AAFA Newsletters

Are you confused by the latest studies because they often contradict each other? One week a study is released with information and two weeks later another study is released which contradicts the first study. Part of the reason may be that different researchers are hoping to prove different theories. It may also be that many of those "latest" research trials are pilot studies that haven't stood the test of time: they enroll a handful of patients with follow-up measured in weeks and months, not in years as in the past, then release their findings, perhaps too soon. This doesn't mean the trials and initial findings aren't valid: it just means they haven't been tested long enough. All research has to start somewhere. Longer studies may invalidate the initial findings for some trials or perhaps they will support them. This issue focuses on the findings of some recent trials and studies that may lead the way to better treatments for asthma & allergy including a study that shows how lung infection in young children can cause asthma later in life and another that states gluten intolerance is due to a hereditary gene. Another study deals with sublingual immunotherapy for grass pollen and another focuses on peanut allergy desensitization food challenges that show very promising results. The latest information concerning epinephrine auto-injectors used for anaphylaxis is also discussed. Read this complete issue for details on all these topics.

The number of children and adults with asthma and allergy is growing. 1 in 4 kids has asthma and according to the CDC, 7% of all adults in the US have asthma and approximately 70% of all asthma patients have allergic asthma. Asthma and allergy present not only a physical challenge to patients but the families of those patients are also greatly affected by these diseases.

Asthma and many allergies are chronic illness, meaning it's always there. They rob the family of free time. Parents and older siblings are the ones who have to train themselves to give the child their medicines on time, to refill prescriptions, to allergy-proof the house, or to loose work when their child is having a flare. These diseases cause anxiety and stress when symptoms are present. Asthma and allergies create a financial burden as well. Asthma is considered a pre-existing condition by insurance providers which could mean lack of coverage or expensive coverage. Asthma medications, vital for many patients, are costly and many have high co-pays even if a family has insurance. If there is no insurance, for many families filling a prescription may mean choosing between asthma meds or groceries. Asthma can take a strong emotional toll on families, too. It's hard to avoid the asthmatic child or adult becoming the center of all family life for all these reasons. Read this entire issue for some tips to help relieve some of the anxiety, stress and emotional drain and how to live a more normal family life.

Just because you have shortness of breath when you exercise doesn't mean you have asthma, yet many patients with this complaint are being diagnosed with asthma. In a study conducted by the Colorado Allergy and Asthma Centers in Denver, researchers discovered that 46.2% of patients who were diagnosed with exercise induced asthma after symptom assessment, physical examination and pulmonary function testing didn't have asthma but were simply overexerting themselves.

If you're an asthma patient over 65, it may be more difficult to control your asthma symptoms. A study conducted by the National Asthma Survey discovered more then 2 million Americans over 65 have asthma and they can have more complications and deaths due to their asthma. One explanation was that those over 65 may have other serious health problems (diabetes, heart, arthritis, etc.) and the patients don't recognize their asthma symptoms or they don't focus on their asthma symptoms. They may think difficult breathing is heart-related and not asthma. Since they are not as concerned about their asthma symptoms they don't follow their asthma control plans and use medications as instructed.

In New York City asthma is the #1 cause of absenteeism and hospitalization for kids under age 14. The NYC Health Department began the "Managing Asthma in Daycare" program. When a child entered one of the 40 daycare centers in Brooklyn, they were screened for asthma using a brief respiratory questionnaire. If the results were positive for asthma, the child was sent home with an asthma action plan parents were to take to their healthcare provider before the child could return to school. What this study discovered later was that these children were either under-prescribed or over-prescribed with inhaled corticosteroid, or controller medications. To learn more about these studies and additional asthma studies, read this whole issue.

Allergy symptoms caused by environmental allergens can range from mild to debilitating. Allergy symptoms include sneezing, cough from post nasal drip, itching ears, nose, throat or eyes, headache, rhinitis (runny nose), congestion or stuffiness, hoarseness, red eyes or blurry vision, fatigue and sleeplessness. But did you know that severe allergy symptoms can lead to sinus infections and ear infections caused by constant nasal drainage?

Middle ear infection, or Otis Media, can be caused by either bacteria or a virus and usually happens from complications with a cold, sinus or throat infection, enlarged adenoids or from allergy. Middle ear infections are the most common childhood illness beside the common cold and approximately 25% of all kids have repeated middle ear infections. Babies and toddlers 3 months to 3 years are most affected but kids up to 8 years can also have repeated middle ear infections as can some adults. Five to ten percent of kids who get them will develop a small hole in their eardrum as a result of the pressure caused by these infections. Read this complete issue to learn the signs of an inner ear infection, how it might be treated and how to prevent inner ear infections.

The human body is amazing in that although all the "parts" are there at birth, some of the "parts" take many years to fully develop. The 4 pairs of sinus cavities in our head are an example. We are born with the cavities behind the eyes and in the cheek area, although they're very small. It will take almost 20 years for the sinus cavities to reach full size. Even though small, babies and young children can, and do, get sinusitis or sinus infections, they're just more complex and more difficult to both diagnose and to treat.

All children have an immature immune system which means they're more likely to get infections of the nose, sinus and ears, especially in the pre-school years. And when they do get these infections, they can become very severe in a short period of time. Most of these infections are caused by colds or flu (viral infections) yet some can be triggered by allergy. If the cold or flu or allergy nasal symptoms hang around for more then 10 days, there is a good possibility the child may have a sinus infection. Sinusitis in young children isn't the same as it is for adults, although the root cause leading to symptoms (poor drainage) is similar. To learn the signs of a sinus infection in young children, the various diagnosis and treatment options for sinusitis in young children, read this complete issue.

Studies now prove that asthma severity and poorly controlled asthma is linked to obesity. Over 2,000 adult asthma patients studied during a 3 yr. period demonstrated that gaining five or more pounds a year results in more poorly controlled asthma, the need to use inhaled steroids more frequently and a poor quality of life in general.

A severe allergy reaction can lead to anaphylaxis even for patients undergoing allergen immunotherapy. Anaphylaxis can take two forms: uniphasic or biphasic. Uniphasic means that there is one single life-threatening reaction that needs immediate treatment with epinephrine and ER follow-up. Biphasic means that there may be two reactions in the same allergen exposure incident. This second reaction may occur minutes or hours after the first reaction. All specialists agree immunotherapy treatments should always be conducted in the medical office setting in case there are any severe reactions during this process that might lead to an anaphylactic reaction.

Mom, try to control the stress in your life because mothers who are chronically stressed when their children are young have children who have a higher asthma rate, according to a study released by the American Thoracic Society.

Exercise programs do more then help us loose weight and improve general health. Scientists believe that certain types of exercise can also improve lung function. Aerobics, walking, running, cycling and swimming are good exercises to improve lung function but another exercise, Pilates, may also be beneficial. Read this entire issue for more on all of these topics.

Just when we think we've survived the winter Mountain Cedar onslaught, spring warmth and wind are stirring up new pollens and causing many to think twice about venturing outdoors. Pollen allergies resulting in runny nose, red and burning eyes, sneezing, congestion and a raspy voice are a major cause for seasonal rhinitis and pollen counts are highest and travel farthest on warm, dry, breezy days, the kind of days we experience in March, April and May. Tree, grass, weed, wildflower pollen and mold are all at their peak at this time and cause many to hunt for Kleenex and head indoors.

Pollens are miniscule, lightweight, dry powdery granules generated by flowering trees, grasses and plants. Plants, like most life forms, are either masculine or feminine. Male pollens are necessary for fertilization to spread plant growth. Some pollen is spread from male to female plants via the wind, others by butterflies or bees. Trees are the earliest seasonal pollen-producers and many trees remain active in Texas into November. Tree pollen is so light that winds can carry their pollens hundreds of miles from their source. Of the more than 50,000 types of trees, less than 100 types contribute pollen — and most of these are native to Texas.

Pollen Counts measure the amount of these granules in the air. In general, they are higher in early morning before 10 a.m. and in late afternoon and evening but lower after a rain storm. They are very high when the winds are strong on sunny, clear days. If you have pollen allergy, often called Hay Fever, you don't have to hide indoors. All you need do is make some wise decisions.

Decide to do something about your seasonal rhinitis for the long run. Immunology shots, otherwise known as allergy shots, have a high success rate for pollen allergy. Make an appointment with your allergist to be tested and begin treatment.

Decide to do something in the short run: avoid your pollen allergens. Numerous sites list daily pollen counts. Check them each morning. When high, plan for indoor activity, keep windows shut and the AC running (window screens won't keep pollens out). Instead, air out the house on days when winds are calm. Avoid barbecues, walks, jogs or other activities on very windy days or before a predicted thunderstorm as pollen counts are higher then.

You don't have to give up gardening or having a nicely landscaped yard, you just have to be smart about your choices. To learn more about gardening with allergies, allergy-friendly plants, trees and grasses, read this complete article.

There's no season for colds. A year-round malady, most adults will get 2-4 colds a year and young children can get 10 a year. Colds are viral: antibiotics won't help unless a secondary bacterial infection appears. Can we prevent colds?

Tobacco smoke = a toxic soup for our lungs, according to Dr. Glantz, director of the Center for Tobacco Control Research at UC at San Francisco. Cigarettes produce not only the same chemicals found in diesel exhaust but also produce benzene, a known cancer-causing agent. Second-hand smoke (exhaled smoke) is even more toxic because it contains fine particles that cause immediate and extensive damage to our body, especially our lungs. There is enough proof now that second-hand smoke does trigger asthma flares and is also shown to induce asthma in both children and adults. If you have allergies your symptoms will be more severe when around tobacco smoke, too. For more on these topics plus the dangers of introducing infants and toddlers to indoor chlorinated swim pools and a possible explanation for the increasing number of people with peanut allergy in the United States, read this whole issue.

Do you have allergies? Is a sore throat and cough driving you to distraction? If you answered yes, chances are your sore throat and cough might be symptoms of post nasal drip caused by allergic rhinitis. The most common cause of rhinitis (runny nose) is allergy. Symptoms of allergic rhinitis include a runny nose, an itchy nose, sneezing and/or congestion, red and watery eyes, ear infections, fatigue, headaches and cough. Some people have chronic or year-round (perennial) rhinitis caused by both indoor environmental allergy to things like dust mites, pet dander, dust, mold, or cockroach droppings plus allergy to outdoor environmental pollen allergens or irritants and pollution. One of the complications of chronic rhinitis is post nasal drip.

Glands in our nose and throat always produces thin beneficial mucus to moisten and clean nasal membranes, trap foreign particles so they aren't swept into our lungs, humidify and warm the air on its way to our lungs and help fight infection. Normally, we swallow this thin mucus without being aware of it. But if the mucus gets thick and there's a build-up of this mucus, or some other cause prevents thin mucus from draining, then we have post nasal drip down the back of the nose into the throat which can cause a sore throat and/or chronic cough.

There are many reasons nasal mucus thickens and also why thin mucus doesn't drain properly. To learn more about these reasons and how to prevent sinus infections by controlling post nasal drip both through allergen elimination or using medications, read this whole issue

Dermatitis is a broad term describing any inflammation of the skin. Triggered by many causes, symptoms include swollen, reddened and itchy skin. A common condition, it isn't life-threatening or contagious but can still make someone affected very uncomfortable and self-conscious. One type of dermatitis is atopic (no known cause) dermatitis or eczema, often found in those with a history of allergy and/or asthma.

Dermatitis in the form of eczema can begin in infancy or wait until later in childhood or even puberty to start. Sometimes a very stressful personal event can trigger it in adults with no childhood history of the disease. The rash can be limited to hands or arms, or it can be on the scalp or even the whole body depending on the individual.

A chronic condition, symptoms may be mild most of the time but certain conditions may make symptoms worse. Scratching your itchy skin irritates the skin making the itch worse, setting up a cycle that can drive someone nuts and if the rash and itch is very bad then almost anything can further irritate the skin making it worse, too.

Eczema may also trigger frequent skin infections caused by scratching especially if the scratching is so hard the skin is broken. To help control dermatitis or eczema, stop scratching the itch, which is easy to say but not to do. Read this issue to learn how to help control the itch from eczema, common medications prescribed when the rash and itch are very severe and what to do for skin infections triggered through scratching.

Air It Out asked Dr. Neil Singhania, MD, who is board-certified in Internal Medicine and Allergy and Immunology, with experience in Biomedical research and now in practice in Arlington and Keller (Allergy & Asthma Centres of the Metroplex, 817-460-7447) for his insight on the causes of asthma and research progress toward a cure.

We have documented proof that asthma existed throughout written history but the questions still remains, what causes asthma? If asthma has been around for thousands of years, WHY can't our doctors and scientists, with all their resources, cure asthma? What causes asthma? Is it genetic or environmental? Why are asthma rates increasing globally? What are the most important current research studies concerning asthma? Read this issue for Dr. Singhania's responses to these probing questions.

The American College of Allergy, Asthma & Immunology is a professional association of 5,500 allergists/immunologists and allied health professionals.  Established in 1942, the College is dedicated to improving the quality of patient care in allergy and immunology through research, advocacy and professional and public education. Their annual meeting was held in November, 2009 in Miami Beach. Read this issue for some of their most noteworthy research updates concerning the use of epinephrine injections for anaphylaxis by emergency vehicle (ambulance) responders, a new alternative endoscopic surgical procedure for those with severe asthma uncontrolled by traditional medications, adult asthma recommendations, the triggers of non-allergic rhinitis and commentary on patient reaction one year after the transition to the new HFA propelled albuterol inhalers.

