I’ve been getting a lot of questions in response to a recent blog I wrote about monitoring H1N1 vaccine side effects, so I wanted to take the time to address some of your concerns. I know the overload of information on this pandemic can be confusing, but I’m here to help, so keep the questions coming and I’ll do my best to answer them for you.

I thought I heard that the H1N1 vaccine is bad for pregnant women as it has long term effects on the baby. Now, I find nothing on Fox about that. Can you PLEASE clear this up? My daughter is 6 months pregnant and does not know what to do!!
 
You must have heard wrong. We have been saying right from the beginning, as we say every year for the regular flu shot: Pregnant women are considered a high-risk group. Pregnant women have an underactive immune system as well as compromised respiratory capacity, so if a pregnant woman gets the flu, she could have serious side effects, which may not only jeopardize her health – but that of her unborn child. So get both flu shots!

Once you have had H1N1, can you get it again in the same season? What about next season? Can we get it again after it mutates?

We do not know the complete answer to this question however, if you have had the current H1N1 flu strain, you probably have immunity to this specific strain of the virus. So this season, you may have nothing to worry about. However, if the virus mutates or a new strain of H1N1 virus emerges, past exposures to the current flu strain may not be protective.

My son is 15 months old and he is borderline asthmatic. Should I get the vaccine? So many people say yes, and so many people say no. I’m so confused and don’t know what to do!! Please help!

The answer to your question is, yes. The CDC is specifically looking at children with asthma. Many of the complicated H1N1 cases we’ve seen have been in asthmatic children. The combination of viral pneumonia and asthma in a small child could be quite devastating and deadly. So talk to your pediatrician and strongly consider vaccinating your child. And don’t forget to get yourself immunized.

If the H1N1 vaccine is not available, will the pneumonia vaccine help protect your lungs from getting pneumonia if you get the flu?

The pneumonia vaccine is targeted to protect against bacterial pneumonia – specifically pneumococcal pneumonia. This will not offer protection against a viral pneumonia – which can be a complication of the flu. So talk to your doctor before you make any decisions.

TOMATOES

Summer dish: Sliced tomato with balsamic vinegar
Nothing says summer like vine ripe tomatoes. Tomatoes naturally lend themselves to health-conscious summer cooking, being sweet, yet low in calories. In fact, tomatoes are one of the most frequently consumed “vegetables” in the United States, whether raw, steamed, fried, stewed, crushed, pureed, or reduced to a sauce. (Though thought of as a vegetable, tomatoes are botanically classified as fruits.) They are also one of our best sources of vitamin C, a powerful antioxidant.

They also contain beta-carotene and several other carotenoids that may have their own disease-preventing properties, particularly against heart disease and cancer. One carotenoid, lycopene, may help reduce the risk of prostate cancer. Tomatoes also offer a good dose of potassium, which helps to reduce the risk of stroke.

SALMON

Summer dish: Simply grilled on the barbeque
Summer marks the beginning of salmon fishing season and the time of year when fresh salmon is again available in your local markets. Salmon is low in calories and saturated fats and high in protein. Wild salmon is one of the best sources of health-promoting fats known as the omega-3 fatty acids. Omega-3s promote cardiovascular health, brain health and provide anti-inflammatory protection.

Cardiovascular health: omega-3’s prevent platelets in the blood from clumping together and sticking to the arterial wall in the form of plaque. They also drive down triglycerides and LDL (bad) cholesterol.

Brain health: Omega-3’s interact with the fatty layers that surround brain cells and help protect brain cells from the diseases of aging, like Alzheimer’s.

CORN

Summer Dish: Corn on the cob
Is there anything more satisfying at a summer bar-b-que than an ear of hot corn on the cob? In addition to being sweet and satisfying, there are many health benefits of corn.

