ALLERGIES: MYTHS VERSUS FACTS

Misconceptions about allergies are rampant, and below I discuss some of the most outrageous:

       MYTH: SOME PETS MAY BE “HYPO-ALLERGENIC”

       FACT: Unfortunately, our dogs and cats are a common source of allergies; however, none are free of these problems, despite much advertising to the contrary. Approximately 10 to 15 percent of the population suffers from pet allergies. The allergen is a specific protein produced not in the animal’s fur, but primarily in its skin and – a lesser extent- urine and saliva. As the animal is petted or brushed, or as it rubs up against furniture or people, microscopic flakes of skin (called dander) become airborne. Since all cats and dogs have skin, all are potentially allergenic.   There’s a lot of false advertising by companies marketing supposedly hypo-allergenic pets, some selling cats or dogs for as much as $7,000 or more. While some of these animals have been bred to produce fewer major allergens from their saliva, sebaceous glands, or other glands, they still produce allergens that cause unpleasant symptoms in sensitized people.

Since short-haired pets have less hair to shed, they send less dander into the air, so are probably preferable for those with pet allergies. Dogs are half as likely to cause allergic reactions as cats, but if you’re allergic to furry animals, the only no-risk pets are fish and reptiles.

       MYTH: ALLERGIES ARE PSYCHOSOMATIC

       FACT: Allergies are very real – in some cases, potentially life-threatening, rooted in heredity and the environment; yet the mind plays a significant role in their behavior. Mental stress can precipitate or enhance allergic reactions, and relaxation techniques can moderate them. A person who is strongly allergic to roses, for example, may react to the sight of a plastic rose, demonstrating the involvement of the mind and the brain, but this relationship is not well understood.

 

     MYTH: BLOOD TESTING IS A GOOD WAY TO DETECT ALLERGIES

     FACT: Allergen-specific serum testing (for IgE) is not a reliable screen for allergy, and often leads to misinterpretation and false-positive results – which in turn lead to diagnostic confusion and unnecessarily eliminating foods from a diet. A negative test provides more useful evidence against such an allergy, but it also is not failsafe.

      MYTH: SKIN TESTING FOR ALLERGY IS UNRELIABLE

     FACT: The idea that skin testing is unreliable until 2, 3, or 5 years of age is sheer myth, but an ongoing one. Most evidence indicates that skin testing is reliable at any age.

A positive result, i.e., red, raised area called a wheal, means you reacted to a substance in a potentially allergic way. Such a positive result means the symptoms you are having are likely due to exposure to that substance. In general, the stronger the response,  the greater chance of  allergy to that given substance.

Skin tests are usually accurate, although people can have a positive response to skin testing without any problems with that given substance in everyday life. On the other hand, if the dose of allergen applied to the skin is large, a positive reaction may occur in people who are not allergic. A negative test result means there were no skin changes in response to the allergen, and that usually means that you are not allergic to that substance. Rarely, however, a person may have a negative skin test and still be allergic to the substance. In general, allergy skin tests are most reliable for diagnosing allergies to airborne substances, such as pollen, pet dander and dust mites. Skin testing may help diagnose food allergies. But because food allergies can be complex, you may need additional tests or procedures.

Your health care provider will consider your symptoms, considering the results of your skin test, to suggest lifestyle changes you can make to avoid substances that may be causing your symptoms.

    MYTH: NO MILK, EGGS, OR NUTS FOR BABIES

    FACT:  Changes in recommendations over the years have contributed to the myth that highly allergenic food such as milk, eggs, or nuts should be avoided by infants until ages 1, 2, or 3 years. The most current recommendations from the American Academy of Pediatrics say that there’s no evidence to support avoiding highly allergenic foods past 4-6 months of age. Some evidence is emerging from recent trials that early introduction of highly allergenic foods may even promote tolerance, but if a baby’s sibling has a peanut allergy blood testing (IgE) before peanut introduction might be useful to provide evidence that this allergy is unlikely.

