms seem to be more intense than ever and people are experiencing new-onset allergies and worsening of existing allergies in the last few years."

"In terms of seasonal allergies," she said, "this has been attributed to global warming leading to more intense, longer seasons. People seem to have worse symptoms and often express breakthrough allergy symptoms even on doses of medications that used to help them before."

Following up with patients is key, Dr. Ogden said, "because there are a number of therapies out there that can be added if the first medication doesn't work. In addition, getting patients on your and their own radar in terms of allergy so they can start medications 2 to 3 weeks before the peak season is also important."

Dr. Gross and Dr. Ogden have disclosed no relevant financial relationships.

American Academy of Allergy, Asthma and Immunology 2011 Annual Meeting: Abstract 838. Presented March 20, 2011.

Source: http://www.medscape.com/viewarticle/739928 Megan Brooksread more

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Shifting Temps May Prime Patients for Spring Allergies

on April 19, 2018

Spring allergy season is again off to an early start in many parts of the country, and doctors say there are some signs it may be even more miserable than usual this year.

Last year was the fourth warmest winter on record, with consistently mild temperatures. That led to record-breaking pollen counts that struck about a month earlier than normal in some places.

But this year, many areas got a false spring. Temperatures rose briefly and then dipped again. The swings caused pollen levels to rise, then fall, then rise again.

That pattern of pollen release sets people with allergies up for something called "the priming effect," says Stanley M. Fineman, MD, an Atlanta-based allergist and past president of the American College of Allergy, Asthma and Immunology.

“When patients are exposed, then the pollen goes away for a while, there’s a weather change or whatever, then they are re-exposed to that pollen, they can have an even more significant effect because their system is primed to respond,” Fineman says.

“It results in patients having a lot more difficulty with significantly worse symptoms” that may be tougher to get under control, he says.

Some parts of the South and East Coast began logging high tree pollen counts in January. Then pollen levels dropped in early February before climbing again by the end of the month. Plenty of allergy-prone people were caught unprepared.

At the Allergy and Asthma Center of Georgetown, in Texas, doctors say they began seeing people with seasonal allergies about a month earlier than usual.

“The typical symptoms are congestion, runny nose, itchy eyes, sneezing, watery eyes, sore throat, itchy throat, headaches, itchy ears,” not to mention all the patients who have asthma that’s triggered by allergies, says Sheila Amar, MD. “It’s pretty miserable."

Blame Climate Change

The bad news is that these amped-up spring allergy seasons probably aren’t flukes. Scientists say that as climate change accelerates, so will allergies.

“Springs are coming earlier,” says Jake Weltzin, PhD, executive director of the USA National Phenology Network, a government project to track the effects of climate change on the habits of plants and animals.

As the weather gets warmer earlier in the year, more plants and trees start to bloom at the same time, creating “a pollen bomb,” Weltzin says.

What’s more, experiments show that plants exposed to higher levels of the greenhouse gas carbon dioxide make more pollen. The pollen they make also has higher levels of proteins that trigger allergies, which makes it more potent.

Beat Allergy Symptoms

Doctors say the best time to treat allergies is before they flare up.

“Once your immune system is revved up and reacting to the allergens, it’s always harder to get it under control,” Amar says. “In general, being proactive is a much better approach.”

That can be tough to do when winter weather is unpredictable. If allergies already have you in their grips, some common-sense steps can cut the misery:

  • On higher-pollen-count days, avoid going outside, especially in the morning when pollen levels are highest. If you have to go out, take your allergy medications with you.
  • Keep windows and doors closed. Run the air conditioner instead.
  • Wear a mask if you have to work outdoors.
  • Take a shower at the end of the day to wash sticky pollen grains from your hair. That can help you get a better night’s sleep.

Source: http://www.medscape.com/viewarticle/780516 Brenda Goodman read more

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EpiPen Supply in Schools Not Enough Without Training

on April 12, 2018

More than one in five cases of anaphylaxis that occur in schools happen in people with no known allergies, and school staff are not always properly trained to handle them, a new study suggests.

"Bottom line, I think our findings underscore the need for continued education in the school setting," Martha White, MD, director of research at the Institute for Asthma and Allergy in Wheaton, Maryland, told Medscape Medical News.

Dr White presented the findings here at the American Academy of Pediatrics (AAP) 2015 National Conference.

The study highlights two different scenarios: people who experience their first anaphylaxis event and would benefit from epinephrine autoinjectors stocked by the school, and people with a diagnosis of anaphylaxis who may or may not have their injectors handy.