One cup of corn provides 18.4 percent of the daily recommendation of fiber. Its high-fiber content is one of the biggest benefits of corn. Fiber has been shown to help lower cholesterol levels and help reduce the risk of colon cancer. Fiber is also useful in helping to lower blood sugar levels in diabetics.

Corn is a surprising source of several vitamins, including folic acid, niacin and vitamin C. The folic acid in corn is now known to be an important factor in preventing neural-tube birth defects. It’s just as important in preventing heart disease, according to studies that show folic acid can prevent a buildup of homocysteine, an amino acid in the body.

SUMMER SQUASH

Summer Dish: Sautéed or grilled squash
Summer squash contains vitamin C as well as beta-carotene, folate and fiber. These nutrients make summer squash a tool in preventing cancers, heart disease and diseases caused by inflammation such as arthritis and asthma.

Whether you’re trying to lose weight or just adopt a healthier eating program, summer squash’s rich fiber content can help you get full faster — and give you many of the nutrients you need.

Tanya Zuckerbrot, MS, RD is a nutritionist and founder of www.Skinnyandthecity.com.    She is also the creator of The F-Factor Diet™, an innovative nutritional program she has used for more than ten years to provide hundreds of her clients with all the tools they need to achieve easy weight loss and maintenance, improved health and well-being.  For more information log onto www.FFactorDiet.com

I have long been concerned about potential overuse of the anti-flu drug Tamiflu, in fact there are sections on this topic in both my book on fear and my book on flu. But in my opinion, the current situation with H1N1 swine flu calls for the careful use of Tamiflu at large camp outbreaks. Use of the drug is warranted to help decrease shedding time in patients with mild cases and to prevent additional cases in their close contacts.

The CDC does not agree with me.

Here are the plusses:

1 – Since Tamiflu is highly successful at slowing spread, its use to squash outbreaks can help keep camps open which has the added benefit of keeping sick kids from bringing flu home to many different zip codes and thereby expanding the outbreak. People who are more at risk (including pregnant women, infants, and those with chronic conditions) may catch it that way. Even though this is a mild virus so far, with millions of cases around the world and only 700 plus deaths, there is always the chance that it will get worse; in fact a recent study shows that it lingers in the lungs of Ferrets (who react to flu like humans), causing lung infections.

2 – More circulating virus may increase the chance of a lethal mutation. The famous second mutation that may have occurred in 1918, when the virus became much more severe in time for the fall flu season, is extremely unlikely, but possible.

3 – Children seem more at risk for severe cases, perhaps because of a lack of immunity to an older H1N1 virus that was circulating before 1957. Older patients who have that immunity may have milder cases.

4 – Isolation of sick people and their contacts is the first priority, but use of Tamiflu (especially when there is no vaccine available), is a useful adjunct which may help to keep the camp open.
Here are the minuses:

1 – Use of Tamiflu may increase the chance of resistance occurring. There are some excellent articles on recent Tamiflu resistance, which also demonstrate that resistance sometimes occurs spontaneously, without exposure to flu:

H1N1 swine flu – the non-sustained Danish and Japanese resistance cases were in patients taking Tamiflu prophylactically. (see New Scientist article)

The interesting case in early July of a girl from San Francisco who picked up Tamiflu resistance in Hong Kong but NEVER took Tamiflu. (see NY Times article)

And the spontaneously generated resistance to seasonal H1N1 (NOT SWINE FLU) in last year’s flu season which led to massive resistance to that strain. (See NY Times article)

2 – Tamiflu shortages could emerge (although the CDC has stockpiled 50 million dose courses, and it is difficult to envision a scenario where there is a shortage of this magnitude, especially with a vaccine in the offing.

3 – Potential side effects of Tamiflu, including nausea, or an allergic reaction. But side effects are rare, Tamiflu is a very well tolerated drug overall.

4 – By having the flu now, when it is mild, a person should be immune later on, during flu season, when the flu could return in a more severe form.