After the heavy spring and fall pollen seasons we've experienced, most of us are looking forward to the first freeze as an end to the symptoms causing us misery. But are you off the hook just because winter is approaching? Not really. Winter can actually cause more asthma and allergy misery then any other season. Why?

Colds and flu are more prevalent in winter and contracting a respiratory disease can trigger asthma symptoms. Asthma patients are at more risk for complications like bronchitis, pneumonia, sinus infections, hospitalizations and even death due to colds and flu. To reduce your risk, 1) get your seasonal flu shot and this year the H1N1 flu shot. 2) Use your asthma meds as directed. 3) Monitor lung function with your peak flow. 4) Make hand washing your priority to help reduce your risk of spreading or contacting these viruses. The rule: wash often and thoroughly with regular soap and water (temperature doesn't matter) but especially when coming home from shopping, school, work or play. Antibacterial soaps are fine for occasional use but cause bacterial resistance. Colds and flu are caused by viruses so antibacterial washes do little to protect you. 5) When coughing or sneezing teach yourself to do so in the crook of your elbow, not in your hands. If you do get a cold antibiotics won't help. Stay home, rest, drink lots of liquids, eat what appeals to you, especially chicken soup and treat the symptoms as prescribed by your healthcare provider. If you have asthma and get the flu, 6) have a medical action plan in place with your healthcare provider. Get help immediately and follow pre-arranged directions.

True, a freeze does stop outdoor pollen and kill mold allergens, but spending so much time indoors in winter also increases your chance of reacting to indoor environmental allergens like pet dander, dust mites and cockroach droppings. Even cold-blooded animals like lizards or snakes can cause allergic reactions for some due to the protein in their urine or feces. These allergens are all more prevalent in winter due to lack of ventilation and our circulating heating systems. You can prevent allergy symptoms by allergy-proofing your house now at the beginning of our winter hibernation. Read this complete issue to learn how to allergy-proof your home in winter and how to prevent exercise induced asthma symptoms.

There are basically 2 types of mold: healthy molds found in food or medication (mushrooms, cheese, yogurt, wines and antibiotics for example) and unhealthy environmental molds. Environmental molds can cause allergic symptoms. Molds are fungi, living substances that feed off both indoor and outdoor surfaces. Fungal spores grow fast: their job is to keep the planet clean of decaying matter. Mold needs moisture, darkness and warmth to grow. It can feed on many surfaces including rotting soil, animal waste or dead leaves. Molds can grow on wallpaper, drywall, paint, carpets, wood, fabrics, adhesives, paper and the biofilm that covers tile or plastics. Mildew is a visible sign of mold spores in damp, dark places. Mold spores grow fast but they're also microscopic in size: if you see mildew that means mold infestation is heavy

Environmental mold can cause allergy symptoms such as nasal and sinus congestion, a dry hacking cough, wheezing, difficulty breathing, a sore throat, shortness of breath, fatigue, burning, watery and/or reddened eyes or blurry vision, skin irritations, headaches or even mood change. Mold is one of the most common and serious triggers for those who have allergic asthma, causing asthma symptoms that result in asthma flares or exacerbations.

The best way to avoid a mold allergy reaction is to eliminate the mold and source of the mold. Since mold is a living substance it must be killed or it will continue to grow and spread. Look for clues that mold could become a problem in your home: condensation on windows, cracking plasterboard or wallboard, loosening drywall tape and warped wood or boards, musty odors or mildew on bathroom surfaces. To learn ways to reduce mold growth, kill existing mold and prevent new mold growth, read this whole issue.

We continue in this issue with more responses to AAFA-TX's patient and healthcare provider Help Line. Our respected specialists, Robert Rogers, MD, Ft. Worth Allergy & Asthma Associates, 817-233-2089, William Lumry, MD, Allergy & Asthma Specialists, Dallas, 214-373-7374 and Richard Herrscher, MD, AIR Care, Plano and Dallas, 972-473-7544 share their expertise on topics including side effects of asthma medications, nebulizers, anaphylaxis during immunization, obesity and asthma and how to store MDI (albuterol inhalers). Read this whole issue to learn more about asthma and allergy.

We continue this issue with more responses to AAFA-TX's patient and healthcare provider Help Line. Our respected specialists, Robert Rogers, MD, Ft. Worth Allergy & Asthma Associates, 817-233-2089, William Lumry, MD, Allergy & Asthma Specialists, Dallas, 214-373-7374 and Richard Herrscher, MD, AIR Care, Plano and Dallas, 972-473-7544 were kind enough to share their expertise and respond to some of the questions on exercise induced asthma, action plans and peak flow meters, allergy diagnosis using spirometry and the most current flu virus information. Read this complete issue for answers to your questions

One of the many services provided by AAFA-TX is a patient and healthcare provider Help Line. Several specialists including Robert Rogers, MD, Fort Worth Allergy & Asthma Associates, 817-233-2089, William Lumry, MD, Allergy & Asthma Specialists, Dallas, 214-373-7374 and Richard Herrscher, MD, AIR Care, Plano and Dallas, 972-473-7544 were kind enough to share their expertise and respond to some of these questions concerning Swine Flu vaccine and asthmatic children, RAST allergy testing, chronic cough, immunotherapy and young children, exercise induced asthma and albuterol use for EIA. Please read this issue for their insightful comments on these topics.

If you're allergic to peanuts, soybean or sunflower seeds, does that mean that you would have an allergic reaction to peanut oil, soybean oil, or sunflower oil? According to a recent article by Steve Taylor, PhD, Food Allergy Research & Resource Program, University of Nebraska, not necessarily. Patients with allergies to these foods were tested in a safe medical environment by eating foods prepared in these oils and none showed any allergic reactions to the oils. The allergen in peanuts, soybeans or sunflower seeds is to a protein found in the foods but there is none of this protein in these edible oils as they are processed here If you have these food allergies, always read labels carefully, ask restaurants what type of oil they use and if they fry foods with your allergens in these oils (which would trigger a reaction). It's best to be cautious to avoid an allergic food reaction that might lead to anaphylaxis.

Are you pregnant and do you have asthma? A recent study published in the New England Medical Journal show that women who manage their asthma during their pregnancy can have as healthy a pregnancy as women who don't have asthma, and their babies have no greater risk for complications due to the mother's asthma.

New research from John Hopkins Medical Center suggests that eating foods or taking supplements with folic acid (Vitamin B9) may stop some allergic reactions and decrease the severity of allergic reactions in general because folic acid is an anti-inflammatory

Why do most Americans just tolerate their allergy symptoms even though we know that allergy symptoms reduce our quality of life and have high economic costs? In Europe, sublingual (under the tongue) immunotherapy has been used for many different environmental allergens very effectively.

Researchers discovered that Buckwheat Honey is a safe alternative to OTC cold meds. To learn more about all of these topics, please read this complete issue of our newsletter.

Researchers still don't know what causes asthma and asthma rates are increasing globally.Twenty-two million Americans have asthma: 6.7 of those are children. We know what causes asthma symptoms but until we discover what causes the disease itself researchers can't develop a cure for asthma. What scientists do know is that there are certain links or risks for acquiring asthma, especially in adults.

If you already have diagnosed asthma and if you have increased asthma symptoms after eating or exercise, or increased asthma symptoms when lying down or frequent coughing or hoarseness, or asthma that isn't in control even when following your medication plan, then you may be one of the 70% of asthma patients who also have GERD, gastroesophageal reflux disease, a disease which affects the digestive system. Our digestive system produces acids to digest food; there is a sphincter valve at the top of the stomach which opens to allow food in, then, like a door, shuts when eating is complete and the digestive process begins and these acids start to form. At least that's what's supposed to happen. This weakness doesn't let the "door" shut completely so digestive acid backs up and can enter the respiratory tract causing asthma symptoms in those diagnosed with asthma.

Environmental and behavioral factors like poor diet, lack of exercise and obesity has caused the number of Americans not diagnosed with asthma but diagnosed with GERD, a weakness in the valve, to increase to 25 million. Dr. Shu Liu of Duke University discovered last year that when non-asthmatic patients inhale even tiny amounts of this stomach fluid that backs up into the esophagus this creates changes in our immune system that can result in someone acquiring asthma, the disease, when this inhaling of stomach acids becomes a chronic or continual response.

Another link to asthma is obesity, a world-wide problem: almost two-thirds of Americans are obese or so overweight that it presents a health problem. The health risks from the disease of obesity include diabetes, heart disease, urological problems, back and knee injuries and a general shortening of our lifespan and quality of life, not to mention the increased cost to our healthcare system. Now CHEST magazine has published a study that links obesity to poor asthma control. Scientists compared obese and non-obese asthma patients and discovered the obese patients had poorer asthma control and less breath volume. They believe this may suggest obese persons have a different genetic type of asthma. Overweight women have a 50% higher risk of developing asthma and obese women have a 75% risk of developing asthma.

There may be a link between environmental pollutants and developing asthma for some persons. The types of environmental hazards which can provoke asthma, the disease, include exposure to fumes, gases, smoke, chemicals, or excessive exposure to extreme heat, cold or dryness. Some of these environmental triggers may be found in the workplace. Environmental occupational factors may cause 5 to 10% of adult onset asthma. If you're an adult and just acquired asthma, how can you tell if it's related to what you do for a living?

If you're a woman with a waist size of more then 35 inches, you have a 37% greater chance of getting asthma. The California Teachers Study, published in Thorax, says the extra body fat around the middle in women, even if they have a normal weight, may be the type of body fat (visceral fat) that could be acting in an inflammatory way and may lead to asthma. Read this complete issue to learn more about GERD, obesity, and other risk factors for adult onset asthma.

A peak flow meter (pfm) is a diagnostic tool that measures how well air moves out of the lungs. A wonderful tool for those with moderate to persistent asthma, it can be used alone or in combination with observation to determine the severity of an asthma flare. It can also be used BEFORE an asthma flare occurs because it helps to discover if there are any blocks or narrowing in the airways hours or even days before other asthma symptoms appear.

Using a peak flow meter routinely and recording the results in a "diary" or log helps a patient, the parent and the healthcare provider in many ways. To learn how to properly use a peak flow meter for accurate readings and how to determine a "personal best" score, read this complete issue.

Chances are, you're not imagining it. According to the AAAAI, (American Academy of Allergy, Asthma & Immunology) global warming climate change is making ragweed allergy worse then ever. Global warming, which raises temperatures and increases carbon dioxide levels is resulting in a longer ragweed season and more concentrated pollen counts. This recent study predicts it will get worse, too. The growing season is now longer then ever and these higher CO2 levels cause pollen production to increase up to 90% for some varieties of ragweed.

To make it worse, for many who suffer with ragweed allergy, they are also affected by cross-reactivity reactions to certain foods. Eating foods that are chemically similar to ragweed can not only make your congestion, runny nose or sneezing worse, but it can cause symptoms of an itching, tingling or swollen tongue, mouth or throat during ragweed allergy season. Cooking the offending foods may help some, but it's best to just avoid these foods during the allergy season. If you have ragweed allergy you may also be sensitive to bananas, cantaloupes, watermelon, honeydew, cucumbers, zucchini and even sunflower seeds or chamomile tea but might be able to eat them with no allergy symptoms when ragweed isn't in bloom. Read this complete issue to learn more about pollen allergies, their symptoms, treatment options and control. You don't need to suffer with allergies.

Shortly, school resumes. For some kids, it's a time to look forward to, for others it's a time of dread. For children with allergies or asthma it can be a pleasant, not fearful, experience with some thoughtful preparations by all. Read this issue detailing our suggestions for a safe and healthy school experience whether your asthmatic or allergic child is entering pre-school or high school. Learn the simple steps to take as a parent and your child's advocate to make the 2009-2010 school year the best experience for your child. Ask AAFA-TX for free Asthma Action Plans, Medication Permission Forms and Anaphylaxis Action Plans.

Anaphylaxis is a potentially fatal allergic reaction that can occur anywhere and at any age. It results from exposure to one of many substances, including foods, insect venoms, drugs or latex. Approximately 3% of all school age kids have diagnosed food allergies. 150 people die annually from food allergies and at least 40 deaths occur annually from reactions to insect stings while approximately 220 cases of anaphylaxis and 3 deaths per yr are caused by latex allergy.

Anaphylaxis is a severe systemic allergic reaction which means it generally affects the whole body although some reactions involve only the respiratory tract. It is generally sudden but reaction time depends on individual patient sensitivity plus the method and amount of exposure to any allergen. Some people have symptoms within seconds, others in hours. In general, it is believed that more severe reactions begin quicker. The signs of anaphylaxis can range from relatively mild symptoms, involving only the skin, to life-threatening reactions, involving breathing and the heart.

The only way to treat anaphylaxis is with an immediate injection of adrenaline, also know as epinephrine. If not injected, the person can die within minutes. If injected and epinephrine wasn't needed (a false alarm) there is no long-term bad effect. It is better to give the injection then to second-guess and not use the drug. A precaution: if the patient uses beta blocker drugs, there may be a serious interaction to epinephrine. Epinephrine should still be used but it's imperative that the patient immediately go to the hospital for further care.