"We want to have this lifesaving medication at school," said session organizer and moderator Mandy Allison, MD, from the University of Colorado in Aurora.

Several states now have passed or are passing legislation that allows the school to stock lifesaving medication not designated to a specific person, she reported.

The data come from a web-based survey of schools participating in the EpiPen4Schools program, developed by Mylan Specialty, which distributes epinephrine autoinjectors to more than 30,000 elementary and high schools, free of charge, in the United States.

Of the 32,387 schools invited to participate in the survey from May to July 2014, 6019 responded. Most were completed by the school nurse.

There were 919 anaphylactic events reported by 607 (11%) of 5683 schools.

Information on the anaphylactic event was included in 852 of the completed surveys. People with no known allergies experienced 187 (22%) of the events, and students experienced 757 (89%) of the events. Of the 757 events experienced by students, 32% were in grade school, 19% were in middle school, and 49% were in high school.

Food, Insect Bites, Other Triggers

Triggers were included in 847 of the surveys: 62% of the triggers were food, 20% were unknown, 10% were insect bites, 7% were environmental or related medication or health factors, and 1% were latex.

Treatments were included in 851 of the surveys: 75% were epinephrine autoinjectors, 24% were antihistamines, and 1% were unknown.

"Epinephrine is the only approved treatment, yet even in the schools that received free EpiPens, only 75% used them," Dr White pointed out. "That is an opportunity for education, because antihistamines won't stop anaphylaxis."

There were no deaths reported, suggesting that those who received antihistamines most likely had mild symptoms that would have cleared anyway, she pointed out.

Of the 636 epinephrine-treated events, 49% used autoinjectors from the school supply and 45% used the person's personal autoinjector.

Use of the school supply does not necessarily mean the individual did not have their own autoinjector with them. It might just have been easier for the school nurse to grab the stock pen than to go searching for the personal pen in an emergency, Dr White explained.

And, of course, the stock pen would have been used in all of the cases of first-time anaphylaxis treated with epinephrine, she added.

Trained to Treat

Of the 5613 schools that responded to questions about staff training, 36% reported that the only people trained to recognize the signs of anaphylaxis were the school nurse and a small number of others, 29% reported that most staff members were trained, and 31% reported that all staff members were trained. However, 54% of the schools permitted only the school nurse and select staff members to administer epinephrine.

"Teach the kids how to use the devices themselves, as long as they're mature enough to do it. For the adolescents, try to reinforce non-risk-taking and the avoidance of triggers. They need to be told this can kill you," Dr White advised.

"There's not always a nurse in every school, so other folks need to be trained to use these medications," Dr Allison told Medscape Medical News. "We still have a long way to go in terms of when to use epinephrine autoinjectors and what the indications are. They're probably being underutilized," she said.

"Our training should focus on school nurses, but also on the folks who are more likely to be present at the moment the reaction occurs. That's not always the nurse," she pointed out.

This can be a real problem if, for example, a child has an anaphylaxis event on the playground, said Dr White. In such a scenario, "the teacher has to transport the kid to the health room to get treated. That's an opportunity for education as well," she said.

She noted that many of her teenage patients know how to administer the epinephrine themselves, and that many teenage babysitters are trained to use the devices for their charges. "If I can train teenagers to do it, I'm sure the schools could train the teachers."

Dr Allison said that these data are fairly consistent with those from other publications, although there is not a huge database to compare them with. And, she said, these results are not ideal because of the extent of the missing data, both in the overall response rate and in the answering of individual questions.

"It's not the perfect study, but it is some of the better data that we have on a national level. It's starting to give us an idea of what's going on in schools," she added.

Dr White is a consultant for Mylan and has worked with most of the other companies that make allergy- and asthma-related products. Dr Allison has disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2015 National Conference. Presented October 24, 2015.

Source: http://www.medscape.com/viewarticle/853486 Miriam E. Tuckerread more

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Severe Allergies and Travel: The Journey Begins With a Single Step

on April 5, 2018

Many travelers now come equipped with tissues and antihistamines. But for those with severe allergies, travel can be a much more harrowing, and potentially deadly, experience.

Consider, for example, a few incidents that highlight how challenging severe allergies while traveling can be for individuals. A recent story that grabbed international headlines drew attention to a 7-year-old boy and his family who were forced by the airline to deplane after he had a severe allergy attack prompted by the presence of service dogs on the domestic flight.

Although in this instance the boy's allergies were not life-threatening, other high-profile stories in the past couple of years have featured young children who have gone into anaphylaxis after consuming, or simply being exposed to, tree nuts during flights—allergic reactions extreme enough to force the planes to land for the children to receive medical treatment.