     MYTH: CHILDREN OUTGROW ALLERGIES

     FACT:  Unfortunately, although children are ten times more likely than adults to have food allergies, many children may outgrow food allergies only to develop others. Some researchers believe that as a person’s gastrointestinal system develops, it gets better at blocking the absorption of components that trigger food allergies. Over time, children typically outgrow allergies to cow’s milk, eggs, wheat, and soybean products. Allergies to peanuts, tree nuts, fish, and shellfish, however, are more likely to be lifelong. And some children will outgrow one allergy only to develop another.

   MYTH: WEARING GLOVES WILL PROTECT YOU FROM POISON IVY

   FACT: “Leaves of three, let them be,” runs the standard advice on how to avoid poison ivy and its equally villainous cousins, poison oak and poison sumac. But those who are allergic to this relative of the cashew—as many as 85 percent of all Americans—find that no amount of armor or vigilance can protect them. The chemical that gives these plants their poisonous reputation is an oily resin called urushiol. And what makes it truly diabolical is that it can hitchhike on clothing, dog’s fur, and even garden tools. If you come into contact with poison ivy, wash the oil off (preferably with brown soap and water) within 20 to 30 minutes, before it soaks into the skin. Since the residue can remain potent for a year or more, scrub tainted items as well.

     MYTH: ALLERGIES AREN’T LIFE-THREATENING

     FACT:  Although it rarely happens, allergies can kill. Some people have such an extreme sensitivity to a particular substance that the allergen can trigger an episode known as anaphylactic shock, a sudden, potentially fatal reaction that lowers blood pressure, swells the tongue, throat, or airways to the lungs, making it difficult to breathe. Such a reaction requires immediate medical attention. Anaphylactic shock is most often triggered by a food or drug, but it can also result from an insect sting or injections of various medical agents. People with a history of severe allergic reactions should always carry a pre-loaded syringe of epinephrine (adrenaline), which can be administered in an emergency.

     MYTH: MANY PEOPLE ARE ALLERGIC TO MILK

FACT:  When adults react adversely to milk – from cramps, gas, and diarrhea – symptoms are often mistaken for an allergic reaction. This is actually a condition known as lactose intolerance – an inherited trait caused by the body’s lack of an enzyme, lactase, needed to break down lactose, the sugar in milk or milk products.  In cases of lactose intolerance, adults may use supplemental lactace—e.g., Lactaid —or consume dairy products from which lactose has been removed.

True milk allergy is only common among infants but is usually outgrown in adulthood.

    MYTH: PEOPLE WHO ARE ALLERGIC TO SHELLFISH ARE ACTUALLY ALLERGIC TO THE IODINE

FACT:  Some people who are allergic to seafood avoid certain skin medications and iodine-containing medical test substances because they fear an allergic reaction. But there is no connection between allergies to fish and shellfish and allergies to iodine. Allergies to fish and shellfish are caused by the protein within these meats and not to iodine, which is not an allergen. Surveys suggest that a majority of radiologists and cardiologists routinely ask patients about shellfish allergy before administering contrast media containing iodine (agents used to demonstrate pictures on X-rays). This myth seems to have originated from a 1975 study in which patients with any kind of reported allergy were twice as likely to react to contrast agents, but this has nothing to do with iodine.

   MYTH: NATURAL (“ORGANIC”) FOODS ARE NON-ALLERGENIC

   FACT: Limiting your diet to organic food is no guarantee that you’ll avoid food allergies. In fact, some of the most allergenic foods are “natural,” unprocessed foods: cow’s milk, eggs, peanuts, wheat, soybeans, fish and shellfish and tree nuts. Combined, these foods account for up to 90 percent of all ingested allergic reactions. Allergies are caused not by chemicals related to growing the food, but by proteins in the food.