Three of four anaphylactic deaths occur in school. Emergency response vehicles aren't required by law to carry epinephrine. Waiting until a patient gets to the hospital may be too late. Being prepared is the only method to prevent tragedy. But how do you use an epipen auto-injector? It's easy and painless and is designed to be self-injected but anyone can help. Follow the steps in this article when a reaction is suspected and you're using the epipen.

People with allergic asthma and allergies have very sensitive airways. They may react to things called triggers, stimuli that can cause asthma exacerbations or flare-ups or allergy symptoms. Some triggers are allergens, substances that occur in nature. Other triggers are substances, usually chemical in nature, called irritants. Some patients are allergic or sensitive to many allergens while others are only sensitive or allergic to one or a few. At this time, researchers don't feel any of these allergens cause asthma, but they can and do start or trigger an asthma reaction or symptoms. A major step in controlling asthma symptoms is to identify individual environmental triggers and then eliminate them.

Read the whole article for hints on how to eliminate environmental allergens so you can control your asthma and allergies.

Having asthma is no excuse for not participating in sports or exercising. Select sports that work well for asthmatics, those that involve short bursts of energy at any one time — gymnastics, volleyball, softball, wrestling and especially swimming.

Scientists have learned it may not be the feathers, down or kapok stuffing in pillows, toys or cushions that cause your allergic reactions: it's the dust mites and mold that live in those stuffed animals and pillows that is the culprit for your allergic reactions. It doesn't matter what your pillows are stuffed with; if you live in a humid environment dust mites and mold can thrive and cause misery in any fabric.

Thunderstorms create a double whammy for some people with allergy and allergic asthma. Before the storm hits updraft winds stir up both mold spores and tiny particles of pollen grains. Mold spore counts can rise 100 times higher then normal before a storm so if mold is one of your allergens, you'll feel miserable while a storm is brewing. After the thunderstorm passes those strong storm winds caused grass pollen grains to release tiny smaller pollen grains (1000 times smaller then normal). These grass grains won't show up on a pollen count, but the winds carry these tiny particles just high enough for us to breathe them deeply into our lungs.

One priority of our current administration is to improve not only the availability of healthcare but also the quality of healthcare for Americans. A 2006 study graded the quality of U.S. healthcare as 66. That's equivalent to a "D", just passing. The U.S. is worse then other industrialized nations as well as marginally industrialized nations in infant mortality rates and we have a lower overall life expectancy. It's not because we don't spend enough money — we spend more then any other nation on health care ($6,000 per person in the U.S. compared with $2,000 to $3,000 spent per person in the U.K., Germany, Canada and France). What is the problem?

If you have a food allergic child or are food allergic, you know the demands made on normal routines. For whatever reason, the number of persons affected by food allergy, especially to peanuts, is rising. At this moment the only certain "treatment" is avoidance of your food allergen but new studies offer hope for those with peanut allergy.

2009 CDC statistics show about 23 million Americans, including 6.8 million children, have asthma. A recent informal response from Texas schools indicates approximately 25% of our kids have documented asthma. Between 2001 and 2005, the number of reported asthma related deaths in Texas was 1,272. In the US as a whole, 14 people die each day from asthma. We don't like to talk about it, but yes, asthma does kill. Untreated or under-treated or severe uncontrollable asthma can cause unnecessary death, no matter the age. If you have asthma, seek the right medical diagnosis, remain in compliance with your medication plans, learn all you can about the disease and eliminate the environmental triggers which can cause asthma symptoms. Your life is very important to us. For more information on all of these topics, read this complete issue.

A nebulizer medication delivery system consists of a nebulizer (small plastic bowl with a screw-top lid which holds medication), a mouthpiece to inhale the medication, and tubing to connect these to a source for compressed air. The air flow to the nebulizer from the compressor changes the medication solution to a mist. When inhaled correctly, the asthma medication has a better chance to reach the small airways. This increases the medication's effectiveness in relieving asthma symptoms. Children under age 5, patients who have problems using a metered dose inhaler and patients with severe asthma or those with asthma symptoms plus secondary illness like bronchitis will often use nebulizers to take their asthma medications, ensuring the patient gets the right dosage of medication.

There are some basic precautions to follow before using nebulizers that are common to most systems: 1) be certain the compressor is placed on a sturdy, solid surface (never rest it on a bed or soft surface while using it) before plugging it in and 2) don't use a nebulizer if drowsy or while sleeping. You should be seated or propped up comfortably while using the nebulizer and 3) always read manufacturer's specific instructions before using your machine. Read this whole issue for easy steps ensuring the nebulizer is used and cleaned properly.

If you're experiencing runny nose, red and burning eyes, sneezing, congestion and a raspy voice there is a great possibility that spring Hay Fever, otherwise known as allergic rhinitis is the cause of your misery. Pollen allergies are a major cause for seasonal rhinitis and pollen counts are highest and travel farthest on warm, dry, breezy days, the kind of days we experience in March, April and May. Tree, grass, weed, wildflower pollen and mold are all at their peak. What can you do if you enjoy gardening and outdoor activities but suffer with allergic rhinitis? The solution is planning and choice.

Pollen counts, in general, are higher in early morning and late afternoon but lower hours after a rain storm. They are very high when the winds are strong on sunny, clear days. Plan gardening activities for the times when you are least affected with allergy symptoms, either mid- morning or early evening on calm, sunless days or perhaps after some rain.

Plant pollens aren't the only allergen that can cause seasonal rhinitis. Molds and mildew affect many people. Cleaning out potential mold sources like leaf and debris piles, stacks of firewood, unused flowerpots and yard implements or neglected lawn furniture will help eliminate mold spores from your outdoor environment and relieve your symptoms.

It's tempting to open windows on sunny spring days to bring fresh air into a stuffy winter house. Avoid that temptation if the fresh air is windy which can push pollens right through your screens and into your home. Choose to air the house when the winds are calm or after a rain.

For specific allergen-proof gardening tips and a list of the best trees and flowers to plant to avoid pollen allergens, read this whole issue.

Recent studies confirm what we know: home environmental conditions do affect asthma and allergies in children. Risks of having asthma and allergy symptoms increase when home remodeling projects such as installing new flooring, painting or buying new furniture occurs because the newer materials used in these products have higher chemical emissions or off-gases. Indoor pollutants play a very strong role in whether a child may have an asthma flare. Exposure to tobacco smoke, mold, and chemical emissions from synthetic surface materials and furniture really do increase respiratory illnesses in children.

Between 2000 and 2005, a great percentage of adults hospitalized for a serious condition such as heart disease, diabetes, pneumonia, depression, or other disorders were also discovered to have asthma as a secondary but previously un-diagnosed disease, an increase over earlier years of 113%.

If you have asthma, learn to listen to your body. Early warning signs that your asthma may be getting worse include runny, stuffy nose, fatigue, chin or throat itches, headache, moodiness, cough when laughing or performing other physical activities, wheezing when active, waking at night or in early morning with a cough or wheeze, a faster breathing rate, irritability. Asthma severity might change at any time for every individual so it's important to see your healthcare provider when you notice these signs.

Do you know the difference between a side effect to a medication and drug hypersensitivity or drug allergy? Every medication, whether prescription or OTC, has the potential to cause side effects or an unpleasant reaction in some people. There can also be unpleasant reactions when certain drugs interact with other medications you might be taking. This type of reaction doesn't involve the immune system: in most cases the bad drug reaction stops if the medication is stopped. But, if you experience a reaction that is caused because the immune system is attacking the substance, then you may have a drug allergy or hypersensitivity to that medication. To learn more about drug interactions or medication allergies, read this complete issue.

Asthma medications come in many forms. Some are pills, some syrup, some are inhaled through either an MDI, (Metered Dose Inhaler — liquid medication propelled with a gas), or DPI (Dry Powder Inhaler) and others are liquids used in inhalation machines called nebulizers. A major part of being in control of your asthma is to be "in compliance" with your medication plan meaning not only using the right medications for your asthma symptoms but also using this medication correctly as prescribed. A fast method to absorb asthma medications directly into the airways and to stop asthma symptoms quickly is through an inhalation technique. A difficult technique to learn, with a little practice, anyone can do this correctly.

The best way to use an MDI or metered dose inhaler is with an added spacer or valved holding chamber yet sometimes it's not possible to use a spacer with the MDI. What is the best technique to use an MDI without a spacer? There is a choice of an 'open mouth' or 'closed mouth' technique. Ask your physician which is best for you to use but the basic steps are the same.

Most MDI's or DPI's don't have a counter to tell you when they're almost empty; it's important to keep track of the number of doses or puffs or sprays (all mean the same) left so you'll know when to refill the prescription. To help calculate, ask your pharmacist how many doses, sprays or puffs the new canister holds. To calculate, divide the number of prescribed sprays or puffs used daily into the total number available in a new canister which tells you how many days it should last. Mark your calendar when you first use the MDI and calculate when you need a refill and mark that on the calendar too.

t's very important to clean your MDI, especially the new HFA propellant canisters. Please refer to the December 2008 issue of Air It Out for detailed directions on the care and cleaning of HFA propelled MDI canisters.

Some asthma medications are DPI or Dry Powder Inhalers. The medications in these are usually controller or maintenance drugs. DPI's don't have a propellant gas. No spacer is needed but children under 4 or patients with severe lung obstruction have difficulty using them since it requires an ability to generate strong inhaling force to use them. Read this complete issue to learn the difference between "open" and "closed" mouth inhalation techniques and how to use a dry powder inhaler.

There is no cure for asthma yet but we can control the symptoms. One way to control symptoms is with the proper medications. Asthma medications take many forms: pills, syrups, inhalers, liquids used in a nebulizer. Medications work in different ways (rescue meds and controller meds) and, for many patients, more than one type is usually required. Because everyone's asthma is different, physicians will prescribe different medications at different times to each person.

Asthma is classified by severity. Someone with mild asthma may only need to take medications for a short time when they have symptoms or a flare-up. Patients with severe asthma may need to use several medications daily. Over time, your doctor may change your medications, which is why it's important to visit your physician regularly. BUT, medication is only effective if it is used correctly. When you are "in compliance" (using your medications as prescribed), asthma is in control. Your symptoms disappear or decrease and your quality of life improves. If you are using your medications correctly but symptoms aren't improving, then perhaps it's not the right medicine for you. See your healthcare provider if symptoms persist or get worse.

MDI's or Metered Dose Inhalers are a convenient way to deliver the rescue or albuterol medications used for sudden flares. These are canisters of medication with a propellant gas that delivers the medication as a spray or mist. It is highly recommended that a spacer (valved holding chamber) always be used with an MDI.

Why use a spacer? Spacers make it easier for kids to use an MDI. An MDI releases medicine at a very high speed and the patient has to inhale quickly to absorb the mist. When using a spacer, the drug is discharged into the spacer and held there in suspension for 3-5 seconds longer giving the child more time to inhale the spray and not have to worry about coordinating pressing a canister and then rapidly breathing it in before the mist evaporates into the air. Spacers make it possible for small children or persons who have poor coordination to use MDI's. Infants and toddlers can use these rescue meds with a spacer plus a mask. Spacers also reduce medication side effects like cough or Oral Thrush and help ensure the drug is delivered to the lower airways and not absorbed by the mouth into the stomach instead, which doesn't help asthma but might cause negative side effects. To learn the correct way to use an MDI read this complete issue.

Everyone looks forward to a break in routines and a change of scenery. Some plan to take their trips during summer and others prefer a winter vacation. Whatever the season or time you plan your vacation trip, if you or a family member has asthma or allergies, this fun trip means planning ahead to ensure the trip remains fun.

The first step to having a pleasant and worry-free trip is to select a location where your allergens aren't active. You can escape your allergens with wise planning. If you have pollen allergies, hiking the wooded trails in the spring or fall might cause allergy misery but skiing those same trails in the winter might be very pleasant. Take a few moments on the internet or with the Hotel and Visitors Convention Bureau for the area you'd like to visit and check for seasonal allergens for your chosen destination.

Once you've selected your vacation destination check your health insurance policy to see what, if any, coverage you'll have in that area in case of an emergency, especially if you're planning a trip outside the country. NOTE: many asthma and allergy medications, especially epinephrine injectors, aren't available in all other countries.

Next, when booking your hotel rooms, request non-smoking rooms. If you have food, insect, medication or any other allergy that might lead to anaphylaxis, take an epinephrine device with you. To avoid any difficulties with customs or airport security, always have your prescription information on all medication and devices.

If traveling stateside, ask your physician for recommendations of any colleagues at your travel destination in case of medical emergencies. Make a list of the prescription medications you use, including prescription number, dosage and pharmacy phone number. Pharmacists away from home can access your prescription information through the store's central computer system if you need emergency medication refills as long as your prescriptions are with a larger chain.

Pack a medication kit and keep it in your carry-on luggage. If you use a peak flow meter, pack it along with your pfm chart. If anyone uses or might need asthma medication delivered through a nebulizer, look into a smaller, portable nebulizer that can be easily transported when traveling. You may need an outlet prong and voltage converter if traveling internationally. The USA uses 110 volts, as does Mexico and Canada but Europe generally uses 220 volts. Voltage varies in Asia, Africa and South America. For more tips on how to make your vacation or business trip as safe and pleasurable as possible, read this complete issue.