Sensational media coverage aside, there is a recurrent thread to stories like these: Severe allergic reactions during travel are unpredictable, can come on swiftly, and are increasingly common. Knowing one's risk and planning ahead may make all the difference, which makes communication between physicians and patients about the management of severe allergies that much more important.

Source: http://www.medscape.com/viewarticle/860408   Rebecca E. Cooney, PhD  March 21, 2016

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Nutrition Before Competition

on March 22, 2018

What you eat several days before an endurance activity affects performance. The food you eat on the morning of a sports competition can ward off hunger, keep blood sugar levels adequate, and aid hydration. Try to avoid eating high-protein or high-fat foods on the day of an event since this can put stress on your kidneys and take a long time to digest.

To perform at your highest level, follow these general nutrition guidelines before an event:

  • Eat a meal high in carbohydrates.
  • Eat solid foods 3 to 4 hours before an event. Drink liquids 2 to 3 hours before an event.
  • Choose easily digestible foods, rather than fried or high-fat foods.
  • Avoid sugary foods and drinks within one hour of the event.
  • Drink enough fluids to ensure hydration. A good guideline to follow is: Drink 20 oz. of water 1 to 2 hours before exercise and an additional 10 to 15 oz. within 15 to 30 minutes of the event. Replenishing fluids lost to sweat is the primary concern during an athletic event. Drink 3 to 6 ounces of water or diluted sports drink every 10 to 20 minutes throughout competition.

Source: http://orthoinfo.aaos.org/topic.cfm?topic=a00370read more

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Acute Injuries

on March 15, 2018

Acute injuries are caused by a sudden trauma.

Examples of trauma include collisions with obstacles on the field or between players.
Common acute injuries among young athletes include contusions (bruises), sprains (a partial or complete tear of a ligament), strains (a partial or complete tear of a muscle or tendon), and fractures.
A twisting force to the lower leg or foot is a common cause of ankle fractures, as well as ligament injuries (sprains).
Reproduced and modified with permission from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.
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Overuse Injuries

on March 8, 2018
Not all injuries are caused by a single, sudden twist, fall, or collision. Overuse injuries occur gradually over time, when an athletic activity is repeated so often, parts of the body do not have enough time to heal between playing.

 

Overuse injuries can affect muscles, ligaments, tendons, bones, and growth plates. For example, overhand pitching in baseball can be associated with injuries to the elbow. Swimming is often associated with injuries to the shoulder. Gymnastics and cheerleading are two common activities associated with injuries to the wrist and elbow.

Stress fractures are another common overuse injury in young athletes. Bone is in a constant state of turnover—a process called remodeling. New bone develops and replaces older bone. If an athlete's activity is too great, the breakdown of older bone occurs rapidly, and the body cannot make new bone fast enough to replace it. As a result, the bone is weakened and stress fractures can occur—most often in the shinbone and bones of the feet.

Source: Dr. Thomas M. Mitchell DC, CCSP - Chicago Institute for Health and Wellness

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Tissue Injury to the Body

on March 1, 2018

Tissue injury to the body is a common issue we see in our patients. It can be from a sports injury, such as improper lifting of weights, or one that occurs through repetitive stresses, such as sitting in an awkward position with poor spinal posture while performing work duties or by improperly going through a sports training.

In any case, injured tissues undergo physical and chemical changes that can cause inflammation, pain and diminished function for the sufferer, all in a short period of time, and can last indefinitely if not properly treated. Spinal manipulation, or chiropractic adjustment, of the affected joint and tissues, begins the process of restoring mobility, thereby alleviating pain and muscle tightness. This process permits tissues to heal naturally.

Evaluating the Patient

I find the most effective method to begin a treatment protocol is to evaluate patients through clinical examination, laboratory testing, diagnostic imaging, and other diagnostic interventions to determine whether chiropractic treatment is right for the patient’s condition. Sometimes, I refer patients to the appropriate health care provider when I determine that chiropractic care is not suitable for their condition. Other times, the condition warrants co-management in conjunction with other members of our health care team and we manage all necessary services within our clinic.

The primary focus of my chiropractic treatment, and any other procedures that we perform in our clinic, is to use the right approach to alleviate the health issue. That’s it!