      MYTH: ALLERGY SHOTS DON’T WORK

      FACT: While immunotherapy given by injections may not work for all allergies and all people, it has been shown to be effective for allergies to insect venom 98 percent of the time, and for hay fever about 85 percent of the time. In some cases, immunotherapy can actually trigger an acute allergic reaction, but if the therapy is properly administered, these risks are minimal.

     MYTH: ARTIFICIAL DYE CAN BE A COMMON SOURCE OF ALLERGY

    FACT:  Despite controversy around artificial food coloring since the 1950s and around food additives in the 1970s, there is no scientific evidence to support a link between exposure to artificial dye or coloring and allergic reactions. Rare cases of anaphylaxis have been reported in reaction to carmine, a natural red coloring derived from dried insects that is commonly used in cosmetics, but not in reaction to artificial dye.

   MYTH: EGG IN VACCINES IS A FREQUENT CAUSE OF ALLERGY

   FACT:  The common MMR vaccine (measles, mumps and pertussis) is safe for anyone with a history of egg allergy, with no testing or allergy referral required. Influenza vaccine also generally can be given safely to egg-allergic patients, as concluded from dozens of trials. In this latter case, the Joint Council of Allergy, Asthma, and Immunology says there’s no need for a waiting period or referral to an allergy specialist, while the Centers for Disease Control and Prevention and the American Academy of Pediatrics recommend 30 minutes of observation for egg- allergic patients who receive influenza vaccine and referral to an allergist if there’s a history of anaphylaxis to egg. Egg-free influenza vaccine is a relatively new alternative.

Vaccine for yellow fever or rabies is contraindicated in patients with allergy to egg, but there are tests and procedures that may allow administration of these vaccinations in a graded manner in some patients. Egg-free versions of rabies vaccine also are an alternative. Gelatin in both of these vaccines can cause allergic reactions, so one must identify gelatin-hypersensitive patients before vaccinating.

   MYTH: MOVING TO THE SOUTHWESTERN STATES WILL CURE ALLERGIES

   FACT: For allergy sufferers, there is simply no safe haven. While desert regions have no maple trees or ragweed, they do have plenty of other plants that produce pollen, including sagebrush and cottonwood, ash, and olive trees. Relocating to such a region may offer relief for a few months, but a fresh crop of allergies to local plants is likely to develop before long.

   MYTH: PENICILLIN ALLERGY IS COMMON

   FACT: Adverse reactions to antibiotics are very common, but true allergic reactions are uncommon. Approximately 10% of people in general say they are allergic to penicillin, but fewer than 10% of those will have a positive skin test or symptoms if challenged. Labeling someone allergic to this antibiotic makes them more likely to receive less-effective, more-toxic, costlier antibiotic alternatives. Thus efforts should be made to clear patients from retaining this label, if falsely applied.

  MYTH: GLUTEN IS A COMMON SOURCE OF ALLERGY

FACT:  Eating gluten is currently being blamed for many ails of humanity,  largely driven by companies with products to sell—so you should avoid self-diagnosing gluten allergy. True hypersensitivity reactions can occur toward wheat, rye, or barley, but generally not to gluten. Celiac disease is an autoimmune condition (not traditional hypersensitivity) that improves with a gluten-free diet. Allergic type hypersensitivity to gluten is very uncommon, but patients more commonly report having “gluten sensitivity” and intestinal symptoms after eating foods with gluten. That’s a poorly defined condition that’s hard to prove. We have discussed this in a previous post (July 7, 2014).

  MYTH: MOLD IS A COMMON SOURCE OF ALLERGY

  FACT:  Mold is everywhere and can cause real problems in susceptible persons, but rarely unless ingested in large quantities. Most health problems attributed to mold exposure are exaggerated, with no scientific basis or supportive evidence.  But “hysteria” around mold has been a boon to some lawyers and companies that sell air purifiers and other detoxification equipment.  So don’t get caught up in this hysteria.

This is a compilation of the most common myths about allergy. Hopefully this can provide you with some reassurance!