According to a survey conducted by Pediatric Allergies in America, parents responded that 1) allergies interfere with their child's sleep 2) allergy symptoms limited their child's activities 3) allergy symptoms interfered with their child's educational performance and 4) 27% polled said the most bothersome symptom was a stuffed nose but 46% said their child had more serious symptoms like headache, ear or facial pain. What does this survey prove? We're not treating children's allergies as well as we should be.

Another study is no surprise: the more environmental allergens found inside a home, the more asthma symptoms patients living in that home have. In the homes studied, those asthmatic children who had fewer symptoms lived in homes that were cleaned more frequently and more thoroughly, eliminating allergens. What does this study prove? We need to adopt better cleaning habits and clean more frequently to eliminate indoor allergens since most of us spend the majority of our time indoors where these triggers can cause asthma flares.

According to a bulletin published by the American College of Obstetricians and Gynecologists, "it's safer for pregnant women with asthma to be treated with asthma medications then it is for them to have asthma symptoms and exacerbations during pregnancy." Pregnant asthmatic women should continue with the lowest possible medication doses that will control their asthma and monitor the pregnancy for any signs the fetus isn't growing at a normal rate or if there are any signs of an early delivery. The goal of controlling asthma in pregnancy is to prevent asthma flares so the fetus has enough oxygen to grow and develop normally.

Read more in this complete issue on these reports and others relating to allergy testing, early indicators of childhood asthma and new strides in protecting those affected by food allergies.

A word that's hard to spell, a leukotriene is, simply put, a group of hormones that cause symptoms of both hay fever (allergic rhinitis) and asthma. There are 2 types of leukotrienes in the body: one type acts on conditions like cystic fibrosis, IBS (irritable bowel syndrome) and psoriasis. The other type is released by mast cells and causes inflammation in the airways (broncho-constriction) during asthma flares. They're also responsible for some of the changes in the airways resulting in irritation to the smooth muscle in the airway and this irritation, also called hyper-reactivity, plays a very big part in both acute (sudden) asthma flares and in chronic (constant) asthma symptoms.

Leukotriene modifiers are the most recent type of medication approved by the FDA to treat both asthma and allergic rhinitis. The last major medication treatment breakthrough for asthma was made in 1972 when inhaled corticosteroids were developed. Not considered as effective as inhaled steroids in treating severe asthma, leukotriene modifiers are recommended for people with mild persistent or moderate persistent asthma or those who have allergic rhinitis.

Asthma is classified by 4 levels or degrees of severity. It's important to remember that these classifications or degrees of asthma can change with each individual over time depending on how well symptoms are controlled and the individual's disease progress. The classifications are: 1) Mild Intermittent Asthma: symptoms occur less then twice a week, flares don't last long, night time symptoms occur less then twice a month and peak flow readings vary less then 20% 2) Mild Persistent Asthma: symptoms occur more than twice a week but not daily, flares affect daily activities, nighttime symptoms might wake you more then twice a month and peak flow readings vary from 20-30%. 3) Moderate Persistent Asthma: symptoms occur daily and you must use inhaled albuterol drugs daily, flares occur more then twice a week and they restrict normal activity, you're awakened more then once a week due to symptoms, peak flow reading varies more then 30% 4) Severe Persistent Asthma: symptoms are constant or always present and they really limit normal activities, flares occur frequently both during the day and night, peak flow reading varies more than 30%.

Leukotriene modifiers work by preventing broncho-constriction (airway tightening), preventing the production of excess mucus in the airways and preventing swelling of the airways. If taken regularly, as they're prescribed, they can prevent asthma flares or exacerbations in mild intermittent asthma patients because they can prevent the symptoms that lead to the flares. Leukotriene modifiers are also beneficial for those with allergies. There is debate about whether using leukotriene modifiers alone, without using inhaled steroids with them, is completely effective for asthma patients. But some patients don't want to use inhaled steroids, even though they are generally safe, so leukotriene modifiers are an option to prevent symptoms for those with mild intermittent asthma. To learn more about this class of asthma medication, read the whole issue.

Most of us realize that sneezing, sniffling or congestion are often signs of an allergic reaction, whether it be an airborne allergy to pollens, dust, dust mites or pet dander or reactions to other allergens like mold or cockroaches. When these symptoms occur, we're usually quick to use medications to relieve those symptoms. But how many of us think that our itchy, watering or burning eyes and blurred vision might also be an allergic reaction to these same allergens?

For women who use mascara, those same eye symptoms could also indicate the products have been contaminated with bacteria. Mascara users are cautioned never to share eye make-up products so as not to spread bacterial contamination and to also discard and change mascara tubes about every 3 months to prevent contamination that could lead to serious eye problems. But for the majority, mascara isn't the cause of our burning, red, blurry or watering eyes. It may be allergic conjunctivitis that's making us miserable.

Some of the allergens triggering these eye symptoms are pollens from trees, plants, weeds and grass. If you only develop symptoms when you're outdoors you may have seasonal allergic conjunctivitis meaning your symptoms only occur when your particular pollen allergens are active.

In Texas, some type of pollen activity occurs every month of the year. A particularly nasty pollen currently active in Texas may be triggering not only your raspy voice, congestion, sneezing and other general allergy symptoms but also the burning, itchy or watery eyes typical of seasonal conjunctivitis. Ashe Juniper, also known as Mountain Cedar trees, disperse pollen from mid-December into February, causing an allergic condition some refer to as "cedar fever" or mid-winter hay fever.

Mountain Cedar grows on 8.6 million acres of Texas land in the middle of the state. It is the largest concentration of these pollen laden trees in the country although some Mountain Cedars are found in Oklahoma, Missouri & Northern Mexico. A very hard wood once used for fencing and telephone poles, they're such potent allergens because each tree produces millions of exceptionally fine pollen spores that are carried by wind throughout Texas and Oklahoma, making most people with pollen allergies miserable from mid-December into February. There is a movement to eradicate these nuisance trees since, besides making people with pollen allergy miserable, new growth trees are harmful to our environment. Each tree guzzles 32 gallons of ground water a day in winter and then dries out in the summer drought, creating a fire hazard. Aside from destroying the trees or staying indoors, there is little you can do to avoid the pollen so prevalent due to strong winds.

The most common indoor environmental eye allergens are pet dander, dust mites and mold. If you have symptoms the whole year while indoors, you may have perennial allergic conjunctivitis.

Chemical irritants, including smoke, can irritate your eyes but they don't cause an allergic reaction. They can aggravate allergic conjunctivitis, whether seasonal or perennial. And, like any other allergy, the first step to prevent or stop the symptoms of allergic eyes is to avoid your allergens but sometimes this is easier said then done unless you live in a bubble. If avoidance is impossible then the next step is to talk to your healthcare provider about medications that can improve your symptoms. There are different types of medications and each has its limitations and success. Read this complete issue for more information on conjunctivitis medication options.

Most asthma patients require two types of medication: quick-relief or rescue medications for emergency use, the albuterol drugs or quick acting bronchodilators, plus controller or preventative medications used on a regular basis to contain the disease and prevent flare-ups or exacerbations.

Quick-relief or albuterol medication is often in MDI, Metered Dose Inhaler, format which uses a propellant gas to deliver the medicine to the lungs. There are many brands of albuterol drugs. In the past, the propellant used for all of these and some other asthma medications was chlorofluorocarbons or CFC's. In 1978, scientists realized CFC propellant, which was also used in many aerosol products besides medications was NOT safe for our environment. CFC's were destroying the earth's protective atmospheric ozone layer located in the stratosphere even though CFC's were safe and effective for their medical uses. There was worldwide agreement to phase out CFC use. There was again worldwide agreement that asthma medications would be exempt from the early CFC phase-out until a safe and effective alternative to CFC's for medical purposes was developed. That time came in 1996 when a safe alternative propellant was developed, hydrofluoroalkanes or HFA's. An FDA regulation ends the manufacture and sale of ALL CFC propelled albuterol medications, no matter what brand, by December 31, 2008 and other asthma medications using CFC propellants will eventually be phased out in the years to come. What does this mean for you if you use albuterol metered dose inhalers as quick relief medication?

It means that after the end of December 2008 you won't be able to fill any old prescriptions for metered dose albuterol that is propelled by CFC's. Healthcare providers have known of this phase out for the past two years and chances are anyone who's had a prescription written for albuterol in that time is already using the new medication propellant. It's important to remember, the active ingredients, the medication itself, hasn't changed. It's only the delivery method, or propellant that's changed. But if you have only mild intermittent asthma and perhaps haven't needed a new albuterol refill for a long time, you will need to see your physician to get a new prescription for the new albuterol. Of course, if you have old inhalers you can still use them until they expire but when you need a refill, it will be with the new format of HFA's.

It means the cost for your metered dose inhaler albuterol will increase since there is no generic alternative yet. There is a branded generic and you should ask your physician about that if finances are of concern to you. Eventually, in a few years, generic HFA propelled albuterol will be released. To learn other ways this propellant gas switch will affect you, please read this whole issue.

Asthma isn't just a children's disease although the majority of asthma patients are children. There are a growing number of patients who first show signs of asthma as adults, many over age 40, even into their late 60's. Why? No one has a specific answer because scientists still don't know what causes asthma, the disease. We know what triggers symptoms but we don't yet know why the disease strikes one person and not another. Why do some patients not show any signs of the disease until adulthood?

One theory is that those diagnosed with adult onset asthma did have the disease as a child but it was mild and perhaps was misdiagnosed as bronchitis, pneumonia or even colds. Another theory is that our polluted environment is leading to more allergic reactions and we know allergies are an asthma symptom trigger. Another theory is that sometimes asthma is misdiagnosed or overlooked in adults because normally, adults have a decrease in lung function as they age and some healthcare providers might attribute asthma symptoms to this normal aging process. Adult onset asthma can lead to serious complications so it is extremely important to have a correct diagnosis.

Who might be a target for adult onset asthma? 1) Women. The link between hormone changes and asthma is now clear. Hormone fluctuations caused by pregnancy often lead to asthma and a decrease in estrogen levels during menopause can also trigger asthma disease. 2) Obese persons are very susceptible to this disease, another reason to remain active and eat moderately to maintain a healthy weight. 3) A history of allergy might trigger the disease in adults. Thirty percent of those first diagnosed as adults have a history of allergy, especially to cat dander, mold, dust, feathers (particularly in bedding), perfume or other common chemicals in our environment. Exposure to tobacco smoke and smoke in general is also another contributing factor, although smoking tobacco itself doesn't cause the disease.

Asthma symptoms for adults are similar to those for a child: a dry cough, (especially at night), tightness or pressure in the chest, difficulty breathing, wheezing when exhaling, shortness of breath after exercising and chest colds that hang on for more then 10 days. The difference is, although kids' symptoms might be intermittent (now and then) adults who are diagnosed usually have persistent symptoms. A good day for them is one without symptoms

It's often difficult to diagnose adult onset asthma because other symptoms from other diseases like hiatal hernia, stomach problems or rheumatoid arthritis mimic or imitate asthma symptoms. COPD or chronic obstructive pulmonary disease also has symptoms similar to asthma but COPD is not the same as asthma. It is possible to have both asthma and COPD at the same time, however. COPD in the form of emphysema is usually fatal. Controlled asthma usually is not.

Adult onset asthma can be very serious so it's important for patients to manage their disease through 1) education about the disease and new treatment developments 2) compliance with any medications prescribed. Take them exactly as directed, don't skip doses just because you're feeling better that day and don't take OTC meds of any kind without speaking to your healthcare provider or pharmacist first. Many OTC drugs, like aspirin or other NSAIDS such as Advil, Motrin, Aleve or Naproxen can trigger asthma symptoms in some adults. Many older adults also have other health issues and are on prescription medications. Some heart drugs like Beta Blockers and sometimes Ace Inhibitors might create interactions or negative side-effects with asthma medications and they can also provoke asthma symptoms. Work with your healthcare provider to develop a medication plan for all medications, even vitamin or herbal supplements. 3) Do self-lung tests daily with your peak flow meter. A Peak Flow can usually show early signs that lungs are tightening up before other symptoms appear. 4) If you have adult asthma definitely get a flu shot and ask your healthcare provider if you should have a pneumonia shot also. To learn more about Adult Onset Asthma, read the complete issue.

MYTH: Children outgrow asthma in their teens. Once they hit puberty their asthma disappears, they don't have the disease anymore so they don't need to use asthma medications. FALSE! Asthma is a chronic disease. The symptoms may disappear or improve because the patient is following their medication plan (in compliance) or has eliminated their asthma triggers which cause their symptoms but the disease is always there. For an unknown reason, probably hormonal, asthma symptoms do lessen or stop during puberty making teens think they no longer have asthma, but this isn't true. They still have the disease but symptoms decrease.

MYTH: An asthma diagnosis means a patient's quality of life changes for the worse. Asthma patients have to restrict their lives or suffer with symptoms. FALSE! With a proper diagnosis and the right management plan asthma patients can live normal lives.

MYTH: Exercise can trigger an anaphylactic reaction. TRUE AND FALSE! A few people are really allergic to exercise but exercise-induced anaphylaxis is rare. It can cause hives, fainting, vomiting and difficulty breathing during a workout with symptoms lasting up to 4 hours. But in most of these cases, the anaphylactic reaction is triggered by a food such as peanuts, shellfish, eggs, or in 2 reported cases, celery. And in order to have this exercise induced anaphylactic reaction, they had to have eaten these foods right before strenuous exercise. If you eat a peanut butter sandwich then go watch TV, nothing. Eat the peanut butter sandwich and jog on the treadmill, it may be bad news for someone affected by this syndrome. Jogging and running are most likely to trigger the anaphylaxis but dancing, skiing, volleyball, even raking leaves or mowing can also cause this reaction. Extremely rare, there have only been 1000 cases of documented exercise-induced anaphylaxis since 1970, with 1 death.