Getting healthier is definitely about lifestyle improvement and the chiropractic adjustment is a powerful tool, but just one of many. The practice of chiropractic manipulative therapy is the most powerful tool that can be applied to physical conditions and does a lot of great things. However, it is not the end all/be all of healthcare. It has to be incorporated and used appropriately when needed, the same way nutrition, rehabilitation and anything else must be used to help a patient improve their health and well- being.

by Dr. Thomas M. Mitchell, D.C., CCSP | Owner, Clinic Director Chicago Institute for Health and Wellness Copyright ©read more

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The Benefits of Kinesio® Taping

on February 22, 2018

You’ve seen it used with professional football players and Olympic athletes, so what is it?

Kinesio® Taping gives strength and stability to your joints and muscles without affecting circulation and range of motion. It is also used for preventive maintenance, edema, and to treat pain.

We use Kinesio® tape to stimulate muscle spindles and Golgi tendons to promote and inhibit muscular function. I call it the Neuro-tape.

Kinesio® Taping is a technique based on the body’s own natural healing process. This Kinesio® Taping exhibits its efficiency through the activation of neurological and circulatory systems. The method stems from the science of Kinesiology (def.: the study of the principles of mechanics and anatomy in relation to human movement), hence the name “Kinesio.”

Muscles are not only responsible for body movements but also control the circulation of venous and lymph flows, body temperature, etc. Therefore, if the muscles don’t function properly, it causes a myriad of symptoms. Kinesio® Taping creates a different treatment approach for nerves, muscles, and organs.

The first documented use of Kinesio® Taping was for a patient with articular disorders. For the first 10 years, orthopedists, chiropractors, acupuncturists, and other medical practitioners were the primary users of Kinesio® Taping. Kinesio® Taping was used by the Japanese Olympic volleyball team and word of its benefits quickly spread to other athletes. Today, Kinesio® Taping is used by medical practitioners and athletes around the world.

Kinesio® Tape is used for anything from headaches to foot problems and everything in between. Examples include: muscular facilitation or inhibition in pediatric patients, carpal tunnel syndrome treatment, alleviation of lower back strain/pain (subluxations, herniated discs). It’s also highly effective in treating knee conditions, shoulder conditions, hamstring, groin injury, rotator cuff injury, whiplash, tennis elbow, plantar fasciitis, patella tracking, pre- and post-surgical edema, ankle sprains and athletic preventative injury method, and is also used as a support method.

Conventional athletic tape was originally designed to restrict the movement of affected muscles and joints. For this purpose, several layers of tape were rolled around and/or over the afflicted area, while applying significant pressure, resulting in the obstruction of the flow of bodily fluids as an undesirable side-effect.

This is also the reason. Kinesio® athletic tape is usually applied immediately before the sports activity, and removed immediately after the activity is finished. Kinesio® Taping is NOT a supportive tape job, so the tape is highly flexible. It doesn’t prevent movement; it allows the muscles to go through their full range of motion.

It also allows the joints to bend and move, so it’s not supportive like an athletic training taping job. Kinesio® Taping is a neurologic taping technique that allows the muscles to function and over a course of one to three days, depending on how long the tape adheres, it helps train the human mind to understand what the body needs to do, and how it should be doing it.

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Dynamic Generalized Warm-Up

on February 15, 2018

Warm-up is extremely crucial. A dynamic, generalized warm up is non-sport/ activity specific. These basic exercises that loosen up the entire body, increase overall blood circulation and lymphatic drainage and increase respiration. Examples of such exercises, include but are not limited to:

  • High Knee Walking
  • Leg Swings Squats: Lateral and Vertical
  • Lunges
  • Chin Tucks with Scapular Tightening
  • Calf Raises and Toe Raises
  • Wall Angels

STRETCHING

Don’t cut corners. Be sure to stretch. The purpose of stretching is to literally lengthen the muscle. Chronically shortened muscles don’t have the same amount of contractile force and don’t perform as well as muscles that are lengthened and provide full range of motion to joints. Stretching is performed after the muscles have been significantly warmed-up. Stretching should be a combination of static and dynamic activities.

Stretching in general helps to minimize injury, increases joint range of motion, creates flexibility in the muscles and increases muscular performance. Remember that your body has to be properly hydrated (at least 2 liters of purified water a day) to be flexible.

SPORTS/ACTIVITY SPECIFIC WARM-UP

Don’t jump from stretching to sprinting. Warm-up in the activity you are about to perform and take the time to do it properly and thoroughly. This allows your nervous system to adjust the muscles’ firing patterns for the activity. This also allows your body to increase blood flow to the area in demand.

Cold muscles don’t perform well and must be warmed up with increased blood circulation. With increased blood flow, comes the necessary nutrients and oxygen needed for performance. Cold muscles are less pliable and at high risk of injury. To maximize prevention and performance, warm up your muscles!

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