I must admit, some of what drove me to put my own 12 year old son on Tamiflu prophylaxis at Camp Modin where there were more than 80 cases was because I have a 4 year old son at home with asthma and chronic ear infections. I was worried about my older son bringing the flu home. But my own scenario was far from unique, which is why I recommended that all of Camp Modin take Tamiflu.

My article on the Modin Protocol I created was published in Slate on July 10th. (see Slate article)

This was followed by a front page article by Tamar Lewin this past Thursday July 23d in the NY Times which described the problem – and solution – at the camp. (see NY Times article)

The following day, Dr. Anne Schuchat, director of the National Center on Immunization and Respiratory Diseases at the CDC, reacted to the Times article by disagreeing with camps using Tamiflu to control outbreaks. She said she “strongly recommended” giving the drug only to people already seriously ill, or to their family members who are pregnant, have asthma or have other conditions that could be life-threatening if they caught the flu.

Finally, on Saturday, July 25th, Donald McNeil wrote an excellent balanced article in the Times describing Camp Modin’s use of Tamiflu, the rationale for my advice compared to the reasons for the CDC’s disagreement. (See NY Times article)

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

So what is in the air? Look out for seasonal tree pollens now wherever you are and learn more about these allergy culprits that are likely to be not only in your backyard — but also in your nose and eyes!  

Plant pollens such as trees, grasses and weeds are not the only allergens that affect the us while working in the garden. Many mold spores also affect people in the outdoors, seasonally, or even year round.

If there is an existing pollen problem in your landscape, replace that plant with a less allergenic selection.  A system that may help you do this and indicates the likelihood of a plant’s potential to cause allergy is the Ogren Plant Allergy Scale.

A pollen-producing tree in your own yard will expose you to up to ten times the amount of pollen as would the same tree planted just down the block from your home! 

Here are some more allergy sufferer’s tips for you and your yard:

• Wear a pollen mask while gardening
• Keep grass cut short
• Avoid touching your eyes and nose while gardening
• Plan outdoor time for rainy, wet, cloudy and windless days — which usually have lower pollen counts
• After yard work, leave your clothing outside of your bedroom, brush off your shoes and rinse your glasses. Also, wear gloves to minimize local contact and reduce irritation to the skin of your hands and arms
• Limit your gardening to short intervals on “high” pollen days
• If you are allergic to mold spores, avoid damp places and stagnant water
• Proximity and location of pollen-producing trees, shrubs and plants will affect your exposure to seasonal allergens
• Planting female trees in one’s own yard may trap incoming airborne pollen from male plants

Other resources are www.aaaaai.org and www.allergyandasthmarelief.org

Happy planting!

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Our soon-to-be First Family faces a personal struggle that millions of other American families face every day: Their daughter suffers from allergies.

An estimated 10-15 percent of people with allergies in the U.S. are allergic to dogs or cats. And about two million people who have cat allergies apparently live with at least one cat in their households. For many pet allergy sufferers, the importance of keeping their pet outweighs the difficulties present due to their allergies. 

The major pet allergens are produced in glands in the skin and can easily get into the animal’s fur, hair and saliva as well.  These chemicals can cause an allergic reaction if an individual is allergen-sensitive.  There are a variety of allergy symptoms including itchiness of the eyes, nose and throat, as well cough, asthma and hives.

If you have pet allergies, consider the following proven survival tips:

• Create an “allergy free” bedroom (where we spend about one third of each day).
• Use a high-efficiency HEPA air cleaner in the bedroom.
• Purchase allergen mattress and pillow covers which may help to prevent pet hair brought into the bedroom from getting into the bedding.
• Use a vacuum cleaner with a HEPA filter and/or a double-bag filter to better catch pet allergens.
• Some studies indicate weekly bathing of a pet may substantially reduce the level of pet allergens in the fur (speak with your vet about any specific suggestions on best ways to do this).
• Learn which prescription or OTC allergy medications are helpful if you have pet-allergic symptoms.
• Allergy injections for pet allergies can be helpful in reducing symptoms if avoidance measures are not successful.
• One study found that it’s easier to transfer pet allergens form person-to-person when wearing wool rather than cotton.
• Washable wall covering, wood and linoleum flooring is easier to clean and remove adherent pet allergens than other surfaces. 
• Ask a non-allergic friend or family member when animal grooming is required.  It is best to do this on non-carpeted flooring. 
• Avoid the area around the cat’s litter box if you suffer with cat allergies.
• Wash your hands after handling a pet to keep from transferring the allergens to your eyes and nose.