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BACK PAIN: A COMMON PROBLEM OFTEN MISUNDERSTOOD AND OVER-TREATED


Almost 80% of our entire population encounters at least one bout of lower back pain during their lifetime. More than 50% of Americans suffer from some type of low-grade chronic back pain. In the majority of cases, standard x-rays show no clear abnormalities to explain the discomfort. Such pains are probably caused by muscle strain and spasm that may be produced or aggravated by emotional tension. Patients over 40 often have minor degenerative changes of the vertebral column in X-ray images, but these rarely produce symptoms. These statistics open wide the door to alternative treatments such as that provided by chiropractors, herbal supplements, and other unconventional measures.

Fortunately, serious spinal disorders are seldom the cause for back pain, which, in the case of recently acquired pain, usually resolves spontaneously within two weeks, regardless what is done. Therefore, in this setting, too many people receive premature high-tech tests, powerful painkiller drugs, or even surgery. Because the pain may be excruciating, most people seek medical help very early, receive aggressive testing and treatment, and, as a result, waste money. Instead of helping, this approach may actually slow one’s recovery.

Not surprisingly, many sufferers from back pain turn to chiropractors, and indeed many large surveys show that patients believe chiropractic works for them. Studies that compare patients’ satisfaction with chiropractic versus conventional medicine in treating low back pain show a preference for chiropractic treatment. The results of a survey of over 14,000 subscribers conducted by Consumer Reports echo those of other studies; 58% of respondents reported that chiropractic treatments “helped a lot.” They also noted that spinal manipulation can be helpful for lower-back pain in the short-term, but Consumers Union, the publisher of Consumer Reports, cautions that manipulations can aggravate structural problems, such as a herniated disk. For chronic back pain lasting more than 12 weeks, however, chiropractic did not appear to be better than general medical care, including physical therapy, exercises, and weight reduction. Chiropractic treatment bears one additional warning: Manipulations extending to the neck carry a slight but definite risk of damage to the spinal cord or proximal blood vessels, both of which can lead to serious—or even fatal—outcomes. Thus elderly patients, especially with preexisting disease of the vertebral column or blood vessels (arteriosclerosis), should be advised to avoid any manipulation of the neck.

So the following comments may help you understand and react to back pain in an appropriate way:

1. In the case of recent onset of pain—even if intense—do not rush to get tests such as X-rays or MRI scans. In most cases the pain will resolve spontaneously, and anything found in such testing will not help in recovery. Moreover, as mentioned, minor abnormalities found in these pictures only contribute to anxiety rather than resolution of pain. Moreover, in the case of X-rays, the radiation exposure produces a small but definite risk of developing cancer later in life.

2. Although recommended for years, try to avoid lying down. Recent studies have shown that after no longer than four days of rest in bed, resuming normal activities results in less pain and earlier recovery. Activities should be low in impact such as stretching and walking, with light exercises that strengthen your abdomen, back and legs. Applying heat to the painful areas may be helpful.

3. Avoid the use of strong drugs such as opiates (OxyContin, Percocet, hydrocodone, etc). Use instead the so-called non-steroidal analgesics such as ibupropren (Advil), naproxen (Anaprox), and others. The opiate drugs are more apt to lead to more disability after several months and may lead to addiction.

4. Some measures that also may be helpful include the following: Tighten your belt, which can help strengthen stomach muscles, a maneuver than can protect the back. Sit forward and straight in chairs, for that relieves strain of the back muscles. Try to sleep on your back or side, and when supine, place a pillow under your knees.  Back massage, which can be done by a physical therapist, may help to relieve muscle spasm and the associated pain.

5. Avoid needless surgery: Back pain often stems from problems that cannot be helped with surgery, such as poor posture, minor arthritis, weak muscles, and others. Even when the pain is caused by conditions such as a herniated disk or spinal stenosis (narrowing of the spinal column), conservative treatment is often enough. Surgery might be considered if you have severe back and leg symptoms clearly linked to a herniated disk or spinal stenosis that hasn’t improved with conservative treatment in three months. But even then, additional measures might first be tried such as local injections with anti-inflammatory agents or analgesics.