MYTH: If you have a stuffy head, sore throat and sneezing, you only have a cold. FALSE! If these symptoms occur at the same time each year they might be allergy symptoms. How can you tell the difference between a cold and an allergy? One way is the quickness symptoms appear. Colds take a day or more to show symptoms and the symptoms gradually get worse, adding loss of appetite and perhaps headache to the list. These symptoms lessen and disappear within 7-10 days. Allergy symptoms begin hard and fast. Sneezing is sudden and strong. Congestion is immediate. And symptoms can disappear almost immediately too, when the offending allergen is no longer provoking symptoms. Allergies almost always cause itchy eyes, nose and throat but colds usually don't. Someone with a cold may have a fever, body aches and colored mucus but these symptoms normally don't occur with allergy.

MYTH: Taking corticosteroids to treat asthma is potentially dangerous, can cause weight gain and should be avoided. FALSE! Asthma corticosteroid medications are not the same as the steroids taken by athletes to improve performance. Oral (taken by mouth) corticosteroids can increase weight but these are only prescribed for the most severe asthma. Inhaled corticosteroid medications are one of the safest and most effective treatments for mild or moderate persistent asthma according to most specialists. To learn more about these and other asthma and allergy "myths" read the entire issue.

Asthma is the most widespread chronic disease in children: it affects not only the patient but the whole family. Asthma can result in family friction, stress, irritation, financial worries, resentment in siblings, or, it can strengthen the family unit as everyone works together to support and control the disease.

Sometimes, asthma, like any chronic illness, can blow family problems out of proportion and tensions within the family can ran high. Asthma and family problems can aggravate each other making each worse and hurting the family unit and quality of life for all. There are ways to cope with having an asthmatic child, ways to improve the quality of family life while handling asthma, especially when it comes to discipline, behavior and teaching a child to be responsible for their own medications.

Behavior: Asthma isn't psychosomatic; it's not a disease caused by emotions. It is a physical disease yet emotions can trigger asthma symptoms. But the stress of the disease can cause psychosomatic behavior problems for some children. If your child exhibits self-destructive behavior, uses asthma as a reason for not going to school or to manipulate the family, or deliberately doesn't take their medications, then it's time to talk about this with your physician and perhaps seek psychological help. The worst a parent can do is to excuse or ignore this behavior.

Discipline: Stress, high emotions (whether happy or sad), fear, anger, frustrations can all trigger an asthma flare in many children and adults but that isn't a reason to avoid disciplining a child when they are breaking family, school or society's rules. It's more harmful to let an asthmatic child break the rules and have their own way then to provide appropriate discipline even if it does result in an asthma flare. It's also harmful for other children in the family or in the classroom to see a sibling or friend "get away" with breaking the rules just because they have asthma. If it's necessary to discipline your child, discipline appropriately and follow the child's asthma action plan if they do have a flare-up or exacerbation. Don't feel guilty for playing the role of a parent.

Medications: If a child is very young when diagnosed naturally it's the parents or caregiver that have the responsibility for administering medications, eliminating asthma triggers from the child's environment and generally protecting the child from exacerbations. As the child grows older, they should assume more responsibility for their own health but this responsibility should always be age and maturity appropriate to the individual child. How can you teach your child the way to use their medications independently? Read this issue for hints on how to teach your child to use their asthma medications effectively.

Researchers have discovered a link between menopause and Adult Onset Asthma. The link is estrogen. Menopause reduces or stops the production of estrogen and this estrogen reduction could lead to asthma, especially for thin women. Women that are underweight are four times likely to develop asthma or allergies then women who are in the upper normal weight range. Obesity or being overweight is linked to an increased likelihood of asthma, though. Obesity is linked to insulin resistance which hurts lung function.

Every year approximately 150 people die from anaphylaxis caused by food allergy. The 12 million people with diagnosed food allergies know they have to avoid their food allergens. They must read labels and be vigilant in restaurants yet sometimes food allergens pop-up in unexpected places. Many street food vendors are now using peanut or soybean oil in their fryers instead of trans fats. Vendors are trying to improve health by eliminating the bad fats, yet they're unknowingly exposing some to serious food allergens that could lead to anaphylaxis.

The Journal of Allergy and Clinical Immunology reported that if you had (have) eczema as a child, this might lead to hay fever and/or asthma. Studies of people who had childhood eczema had twice the incidence of asthma then those who never had eczema. Many physicians aren't surprised by these findings since they support the "atopic march" theory: a child begins with a food allergy then gets eczema and goes on to hay fever or asthma or both.

Are you bothered by sinusitis? Traditional treatments include prescription corticosteroid sprays, nasal sprays or saline irrigation, all effective methods to open clogged sinus cavities so they can drain properly and not become infected. If these methods fail, surgery may be necessary to open sinus cavities by removing bone and nasal tissue, surgery performed under anesthesia and requiring several days to recover. There may be another treatment, a minimally invasive surgical procedure appropriate for some patients. There is a question by many physicians that this procedure could cause nerve and tooth root damage, however.

Are you trying to exercise more but every time you venture outdoors your allergies go into attack mode and you feel miserable? You're not alone. Read this issue to learn why you're miserable and more on all these topics.

More then 22 million Americans now have asthma, a chronic but treatable disease. Asthma is a disease that impacts patients not only with regards to health but also with their work and play options, finances and generally their quality of life. Asthma affects the lives of caregivers and family members of patients in the same ways, too. Asthma also impacts the whole community.

It is the number one cause for both school and work absenteeism, is responsible for 25% of all emergency room visits, costs patients more than $10 billion each year ($5 billion of which is spent on prescription drugs) plus indirect (lost productivity costs) to employers of another $8 billion annually. Everyday, 40,000 people miss school or work because of asthma: every day 14 people die from asthma. Asthma can't be cured (yet) but it can be controlled with proper diagnosis and management plans.

Periodically, as more disease information accumulates, the NAEPP, a part of the National Institute of Health (NIH) updates physician diagnosis, treatment and management guidelines for standards of asthma care. New guidelines for medical professionals were issued late in 2007. What do the new guidelines suggest? Do they make changes in treatment for asthma?

Treatment goals remain the same: controlling symptoms so patients can lead an active life without danger of flares or complications. Not all patients have the same degree or kind of asthma. Asthma is a very individual disease. Some have mild intermittent asthma, others have mild persistent, others have moderate persistent and yet others severe persistent and these classifications can change over time with each patient. To make diagnosis and treatment even more complicated, an effective treatment plan for a patient can change with time. What worked last year might not work this year. This is why it's so important to see your physician regularly to monitor the progress of the disease and its treatment. Every patient's assessment and treatment should be individualized to fit their degree of asthma at a given time.

These new asthma care guidelines focus on 4 areas: 1) steps and procedures to diagnose, assess and monitor the disease 2) patient education 3) the need to control environmental factors and co-existing illnesses which can make asthma worse and 4) medications to best treat the disease. What does that mean for you? It means your physician should ideally work with you to individually develop a plan to control your asthma. Asthma is not a "one size fits all" disease. To learn more about these new asthma guidelines and how it may impact your life, please read this whole issue.

Have you heard about vog? It's not the latest video game but another form of air pollution, a smog cocktail of sulfur dioxide gas, dust and sunlight and it's affecting the Big Island of Hawaii. This sulfur dioxide stew is making people wheeze, causing headaches, raspy throat and killing plant life. What's responsible for this newest air pollutant? Mother Nature. Kilauea volcano, which has been erupting regularly since 1983, blew a second vent this past spring so the volcano is now spitting out twice the volume of volcanic chemicals into the air, causing the vog. This gray haze of toxic air is dangerous to those who have asthma or other respiratory problems..

According to the Agency for Healthcare Research and Quality, we Americans spent $11 billion in 2005 on doctor bills, prescription drugs and other medical care to relieve the allergy symptoms of watery eyes, congestion, wheezing, coughing and headaches. By comparison, in 2000, we spent $6 billion. This increase is caused partly because patients now pay out-of-pocket for allergy-related meds since many insurers no longer cover allergy related illness, partly because many drugs once covered by prescriptions are now OTC, partly die to inflation and mostly due to the increase in the number of people who are suffering with allergies.

In 2002, 20% of Americans had a known allergy. In a 2005 report, 54% of all Americans tested positive for one or more allergens. Almost 40% of all children have allergic rhinitis, also known as Hay Fever, and allergic rhinitis along with asthma is the number one cause for absenteeism. Is there anything that can help reduce both costs and symptoms? According to a 2007 study the time of day we take medications is important.

Because hay fever symptoms (weepy eyes, runny nose, sneezing) are worse in the morning, we should take our allergy medications at night before bedtime so these meds will still be in our bloodstream in the morning and effective in controlling morning symptoms. To help remember to take meds, get in the habit of taking them when you do any regular nighttime chore like brushing your teeth or setting the alarm. Medications can only help relieve your symptoms if you use them — and using them at the right time helps more.

Almost 2/3 of adults over 50 are using complimentary and alternative medicine as part of their healthcare program — yet very few mention these alternative meds or treatments to their physicians and this can be dangerous. All herbs and vitamins can have potential side-effects or negative inter-actions with prescription or OTC medications. Why don't patients tell their physicians that they're taking vitamin supplements, herbal remedies, using acupuncture, massage therapy, meditation or naturopathy, all considered alternative medicine? The most common reasons are a) physicians don't ask b) patients didn't know they should discuss these treatments or medications with their physicians, and c) there isn't enough time during an office visit. Patients need to take control and tell their physicians they're using alternative medication or practices. By sharing, patients can really manage their own healthcare.

Scientists are still trying to discover why the incidence of childhood asthma is increasing so drastically worldwide. Doctors at New York University discovered that there may be a link between asthma and a simple bacterium called H. Pylori. The New York study links adecrease in H. Pylori bacteria to a rise in childhood asthma. To learn more about this link and other information on asthma and allergies, read this whole issue.

Adults need 7-8 hours of sleep every night and school-age kids require 10-11 hours a night, according to the National Sleep Foundation. Adequate sleep helps keep the body healthy by allowing some of the body's systems — circulatory, respiratory, digestive, immune, muscular, skeletal and nervous symptoms — to have the quiet time required to recharge, repair and heal. For children, sleep is a physical, mental and emotional growth period, yet studies show most adults and too many children aren't getting the sleep required by nature, leaving our bodies deprived and vulnerable to illnesses including heart, digestive and respiratory diseases and other complications. If you have asthma or allergies, restful and adequate sleep allows our bodies to combat the symptoms of these diseases and helps prevent infections which make these diseases worse. What causes us to be sleep deprived?

Often our bedroom lacks the right environment. In today's plugged-in world, electronic distractions cut sleep time. Bedrooms should be peaceful havens dedicated to sleep, not watching TV, working on the computer or playing video games. Remove these distractions if you want to sleep better.

Sometimes distractions are outside the house or apartment. Inconsiderate and loud neighbors or traffic noise can leave you tossing and turning. If installing double-paned glass windows which reduces the noise level, isn't an option, a "white noise" machine helps mask noise for most people.

Pets can help keep you sleep deprived if they sleep in your bedroom, or worse, on your bed, especially if you have a dander allergy. Put a comfortable bed for your pet outside the bedroom and shut your door at night.

A partner who snores can interfere with quality sleep, and if they snore loud enough they can keep the whole house from getting rest. There are many causes of snoring and one cause is obstructive sleep apnea. A recent study said women with asthma are twice as likely to have sleep apnea. We asked Dr. David Ostransky, DO, Pulmonary and Critical Care Medicine specialist of the North TX Lung & Sleep Center, Ft. Worth, 76109 (817-731-0230) to clarify some questions about sleep apneas. Read this complete interview to learn more about the dangers of uncontrolled obstructive sleep apnea and their relationship to asthma and allergies.

It's always a challenge to start a new school year when a child has asthma and allergies, but it doesn't have to be a fearful or unpleasant experience if you take a few steps to prepare. We make these suggestions for a safe and healthy school experience whether your child is entering pre-school or high school.

1) Make a doctor's appointment before school begins to assess your child's asthma control.

2) Fill any new prescriptions. Check that all old inhalers are full and ask your physician for a spacer to use with them. Spacers increase the amount of medication actually inhaled so benefits of meds improves. New HFA propelled albuterol inhalers act differently; ask us for more info on new inhalers. Get an extra peak flow meter to keep at school; use labels to mark all medications and devices with your child's name.

3) Make an appointment with your child's new teacher and give them the new action plan and permission form. At this meeting, discuss your child's asthma or allergies. Clarify what the teacher knows about asthma and allergies; discuss your child's triggers; if you feel your child is too young to handle their own meds at school, ask where medications will be kept — and how the child accesses them so everyone feels safe and empowered; develop an emergency plan with the teacher and nurse: make sure the teacher knows how and when to use asthma devices; discuss how exercise and emotions effect the disease and perhaps your child's actions. This is also a good time to discuss any side effects asthma or allergy medications or the disease itself might have for your child. And don't forget to discuss the most appropriate way to deal with any of these side effects.