LIVE SMART WITH YOUR PETS!  

Check out more tips about pet allergies from the American Academy of Allergy, Asthma and Immunology at their consumer friendly website at: http://www.aaaai.org/patients/just4kids/pet_allergies.asp

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine. He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology. No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Asthma may affect as many as one out of ten children in the US.  During the fall months and in to winter we see a tremendous increase in the number of children with active symptomatic asthma.  A respiratory viral infection is a rather frequent co-conspirator responsible for a higher number of children suffering with worsening asthma.  Other important factors include a change in weather, cooler, drier air as well as increased exposure to indoor allergens. Another issue is children who are given less medication during the later summer and early fall now more than ever need a provider directed asthma regimen to prepare for cold and flu season as well as winter. 

According to a study presented at a meeting held by the American College of Chest Physicians it was observed that October and November are the peak months for children’s asthma, including ER visits, hospitalizations as well as needed asthma medication. Make it an ideal time to review asthma “action plan” (including the proper use of a peak flow meter) with your physician or health care provider at:

http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.htm

What are some symptoms that may indicate that your child’s asthma may not be well controlled?

• Recurrent and persistent cough
• Cough as a result of exposure to pets, exercise and even laughing
• Wheezing
• Trouble breathing or catching your breath
• Tightness of the chest and “congestion”
• Worsening asthma after cold virus and sinus infections
• Nighttime cough
• Increased use of quick reliever “rescue” inhalers

Why are more children suffering from asthma?

Read on in an upcoming blog in order to assist you in reducing asthma symptoms in your child.  Don’t forget the flu shot!   

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

There has been much debate surrounding the dramatic increase of asthma in the United States and throughout the world over past several decades.

A study released by a group of researchers from New Zealand published in the September 20, 2008  issue of the The Lancet found an association between paracetamol use in infancy (known as acetaminophen in the U.S., and a very commonly used non-aspirin containing analgesic) and childhood risk of asthma, allergy and eczema in children at 6-7 years.  The authors suggested  the use of this commonly prescribed pain reliever and fever reducer might be a risk factor for the development of childhood asthma. 

 There has been an increased use of these non-aspirin containing analgesics over the past five decades, especially in children.  Additionally, the researchers reported those children that were given more frequent doses were more likely to develop asthma on a risk adjusted basis. 

 It is important to note that approximately, and this is just an estimate,  about 10 percent of adults and children with asthma find aspirin and non-steriod anti-inflammatory drugs (NSAIDS) actually worsen their asthma.  Aspirin “intolerance” appears to be more common in those patients with moderate to severe asthma, particularly individuals that also have nasal polyps and sinus disease. 

Another study reported in the journal Thorax found at least in adult women that aspirin may reduce asthma risk.  The authors cautioned  their findings were “still not enough to recommend taking aspirin regularly.”  Separately, the incidence of asthma is increasing and other asthma researchers believe another cause for this possibly is an association with obesity and dietary factors. 

In any event I have not observed any issues with acetaminophen analgesics in our allergy and asthma patient population when used in appropriate dosages and for the correct reasons.  Obviously more work and further studies are needed to explain the explosion of new cases of asthma, both in adults and children.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

If you have a child with allergies or asthma – this is a very good time to review your “allergy action plan” for the upcoming school year.  First, if your child has asthma – learn about asthma triggers, including exercise associated asthma.