We medical practitioners often encounter patients who have undergone one or more surgical procedures without relief, and to me, that represents a real tragedy!



 

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SLEEP NICE OR PAY THE PRICE!

     

     Most people, having busy schedules, often resort to cutting down on their hours of sleep. But even minimal sleep loss takes a toll on your mood, energy, and ability to handle stress. The quality of your sleep directly affects the quality of your waking life, including your mental sharpness, productivity, emotional balance, creativity, physical vitality, and even your weight. No other activity delivers so many benefits with so little effort!

Sleep isn’t exactly a time when your body and brain shut off. While you rest, your brain stays busy, overseeing biological maintenance that keeps your body running in top condition, preparing you for the day ahead. Without enough hours of restorative sleep, you won’t be able to work, learn, create, and communicate at a level even close to your true potential. As you start getting the sleep you need, your energy and efficiency will go up. In fact, you’re likely to find that you actually get more done during the day than when you were skimping on shuteye. You may not be noticeably sleepy during the day, but losing even one hour of sleep can affect your ability to think properly and respond quickly. It also compromises your cardiovascular health, energy balance, and ability to fight infections. Loss of sleep during the week leads to accumulated “sleep debt” that can only be partially repaid by extra sleeping during weekends.

    Both the quantity and quality of sleep you get are important. Some people sleep eight or nine hours a night but don’t feel well rested when they wake up because the quality of their sleep is poor. The best way to figure out if you’re meeting your sleep needs is to evaluate how you feel as you go about your day. If you’re logging enough hours, you’ll feel energetic and alert all day long, from the moment you wake up until your regular bedtime. Extra sleep each night can cure you of problems with excessive daytime fatigue. Some people can benefit from a sleep deficit by taking short daytime naps. Older adults also often have trouble sleeping this long at night; daytime naps can help fill in the gap.

How much sleep do you need?

   Although there is some genetic variation, most adults require 7.5 to 8.5 hours of sleep per 24-hour period to function optimally.

You can find your optimal sleep time if you set aside several days (perhaps during a vacation) to allow yourself to sleep as long as possible.

Once you know how much sleep you need, it’s important to allot that amount of time in your daily schedule for sleep.

       Sleep deprivation can even add to your waistline

Most of us who are short on sleep crave sugary foods that may impart a quick energy boost. There’s a good reason for that. Sleep deprivation has a direct link to overeating and weight gain. There are two hormones in your body that regulate normal feelings of hunger and fullness. Ghrelin stimulates appetite, while leptin sends signals to the brain when you are full. However, when don’t get the sleep you need, your ghrelin levels go up, stimulating your appetite so you want more food than normal, and your leptin levels go down, meaning you don’t feel satisfied and want to keep eating. So, the more sleep you lose, the more food your body will crave. Overweight is compounded further by lack of sleep by impairing your long-term chances of survival, as we explain below.

   Health Dangers of Inadequate Sleep

.Previous studies have shown that inadequate amounts of sleep are associated with a higher long-term mortality risk. A recent study has shed more light on this subject, at least when evaluating sleep duration in combination with other well-known factors that lower one’s survival outlook.

In the National Institutes of Health-AARP Diet and Health Study (1995-1996), researchers examined associations among sleep duration and various causes of death. They studied cardiovascular disease and cancer mortality among 239,896 US men and women aged 51-72 years who were free of any of these diseases at the beginning of study. They evaluated the influence of moderate-to-vigorous regular physical activity, television viewing, and body weight on the interplay between sleep and mortality.