Ask the teacher 1) for make-up plans for absenteeism 2) if any other children in the class have asthma or allergies. 3) if the school is practicing a plan that eliminates the most common allergens from the school environment 4) AAFA-TX is a resource: recommend teachers, nurses and staff contact us to learn more about these diseases by checking our website or attending one of our programs. 5) Middle school children and teens present another challenge. Peer pressure and the need to conform plus a basic teen belief in invincibility prompts kids of this age to ignore their medication plans and "loose" their inhalers. Fortunately, teens often show disease improvement after they hit puberty so their symptoms might fade or improve. Nonetheless, prepare an emergency plan with your child's teachers so they know what symptoms indicate a flare is coming. It is also important to discuss your teen's asthma with the coaching and P.E. staff, especially if your child participates in competitive athletics. Serious flares, even hospitalizations or death, can occur when kids are training too vigorously in the wrong environment such as extreme heat, days with high ozone levels, days when the pollen counts are especially high, winds are strong or practice sessions are held near congested highways exposing them to vehicle exhaust. Teens won't protect themselves so sometimes parents and teachers have to do it for them.

Does your child have allergies that might be life-threatening (food, insect stings, meds)? If at risk for anaphylaxis ask your physician for epinephrine auto-injectors, one to send to school, one to keep at home. Ask what the school does to prevent cross-contamination of food allergens.

Become your child's advocate, help to empower both your child and the school with information. For more specific information, read this whole issue.

If you, or your child, sleep through the night without symptoms of cough or wheezing, are doing well at your job or in school, attending and performing to your peak, can play, exercise and participate in sports and other fun activities without asthma symptoms slowing you down, then you're probably in control of your asthma. Being IN CONTROL means asthma or allergies aren't interfering with your quality of life. But how do you get control? Naturally, to get control of asthma a patient needs to follow their medication plan, (be in compliance), yet many who do follow their plans still have frequent asthma symptoms and flares; they might say their quality of life isn't the best. So taking medications isn't always the only answer to control. Perhaps a more complete route to control and a better quality of life in general is to adopt a "lifestyle" approach to controlling asthma symptoms.

First, get a proper diagnosis and an appropriate medication plan suitable for the severity of your asthma, then, follow that plan. Use a controller medication if it's needed and rescue medications as directed and needed. Use spacers on your inhalers and take your Peak Flow readings. Keep 6 month follow-up appointments to assess your asthma control and learn if you should "step-up" (increase or change) medications or "step-down" (decrease or change) medications. The ultimate goal is to reduce dependency on drugs and yet not have any asthma symptoms.

Almost 70% of asthmatics have asthma symptoms triggered by allergies. AAFA-TX suggests you learn what triggers your asthma symptoms and then eliminate those allergens or irritants from your environment.

More than 60% of Texan children and adults are obese. Obesity has a bad impact on respiratory disease. Asthma symptoms are worse, more frequent and more difficult to bring into control if a patient is obese or greatly overweight. Decide that you really are in control. Reduce your calorie count by eating smarter and eating smaller portions. To help loose weight and improve over-all health, move your body! Don't be a couch or computer potato. Just become active. For many, asthma symptoms are triggered by exercise but that doesn't mean someone with asthma should forgo fun and exercise. There are many activities and sports suitable for someone with asthma, those which require "bursts" of energy instead of forcing the lungs to work hard for a long or continual period of time.

Maintain a strong immune system by adopting healthier eating habits which can help improve resistance to respiratory infections that might trigger asthma symptoms — and help reduce obesity, too.

If you smoke, stop. If there are smokers in your household, help them stop smoking. Smoke, whether generated from cigarettes, pipes, cigars, barbecue grills or a fireplace is a major trigger for asthma symptoms. Eliminating smoking from your environment will not only improve your asthma symptoms but it will help our total air quality.

Have fun to reduce stress. For some, asthma symptoms are triggered by emotions or stress. Adopt a hobby, learn to play an instrument, keep strong ties with friends and family in order to help reduce stress. Learn and practice relaxation breathing and meditation techniques to control your stress and prevent asthma symptoms.

Get adequate sleep to keep your body and mind strong. Adults need at least 7-8 hours of sleep and children 10-11 to remain balanced and healthy. Adopting a lifestyle approach to controlling asthma will help your medications work more effectively because you're controlling all the triggers for your asthma symptoms. You will be in control of your asthma and your quality of life will improve. Read this complete issue for more suggestions on allergen control and lifestyle issues as related to asthma.

There may come a day in the near future when those who suffer from severe asthma can reduce the severity of their disease, increase the number of symptom-free days and generally experience an improved quality of life without taking more medications. In fact, severe asthma patients would REDUCE medication intake if and when a new minimally invasive surgical procedure completes clinical trials successfully. The Cleveland Clinic believes that the new procedure, called bronchial thermoplasty or BP, is one of the top medical innovations of past years. Muscle tissue inside the bronchial tubes contracts (tightens) during an asthma flare-up or exacerbation, narrowing the airways and making it hard to breathe. With this BP surgical procedure, performed when the patient has no asthma symptoms, a thin flexible tube called a bronchoscope is passed down the windpipe into the lungs where it applies heat to the tissue in order to seal it and create a smooth wall of muscle in all the airways. This reduces the airways' ability to constrict or tighten up during a flare-up. BP is the first non-drug treatment for asthma and shows promise of reducing the need for medications and reducing the number and severity of symptoms. Watch for more information about this experimental procedure.

"Here kitty, kitty" isn't what people with dander allergies should say. Cat dander is one of the most prevalent and potent allergens for many of the 150 million Americans with allergies. Most warm-blooded animals produce dander which is the microscopic dandruff-like saliva residue left on their coats or hair from licking. Since cats are in a constant "grooming" mode, their licking produces a lot of dander. We can't see dander, it's so fine, but it becomes airborne and then we inhale these tiny particles and have an allergic reaction. People with dander allergens are cautioned NOT to adopt a warm-blooded animal, especially cats, but who can resist? And if you already are owned by a cat it is almost impossible to part from them. Actually, you don't even need to live in the same house with a cat to be exposed to their dander since it's carried on the clothing of those who do live with cats and can be found in carpeting 6 months after a cat is removed. What can you do to minimize the impact of a dander allergen? 1) For some reason, neutered pets produce less dander, so have your pets spayed or neutered. 2) Keep cats (and dogs) out of the bedroom and try to keep them off furniture. 3) Use a HEPA vacuum at least weekly to pick-up as much pet hair and dander that sticks to it, as possible. 4) Pet hair acts as a magnet for outdoor pollens too, so keep cats indoors rather than letting them roam. 5) Ask your vet the best way to bathe your cat. Anyone who owns one knows cats and water don't mix so discuss the most appropriate method to bathe your cat, which helps reduce dander. Suggestion: use extreme caution when bathing cats. 6) Wash your hands thoroughly after handling your cat, and don't put your hands near your eyes, nose or mouth after playing with your cat.

Looking for non-medicinal methods to help with your sinusitis symptoms? Many find relief in using their neti pot, a utensil that looks like a magic genie pot or a tea pot with a long narrow spout. The neti pot has been used in the Orient for many centuries to help unclog sinus passages. Using 1 cup of distilled slightly warm water, fill the pot and add ½ teaspoon baking soda and ½ teaspoon sea salt (it has less sodium than regular salt). Bend over a sink basin and gently pour water into one nasal cavity until it flows out the other cavity, then reverse. The process helps clear sinus passages of the mucus which can lead to infections. Neti pots can be found online or in some drugstores, but if this process sounds awkward, there are plastic squeeze bottle nasal irrigation kits, sold in drugstores, which do the same thing and are easier to use for some. Always ask your healthcare provider if this method might provide relief for your sinusitis.

No surprise, a new study from Spain shows that using various household spray products not only causes asthma symptoms like wheezing, nasal irritation, inflammation and allergic reactions, but may also trigger asthma itself in some patients. Chemicals in common household products can present a serious health risk for much of the population with the biggest health risk coming from air fresheners, furniture polishes/cleaners and glass cleaners.

Read the whole issue for more bits and pieces about asthma and allergies.

Three percent of elementary aged children and 2% of American adults have proven food allergies. Most other people will sometimes have an unpleasant reaction to a food, an intolerance. A true food allergy is an abnormal immune system response to a food; food intolerance is sensitivity, not an immune reaction. The difficulty is in determining if a person does have a real food allergy or is only sensitive (intolerant) to a food.

Children are most commonly allergic to cow's milk, hen's eggs, peanuts (a legume, not a nut), tree, nuts, soybeans and wheat. Note: peanut allergy in the US has doubled between 1997 and 2002. Adults are most allergic to peanuts, tree nuts, fish, shellfish (shrimp, crabs and lobster), mollusks (clams, oysters and mussels), eggs, fruits and vegetables.

These aren't the only foods someone can be allergic to; any food could cause an allergic reaction including berries, cinnamon, citrus fruits, coconut, corn, mustard, pork, buckwheat, chocolate, sugar, tomatoes, dairy foods and wheat, among others.

The signs of food allergy vary and can include any of these: skin reactions like hives; red sandpaper-like facial rash, or dry scaly itchy skin (mostly on the face); swelling in hands and feet; puffy eyelids; dark under eye circles; swelling lips; sore tongue; respiratory reactions like sneezing, runny or stuffy nose; wheezing; watery eyes; chest rattle; persistent cough; congestion; bronchitis recurring ear infections; digestive signs such as a burn-like rash around the anus; abdominal discomfort; diarrhea; constipation; intestinal bleeding; poor weight gain; bloating, gas, or excessive spitting up; vomiting; behavioral symptoms include fatigue; migraines; hyperactivity; crying; irritability; sleep problems; anxiety; crankiness; sore muscles and joints. Food allergy reactions can have such severe consequences (anaphylaxis leading to death) so it's vital to always avoid food allergens, the substances that cause the allergy reaction. To do this, the first step is a proper diagnosis: is it food allergy or food intolerance? If it is an allergy, what are you allergic to?

Food allergy testing should be done by an allergy and immunology specialist. Some methods used to test for food allergies include 1) a RAST (Radio-Allergo-Sorbent Test) blood test, which measures the antibodies in the bloodstream to certain food allergens. A RAST test has a high degree of false negatives meaning it doesn't detect all the food allergies a patient might have. 2) A skin prick test is helpful in uncovering hidden food allergies, but they have a high incidence of false positives, meaning the skin test is likely to show that patients are allergic to a food when really they're not yet a negative skin test (the patient doesn't react to a certain food allergen injected in the skin) is reliable. 3) A Controlled Food Challenge is usually the best test but these could be dangerous by triggering an anaphylactic reaction in the patient being "challenged" (eating a small amount of the suspected food). The test is "blind" in that patients don't know which food they're testing. 4) An Open Food Challenge isn't blinded, the patient knows which food is being tested In both cases, some of the suspected offending food is eaten, then after 15 minutes reactions might show up if there is an allergy to that food. Food challenges should always be done in a physician's office under medical supervision.

Testing sounds complicated, doesn't it? It is. Many of the signs of food allergy could also be symptomatic of other health issues, making it even harder to diagnose food allergies. Read this issue for more information on testing for food allergies.

Call it smog, call it ozone but call it polluted air and call it dangerous. Polluted air is air contaminated by toxic wastes, gases, (including ozone) and fine particulate matter and is a worldwide problem. Polluted air isn't pretty, it isn't healthy. Sometimes you can see polluted air as an orange-red color in the late afternoon sky, caused by the nitrogen dioxide in the air. Fine particulate matter, perhaps the most toxic aspect of dirty air, is a mixture of solids and liquid droplets from aerosols, smoke, fumes, dust, ash and pollens and is smaller than a human strand of hair; it seeps right into your lungs and then into your bloodstream. Dirty air makes it difficult to breathe, makes eyes water and burn, literally takes your breath and voice away; it makes your chest hurt, causes coughing and headaches. Dirty or polluted air, especially fine particulate matter in the air, contributes not only to asthma symptoms but to heart disease, cancer, diabetes and premature death. Scary, isn't it? But what does it have to do with you? And what can you do about it?

It's important to you because polluted air, especially dangerous for anyone with a respiratory illness (asthma, allergies, COPD, bronchitis, lung cancer) also has harmful affects for all, even the healthiest individuals like competitive athletes, people with no history of respiratory illness. Our athletes preparing for the 2008 Summer Olympics in Beijing, China are concerned about polluted air because Beijing is situated in a geographical bowl and toxic wastes and exhaust gases (ozone) are trapped. The result is some of the most polluted air on the planet. For the first time, Olympic athletes are opting to train outside the host country and many will not even arrive in Beijing until just 72 hours before their competitive events.

Polluted air isn't only found in Beijing or Los Angeles: Mexico City, London, Cleveland, Pittsburg, Chicago and St. Louis among other cities all have toxic air year round. Texas has serious bad air problems. In 2007, the ALA ranked Houston 5th and DFW 7th in the nation for having the worst ozone-polluted air year-round; in 2007, Tarrant county ranked 9th and Harris county 5th in the nation for ozone pollution. The EPA classifies the DFW metroplex, San Antonio and most of southeastern Texas (Houston, Brownsville, Corpus Christi) as areas where air quality standards are not met, in other words, total air pollution levels (both ozone and fine particulate matter) are dangerous to humans. It's not just "their" problem in China, Ohio, England or California, it's our problem in Texas and that's what it has to do with YOU.