Second, more than 2 million children have allergies to one or more foods, making it imperative to incorporate a savvy avoidance and elimination diet 24/7 both at home and at school.  If you need help, enroll in the Food Allergy and Anaphylaxis Network at www.foodallergy.org.

Third, seasonal allergies and indoor allergies can cause a decrease in learning in the classroom. As a result, your child may require proper attention and pre-treatment before they head to the classroom.

Here are some more tips to get you started:

– All children with a history of severe allergy or allergic emergencies should have an auto-injector with epinephrine immediately available to them and appropriate school personnel. A written plan of action should be in place.

– If your child has asthma – work with your child’s physical education staff to allow for safe and enjoyable athletic activities during the school year. It is very important to provide time for a warm up and adequate cool down as well as have available drinking water during exercise.

– Wear protective eyewear on windy days to reduce pollens and molds entering the eyes.

– Work with your family doctor and/or allergist to get proper allergy treatment for environmental allergies that may be aggravated by exposure to indoor allergies such as pet dander (cat hair is often present in high levels in schools, and is usually from exposure to clothing).

– For kids allergic to food, always plan ahead with safe snacks for school and reinforce “reading food labels.” 

Let’s make the school year a safe, successful and fun-filled experience, especially if your child has allergies or asthma. Learn more at www.acaai.org and www.aaaai.org.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

Alert: FDA Advises Patients to Switch to HFA-Propelled Albuterol Inhalers Now

The U.S. Food and Drug Administration is encouraging asthma patients to speak with their physicians and health care providers about the “switch” to HFA-propelled rescue inhalers (albuterol).  These environmentally friendly inhalers will replace the old CFC propelled inhalers that are harmful to the ozone layer. 

The FDA is encouraging patients to talk to their health care providers now about switching to HFA-propelled inhalers.  The new inhaler may give some patients a perception of a softer mist as compared to the old CFC inhalers.  The medication (albuterol) is exactly the same, and has not changed. 

The phase-out of CFC-propelled inhalers is the result of an international environmental treaty: the Montreal Protocol on Substances that Deplete the Ozone Layer and the U.S. FDA mandated these inhalers been phased out by the end of 2008.

Again, many patients have already been transitioned to the new propellant in their rescue inhalers and may not have even noticed the change. Talk with your provider or asthma specialist to learn more about asthma triggers and optimal control.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.

As we approach the Olympic Games in Beijing, China this week is time to take note if you find yourself “breathing heavy” during or after exercise.  This may a sign of more than just good aerobic activity.  Exercise-associated asthma can be the culprit; in many cases you may not realize you have this form of intermittent asthma.  Symptoms such as coughing or difficulty breathing during or shortly after exercise are commonly seen. 

In the past several Olympic Games up to one-fifth of athletes have a history of EIA (exercise induced asthma).  It certainly does not keep these elite athletes sidelined.  EIA may be triggered by “oversensitivity” to changing conditions including temperature, humidity as well as air quality, during the workout.  

Strategies in dealing with EIA

·         Hydrate with water before, during and after exercise

·         Warm up with a decent stretch and light exercise

·         Give yourself an adequate period for a “cool down” when done

·         Control your allergies and asthma triggers (especially on high pollen count days)

·         Check out the air quality index (pollution and ozone levels) before you exercise outdoors

·         Pre-treat with inhaled medication as advised by your doctor (after your diagnosis is confirmed) to prevent symptoms

Additional info and tips on “exercise induced asthma” can be found at www.aaaai.org/patients/publicedmat/tips/exerciseinducedasthma.stm.

Dr. Clifford W. Bassett is an assistant clinical professor of medicine at the Long Island College Hospital and on the faculty of NYU School of Medicine.  He is the current vice chair for public education committee of the American Academy of Allergy, Asthma and Immunology.  No information in this blog is intended as medical advice to any reader or intended to diagnose or treat any medical condition.