Compared with 7-8 hours of sleep per day, shorter sleep durations were associated with higher total mortality, especially due to cardiovascular diseases. Especially noteworthy was a higher cardiovascular mortality in those with lesser sleep among overweight and obese people, suggesting a special interaction between reduced sleep and overweight. People in the unhealthy categories of all four risk factors—sleep less than 7 hours/day, less than one hour of vigorous physical activity weekly, television viewing greater than 3 hours/day, and moderate to severe overweight—had an all-cause greater risk of dying approaching 50% greater than that of those lacking any of these factors. Although deaths in this group were most likely attributable to cardiovascular disease, they surprisingly also had higher than normal rates of cancer.

Although this study does not provide any single answers, it adds further support to the idea that adequate sleep is highly desirable, but it needs to be buttressed by the other lifestyle factors that we all recognize as conducive to better health.

 

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MORE ABOUT SODIUM: SNEAKY WAYS IT ENTERS OUR DIETS

Studies uniformly show that cutting down on sodium (the primary component of table salt) in your diet can lower blood pressure — reducing your risk of stroke, heart failure and other health problems.

Although the exact numbers are still controversial, experts say most people should consume less than 2,300 mg of sodium each day. That’s about the contents found in 1 1/2  teaspoon of table salt. People with certain medical conditions should consume even less.

However, the average American consumes at least 3,400 mg of sodium per day – or 48 percent or more than the recommended daily limit. So why is this? We have already demonstrated how huge amounts of sodium are unwittingly consumed when we dine in restaurants. But even at home we are subject to “sneaky” forms of sodium intake.

For instance, one slice of white bread can contain as much as 230 mg. of sodium,

In the effort to seek a “healthier” form of salt, some believe that sea salt is the answer. No, it is not, for, although this latter form of salt is different in taste and texture, it contains the same amount of sodium than ordinary salt.

Avoiding the salt shaker is a useful start, but unfortunately, a major part of the sodium in American diets – almost 80 percent – comes from processed and packaged foods. These foods can be high in sodium even if they don’t taste salty.

The processed foods to which I am referring include the following:

  • Frozen meals
  • Canned or pickled foods
  • Snack foods
  • Deli meat
  • Cheese
  • Condiments, sauces and dressings
  • Breads
  • Cereals
  • Soda (including diet soda)

Checking labels is the only way to know how much sodium is in your food. If you buy packaged or processed foods, first choose foods that are labeled “sodium-free” or “very low sodium,” but then check the actual numbers on the labels. Also, remember that the amount of sodium listed on the ingredient label references a particular serving size. If you eat more than the listed serving size, you’ll consume more sodium.

Let’s look at some ways to shop and cook low sodium:

We begin by assessing how much sodium is in popular foods.

The Centers for Disease Control has a list of six popular foods with high sodium content dubbed the “Salty Six.”

  1. Breads and rolls – each piece can have up to 230 mg of sodium
  2. Pizza – one slice can have up to 760 mg of sodium
  3. Cold cuts and cured meats – Two slices of bologna have 578 mg of sodium
  4. Poultry – especially chicken nuggets. Just 3 ounces have nearly 600 mg of sodium
  5. Canned soups – one cup of canned chicken noodle soup can have up to 940 mg of sodium
  6. Sandwiches – consider the bread, cured meats, processed cheese and condiments, and sandwiches can easily surpass 1,500 mg of sodium

Diet for High Blood Pressure

If you have high blood pressure, the DASH diet (Dietary Approaches to Stop Hypertension) is a low-sodium intervention that I have presented in a previous post (5/2/13). Most of the foods in that diet are also low in fat. The diet calls for four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy. It’s also rich in whole grains, fish, poultry, beans, seeds, and nuts – while also limiting sugar and red meats.

Train your taste buds

At first, foods may not taste as good without sodium. But you will adjust over time. Natural substitutes that taste great include lemon, ginger, curry, dried herbs (such as bay leaves, basil and rosemary), onion, garlic and dry mustard. You might also use salt substitutes, which are usually rich in beneficial potassium, but check with your doctor first, especially if you are taking any medications.

 

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