When we, whether a trained athlete or someone with respiratory problems, inhale polluted air it is very dangerous to our respiratory tract, damaging the air sacs in the lungs. Exposure can inflame lung tissue and cause respiratory infections, especially for people with asthma, allergies or COPD; it causes your voice to get raspy and your chest to hurt. There are many aspects of world wide air pollution we individually can't control, but there are ways you can protect yourself and your family in summer heat when ozone levels climb higher and our air is even more polluted. Read this issue for suggestions on how you can protect yourself and family from dirty air and help to solve the problem.

Eczema is a difficult word to pronounce; it sounds menacing. Although not life threatening, this skin disorder causes extreme discomfort and reduces the quality of life for the approximately 15 million Americans who have it. 90% of these patients acquired eczema (atopic dermatitis) before the age of 5 and most will have it their whole life. Atopic refers to an inherited tendency to develop allergies or allergic diseases like asthma, food allergies or rhinitis (hay fever); dermatitis refers to the skin. No one yet knows what causes eczema; some scientists think it's an inherited trait (genetic), others blame the environment and others believe its an impaired immune system and yet others think its a combination of these factors, but all agree these is a link between eczema and allergies.

Eczema appears on an infant's skin as a rash over large areas of the body including the face, hands, scalp, arms, legs, feet and the diaper area. For adults and older children the rash usually appears on hands, neck, upper arms, in the crook of the elbow, behind the knees and even on the eyelids. Beside a rash, other symptoms, like dry skin, vary among individuals but the intense itchiness is true for almost all patients. Scratching can lead to bacterial infections which then can lead to impetigo. Controlling eczema means keeping the original rash from becoming worse so that scratching doesn't cause these secondary skin infections.

Treatment to prevent itching, which can cause the other infections, includes keeping the skin moisturized to prevent dry and irritated skin. It's recommended to bathe in warm, not hot water and to avoid bathing too often or too long. This is especially true in winter when normally there's less moisture (humidity) in the air (low humidity causes skin to dry out). Another important part to controlling the rash/itch is to use unscented soaps or soap-free cleansers and apply unscented lotions and creams immediately after bathing to keep the skin moist.

When the rash does become worse and is inflamed or swollen, a flare-up is occurring. A physician might then recommend a topical corticosteroid cream to reduce the inflammation, which will then hopefully stop the itching. There can be side effects to these creams if the dosage is too high or if they're used for a long period of time (usually more than 4 weeks). These side effects include thinning of the skin, developing visible blood vessels just under surface skin (spider veins), or developing little purplish or reddish spots that contain blood, or even encouraging stretch marks. There is a new type of corticosteroid cream and ointment, calcineurin inhibitors, which works on the immune system to help reduce the causes of inflammation. Ask your physician if these prescription medications might be best for you. Read the entire issue for more eczema control treatments.

Discovering the cause of any disease will help discover the cure. This is as true for allergies as it is for cancer. We are seeing a worldwide increase in the number of children who have allergies, eczema and asthma. One theory for this is that solid foods are introduced into an infant's diet too soon. Is this early exposure to solid food a reason the rate of allergies in children is growing? Some physicians believe it is, but the scientific proof isn't conclusive. Read the issue for more views on this topic.

Are you ruled by Sinusitis? Sinusitis is an infection or inflammation of the empty spaces in our head called sinus cavities. These cavities serve no purpose other than to make our heads lighter and easier to move, yet the lining of these cavities DO serve an important purpose: they protect us from breathing in dust, pollen and other foreign matter and germs. The sinuses are lined with a membrane, a soft, moist tissue covered with mucous and densely covered with tiny hair-like cilia which act like little combs or wands moving all the pollen, germs and other irritants caught in the sinuses, then flushing them into the stomach through the back of the throat, nature's way of filtering bacteria from entering our body when we breathe.

We have 4 pairs of sinus cavities: 2 above the eyes just behind the forehead; 2 to the side of the nose and below the eye just above the upper teeth; 2 between the eyes, and 2 far in the back of the head, far behind the eyes and above the throat, just in front of the brain case. Any complications in those particular sinus cavities are very serious.

At any given time, more than 35 million Americans have sinusitis which is any kind of inflammation or irritation of the sinuses and is usually caused by bacterial infections but can also be triggered by allergies. Symptoms start with a stuffy nose and heavy nasal drainage, but can also begin with nasal blockage instead or draining, and/or a thick yellow/green discharge. Problems occur if sinusitis becomes acute or sudden, with pain in the cheeks, forehead or between the eyes that worsens when coughing, lying down or bending over; with headache or toothache in the upper jaw; with fever or loss of sense of smell. These symptoms usually indicate infection. If you have a sinus infection you not only feel miserable but this infection can weaken the whole body's mechanism for keeping other infections away because the washing action by the cilia is compromised. And the worse your sinuses get, the worse you feel. You can't breathe properly until the sinusitis is treated.

Sinusitis may be caused by either a viral or bacterial infection and, in some patients with immune system disorders, sometimes fungus. Poorly controlled rhinitis or structural problems in the nose caused by tumors, polyps or a deviated septum (the wall that separates the left and right side of your nose) can also trigger sinusitis. Read this complete issue to learn how to prevent and treat sinusitis and the pain of sinus headache.

"Air it Out" continues our discussions with Dr. William Howland, MD, Board certified in Internal Medicine & Allergy and Immunology, Allergy & Asthma Center of Austin, (512-345-7635) concerning some difficult patient inquiries.

GERD (Gastroesophageal Reflux Disease) is linked to so many respiratory illnesses — asthma, allergies, food allergies, vocal cord dysfunction, chronic cough, COPD, Chronic Bronchitis to name a few. What exactly is GERD?

Dr. Howland explained that GERD (Gastro = stomach, Esophageal = swallowing tube) Reflux Disease is more commonly known as heartburn or indigestion. Reflux, or a back-up of stomach acids, occurs when stomach acid and digestive juices flow back up the swallowing tube (esophagus) and irritates or damages the membrane lining the esophagus. GERD patients may experience a burning or gnawing pain in the upper stomach or lower chest. A weakness of the muscle at the bottom of the esophagus as it passes through the diaphragm (muscle under the lungs which aids in breathing) is the usual cause.

Some people have a "hiatal hernia" which is a small part of the stomach dropped through the diaphragm into the chest cavity. With a hiatal hernia, acid reflux occurs because the diaphragm is no longer helping the esophageal muscle keep stomach contents in the stomach.

We asked "which comes first, the chicken or the egg? In other words, does having GERD provoke respiratory illnesses like asthma or do these respiratory illnesses cause GERD?" Dr. Howland replied that GERD is common in about 60% of asthma patients. It can make asthma worse in a number of ways. When stomach contents back-up into the lower esophagus, a reflex cough and broncho-spasm can occur, leading to asthma symptoms or exacerbation. Cough and heavy breathing associated with asthma can actually increase gastric back-up which can increase asthma and cough which results in a vicious circle of symptoms. GERD is often worse when a person is lying down; stomach contents can more easily back-up into the esophagus, a reason that asthma can flare at night while a patient is in bed. Reflux should be suspected for the asthma patient who wakes suddenly with a choking cough. Sometimes a patient will have spasm of the vocal cords as the body tries to protect the windpipe. The patient may feel tight in the throat or upper chest, feel they can't get a breath, or make wheezy sounds while trying to breathe in. The acute or sudden symptoms may pass in a few minutes but may be followed by asthma problems lasting minutes to hours. Reflux associated asthma and cough symptoms are worse if the underlying asthma is not under good control.

If cough and wheezing are prominent asthma symptoms, GERD may be a reason. To make things even more complicated, many asthma patients with GERD don't have heartburn or indigestion and are unaware that GERD is playing a role in their asthma. Theophylline, a popular pill which was used extensively in the US for asthma control until the 1990s, can actually make reflux worse.

Read the complete issue to learn how GERD is diagnosed and how it can be controlled.

Frequently, AAFA-TX receives some difficult patient questions. Air It Out asked Dr. William Howland, MD, Board certified in Internal Medicine & Allergy and Immunology, Allergy & Asthma Center of Austin, (512-345-7635) for his insight into these questions. The question today relates to geographical environment and asthma and allergies.

Many ask AAFA-TX the best place to live if they have respiratory illness. How does a humid or dry environment, or a heavily polluted environment or a thin atmosphere due to higher elevations affect those with respiratory diseases? Dr. Howland responded that weather, location and elevations affect the environment which can have secondarily affects on the respiratory tract, affecting asthma and allergies.

Lower elevations in metropolitan areas are associated with higher levels of air pollution and, depending on climate, higher levels of vegetation. Air pollution has a minor or major effect on allergies and asthma depending on the individual patient.

There are different types of air quality (AQ) problems associated with urban areas including gases (sulfur dioxide, ozone, diesel exhaust fumes) and fine particulates (carbon particles, latex particles from tires, etc). In general, these act as respiratory irritants and may also promote inflammation in the respiratory tract. In addition, increased levels of 'greenhouse gases', particularly carbon dioxide, can cause increased growth of plants (plants absorb carbon dioxide as food). Consequently, more pollution causes plants to grow larger and release more pollen resulting in more allergies. And, as our climate grows warmer (global warming) plants are pollinating for longer periods each year resulting in more allergies, too. Air pollution creates a vicious cycle for respiratory problems.

Geographic locations and elevations do affect respiratory illnesses. Locations closer to oceans may be better for allergic people. However, coastal areas are often humid with an increased mold spore count, a problem for those with mold allergy, plus heavier rainfalls encourage plant growth on shore, yet generally, tropical plants aren't pollinated by the wind but by birds and butterflies. Land located near lakes and rivers has an increase in vegetation pollen near the water and is generally associated with higher humidity levels which also encourage mold growth.

Desert or arid (dry) climates are generally better for allergy sufferers due to minimal vegetation and mold spores. Growing seasons in the desert are short except where there is heavy irrigation, too, which mean less pollen

Higher elevations have shorter growing seasons and less pollen too and dust mites can't survive at elevations above 5,000 feet. Many people find lower humidity and 'thinner' air at higher elevations is better for their respiratory symptoms but above 7,000 feet, many people experience shortness of breath associated with less oxygen in the air at elevations over 5000 feet. Most people adapt to this over several months; however, some people develop altitude sickness but it is rarely life threatening, just not pleasant. For more information on this topic, read the whole issue.

What is Vocal Cord Dysfunction and how does it relate to asthma? Perhaps it's easier to say what VCD isn't: it's not asthma although sometimes it mimics asthma and is mistaken for asthma and treated as asthma. VCD isn't a new condition although few doctors knew much about it until it was studied in depth at the National Jewish Medical & Research Center in 1983.

Symptoms mimic asthma and sometimes VCD is misdiagnosed as Exercise Induced Asthma when the patient doesn't have asthma at all. The Ohio State University Division of Pulmonary and Critical Care Medicine discovered that approximately 20% of their patients referred to them for disability evaluation due to asthma really had Vocal Cord Dysfunction, not asthma. VCD occurs when the vocal cords don't open and shut properly causing symptoms similar to asthma but there is no airway inflammation as there is in asthma. Symptoms of VCD include shortness of breath, intermittent hoarseness and/or wheezing, chronic cough and/or throat clearing, chest and/or throat tightness and difficulty taking in air. Many physicians unfamiliar with VCD treat the disorder as Exercise Induced Asthma, prescribing corticosteroids or bronchodilators but these have no beneficial affects for VCD.

There are differences between EIA and VCD: In Vocal Cord Dysfunction, symptoms occur less than 5 minutes after exercise begins; the patient complains of throat tightness and maybe some upper chest tightness; a high-pitched sound is heard when inhaling; repeated episodes will occur right after re-starting the strenuous exercise; recovery from an episode is usually less than 10 minutes; inhalers or corticosteroids have no affect on symptoms. With Exercise Induced Asthma, symptoms occur more than 5 to 10 minutes after beginning an exercise; there is usually middle or lower chest tightness; coughing or wheezing might occur when breathing out; it's easier to resume exercising because symptoms don't re-occur for several hours and inhalers and/or corticosteroids do usually ease symptoms.

The cause for this condition is unknown; but it does seem to be provoked by conditions such as post nasal drip, GERD (gastroesophageal reflux) or environmental triggers such as using the vocal cords harshly while singing or shouting, by exposure to tobacco smoke or exposure to chemical fumes or strenuous physical activity. A very real condition affecting thousands, it can also be precipitated by psychological stress and sometimes misdiagnosed as panic attacks. The strongest link to any other medical condition is to GERD, although it's not clear if the GERD is caused by VCD or the opposite. Part of a treatment plan for VCD is to treat the GERD, too.

Because it is so easy to confuse Vocal Cord Dysfunction as asthma or anxiety, it is important to have a correct diagnosis. Refer to this issue for more information about the diagnosis and treatment of Vocal Cord Dysfunction.

The majority of asthmatics (approximately 70%) have asthma that is triggered by allergies and 80-90% of asthmatics will also experience Exercise Induced Asthma while exercising, but some people who don't have asthma can also experience the symptoms of asthma during or immediately after vigorous or prolonged physical activity. How can that be?

During hard and/or prolonged exercise or strenuous activity like hard exercise, dancing, mowing the grass or moving furniture, we tend to breathe through our mouths rather than through our nose and this means the air we're breathing is colder and drier when it reaches our lungs because it misses the first few "stops" on the way to our lungs which cleanse and warm the air. The muscle bands around the airways are sensitive to temperature and humidity changes; they react by contracting or spasming if the incoming air is too cold or dry and this narrows the airways. These contractions result in asthma symptoms such as coughing, tightness in the chest, wheezing, or unusual fatigue while exercising or working strenuously, plus an accelerated heart rate and feeling a shortness of breath. If pollen counts are moderately high or high, or if the air is polluted with ozone, dust, exhaust, or smoke, or the air is cold or too dry, or if you have an upper respiratory infection, then the symptoms of exercise induced asthma could be worse.

If you're affected by EIA (exercise induced asthma), symptoms will usually occur within 5 to 20 minutes after the start of physical activity or 5 to 10 minutes after you've stopped the strenuous activity. Having EIA is not a reason to stop exercising or performing strenuous activity: an active lifestyle is important to both our physical and mental health. EIA can be treated. As always, the first step is to visit your physician for a proper diagnosis and then to develop a personal management plan tailored to your needs and activity preferences. Your physician may prescribe inhaled medications such as short-acting Beta2-Agonist or albuterol 15-20 minutes before you do strenuous exercises.

Select an activity or sport that works for you, one that fits your management plan. Many doctors feel all exercise or sports activities can work for most asthmatics if the proper management plan is followed; however there are some sports or exercises that have a greater tendency to induce EIA symptoms, exercise that forces your lungs to work hard over a long period of time or that expose your lungs to cold, dry air. Read the whole article for suggestions of appropriate sports activities and other tips on how to cope with Exercise Induced Asthma symptoms.

Stress is harmful, a condition we experience when we feel that the demands made on us exceed our personal ability to cope, in other words, a feeling of being overwhelmed. It can take many forms: internal, from a physical illness; external, caused by pain, extreme heat or cold; psychological, caused by poor working or living conditions, financial strain or by difficult social and personal interactions. Stress is a genetic response which is designed to save us from danger by releasing hormones that provide a burst of energy or adrenaline that protects us from a real danger. But this survival technique also has a negative impact for modern living: if not controlled, stress causes health problems by lowering our resistance and making us prone to diseases and skin eruptions like hives. Stress can also be a major trigger for asthma exacerbations or flare-ups. A chronic illness like asthma creates its own stress because of the constant medical, emotional, physical and financial disease pressures. Stress and strong emotions can worsen asthma symptoms in some people. The hormones released by the body during times of stress cause the muscles around air passages in the lungs to tighten, which narrows the air tubes, making it difficult to breathe. It is important that asthmatic patients learn to recognize stressful situations (an asthma exacerbation is definitely a stressful situation) and know when they need to relax and how to concentrate on slowing down their breathing in order to relax.

Stress also makes many allergy related symptoms appear or worsen. When we are under stress, allergy symptoms tend to pop-up; you can actually acquire more allergies during times of stress as your body's immune system goes into overdrive.

Dealing with stress levels is an important step towards controlling and preventing asthma and allergy symptoms as well as enjoying life a lot more. The key to avoid stress-induced asthma symptoms is to learn basic relaxation breathing techniques and practice them BEFORE an asthma flare-up occurs and to know how to use these same techniques during an exacerbation to help reduce the affects of the symptoms. This issue describes breathing and relaxation techniques to help reduce stress and help reduce the affects of stress related asthma and allergy symptoms.

Severe food allergy can result in anaphylaxis, a life-threatening response to an allergen. Anaphylaxis can also be provoked by allergy to insect stings or bites, latex and medications. What can a child or adult with these severe allergies do? 1) They should see a physician to identify their allergens and then avoid them completely. 2) For those with severe allergies that could lead to anaphylaxis, day-to-day living is more complicated by the need to avoid their allergens. Be vigilant in avoiding the allergic foods or other allergen. Read labels carefully as products often change their recipes or formulas. Learn the food family your allergen falls into and if instructed to do so by your physician, avoid foods in the whole family. Take care eating outside the home, always asking the chef if there is danger of cross-contamination for your allergen. 3) Persons at risk for anaphylaxis should carry an epinephrine device such as Twinject or Epipen at all times (in an emergency, it serves little purpose at home in the medicine) 4) Wear a medical alert ID bracelet or necklace so others will know the cause of distress in an emergency. Some examples of these are found on American Medical ID's website.

But what if your children don't have serious allergies that can lead to death? 4 of 6 food allergy deaths occur in schools; what can schools do to help prevent a food allergy provoked death on campus? What can you, the parents of children with classmates or friends with severe allergies do to prevent an anaphylactic incidents for those classmates? The answer focuses on compassion. The goal is NOT to ostracize any child or adult with severe allergies which might lead to anaphylaxis but to respond with understanding and compassion. Read the entire issue for suggestions how you can help those with severe allergies prevent a life threatening incident.

Did you know that asthmatics who breathe air containing coarse particulate matter (road & construction dust, etc) may be exposing themselves to heart problems according to a recent study by the University of N. Carolina Center for Environmental Medicine. For asthmatics, even breathing a small amount of these particles found in poor quality outdoor air can increase their bad cholesterol levels and increase inflammation-linked white blood cells.

Did you know that

one of three university athletes has exercise-induced asthma, or EIA. A recent study conducted at the Ohio State University Asthma Center said these athletes may have no prior history of asthma. EIA usually occurs 5 to 20 minutes after intense physical exertion with symptoms like shortness of breath, chest pain, wheezing, chest tightness or coughing. Approximately one in ten people with no history of asthma can experience EIA, and neither gender nor sport made any difference in testing positive for EIA. Often EIA in competitive athletes is misdiagnosed because the symptoms vary so widely. Researchers stressed the need to develop routine asthma diagnosis and management standards for competitive athletes.

Did you know the number of medication allergies is rising, and if a patient with a drug allergy is admitted to hospital and is unconscious or otherwise unable to share drug allergy information to the admitting nurse, this omission could be fatal. Even if an allergy is in the patient's personal medical records there is no way (yet) the hospital can tap into those records in an emergency.

Did you know some adults who have chronic bronchitis and are smokers may have or develop COPD or Chronic Obstructive Pulmonary Disease. Chronic bronchitis in a smoker (or past smoker) may be one of the earliest signs of COPD, an irreversible disease where there is inflammation in the small airways with airflow obstruction, shortness of breath, a chronic cough and lots of phlegm.

Did you know the beach phenomenon known as "Red Tide," found seasonally along the Gulf coast of Florida, is actually blooms of an ocean organism that produces potent toxins. A healthy person who inhales these toxins may have eye irritation, rhinitis, wheezing and a non-productive cough which usually disappears an hour after leaving the beach. These toxins affect asthma patients to a greater degree. Asthmatics exposed to the toxins for just an hour experienced respiratory problems and decreased lung function. If you live in Florida or plan a vacation there and are asthmatic, be alert for "Red Tide" invasions and stay off the affected beaches.

Did you know the number of persons experiencing allergic rhinitis worldwide is rising, perhaps due to an increase in poor outdoor air quality due to Global Warming plus an increase of poor indoor air quality due to our use of volatile compounds and chemical irritants in building materials and home furnishings.

Did you know that if you have red or puffy skin on parts of your body, you might have an allergic skin condition called angiodema which is swelling in the deeper layers of the skin and often occurs along with hives. Angiodema usually occurs in the soft tissue of the body — the eyelids, mouth or genital area and can be chronic or acute. Like hives, they are an allergic reaction of histamines but in deep tissue, not surface skin.

To learn more about these topics, including how to control these issues, read the full article.

The number of people afflicted with asthma continues to rise. It is now the third leading cause of hospitalizations in the US. In Texas in 2005, 6.8% of the adult population and 6.2% of children under age 17 had asthma. Between 1999 and 2005, 1,831 Texans died of asthma complications. This isn't a local problem but a worldwide problem with every nation reporting major increases in the incidence of asthma. Why are we seeing this drastic increase in asthma patients? Scientists first have to examine what causes asthma before they can examine why there is such an increase in the number of children and adults presenting with this disease.

There is no single cause of asthma; there is no simple answer. Many physicians now believe asthma is a syndrome, signs and symptoms indicating characteristics of a disease. Many factors determine why one person has asthma and another doesn't. One reason for asthma is genetics; some people have an inherited tendency to allergies and asthma.

.Asthma may be triggered by the "hygiene hypothesis." In order for our immune system to develop properly, it must be exposed to bacteria, viruses or other invaders to build up resistance, yet now we sanitize everything with antibacterial cleaners, we overuse antibiotics when not needed, killing all bacteria, the good and the bad. We don't allow our immune systems to develop and do their job. But the hygiene hypothesis alone doesn't explain the immense growth in the number of asthma cases.

The rise in obesity also affects the increase in the incidence of asthma. There is a connection between these two diseases. Many scientists believe the most likely cause of the rapid asthma growth rate may be due to environmental factors.

What are these contributing environmental factors? 1) Smoking: anyone who smokes and has asthma, or who is around a smoker, will have more severe asthma symptoms and those who don't have asthma are at risk for developing asthma (and cancers) if they smoke or are around smokers. Even your pet dog could develop cancer or respiratory problems from being around a smoker. The message: stop smoking. Yes, it is difficult to stop since nicotine is addictive, so it's best not to start. Whatever means it takes stop smoking. 2) Air pollution: we know dirty air makes asthma symptoms worse but it hasn't been proven that bad air quality will actually cause anyone to develop asthma. 3) Environmental allergens: these are the substances which cause our immune system to react with an allergic reaction. The most common include animal dander, particularly cat dander; dust mites, mold and pollens. Again, scientists don't feel that any of these allergens can cause asthma, but they do cause symptoms in those with asthma.

So, if it's not 100% genetic, not caused by smoking, dirty air or cat dander, what is causing this increase in asthma? The BAD NEWS is, no one knows for certain and until scientists do determine the cause of this disease and how to prevent it, the GOOD NEWS is, asthma can be controlled! YOU have the power to control your asthma. Read this issue and learn tips to empower yourself and control this life-threatening disease.

In this issue, we continued our conversation with Dr. Richard Herrscher, MD, Board Certified in Internal Medicine and Allergy and Immunology. Dr. Herrscher has offices on Communications Parkway in Plano (972-473-7544). We asked him how infant asthma is diagnosed. Dr. Herrscher responded that diagnosing asthma in infancy (children up to 2 years of age) is extremely difficult and is based primarily on visible symptoms including wheezing or chronic cough. The main problem with symptom diagnosis is that many infants will also wheeze when they have a viral respiratory infection. Many times an asthma diagnosis is deferred until after age 5 when the progression to asthma can be more accurate. Currently available diagnostic tests aren't reliable or possible for infants. Typical diagnostic tests such as office based tests of lung function (forced expiration and impulse oscillometry) can sometimes be used reliably down to age 3 but not below that age. Exhaled nitric oxide testing has shown promise in diagnosing asthma, but this test is not widely available and again has limits down to age 3. Invasive procedures such as bronchoscopy or closed loop spirometry can be used in infants but are usually reserved for research situations or in severe cases when a diagnosis or the need to rule out other diseases is critical. High resolution CT scanning has the ability to show changes in the airway in infants indicative of asthma, but this test is still not validated or proven. This brings us back to the point of symptoms for most infant diagnosis.

Current studies and the 2007 asthma guidelines give risk factors that can be used to predict the probability of infant wheezing progressing to asthma. These risk factors include 4 or more wheezing episodes in the last year that lasted more than 1 day and affected sleep AND have EITHER one of the following: parental history of asthma, physician diagnosed eczema, or evidence of IgE sensitization to aeroallergens OR two of the following: IgE sensitization to foods, blood eosinophils more than 4%, or wheezing not related to colds. Infants with these risk factors have a high probability of asthma after age 5.

There are some signs to look for indicating an infant might be having an asthma flare-up or exacerbation. The typical signs are wheezing or audible sounds while the infant is breathing. Pressing one's ear over the infant's chest or back closely mimics what can be heard with a stethoscope and improves the ability to pick up wheezing sounds. Chronic or frequent cough is often the only sign seen in infants, particularly if it worsens at night or after exertion/play. Other more serious signs include rapid breathing or retractions (sinking of the skin inward) of the abdomen/chest/neck, cyanosis or pallor (either a blue or a pale tint to lips, face or hands, feet, nails), and restlessness during sleep or listlessness while awake.

We asked Dr. Herrscher the difference between RAD (Reactive Airways Disease) and asthma, also. Read this article for his response concerning RAD as well as some valuable tips for patients who use albuterol. New inhalers propelled by HFA (hydrofluoroalkanes), an aerosol gas that is environmentally friendly, will be mandatory by December 31, 2008. What differences will patients who use albuterol notice in their new inhalers? This issue helps explain those differences.

AAFA-TX has a patient & caregiver "helpline" to answer questions on asthma and allergies, provide referrals or sources of assistance for disease-related issues. Some questions are complicated. Air It Out asked Dr. Richard Herrscher, MD, Board Certified in Internal Medicine and Allergy and Immunology, for help. Dr. Herrscher has offices on Communications Parkway in Plano (972-473-7544).

We asked Dr. Herrscher if there was a difference between asthma diagnosed in childhood and Adult Onset Asthma. Dr. Herrscher remarked that while the majority of asthma cases do begin in childhood there are subgroups including early onset (infancy) asthma, with wheezing due to viral respiratory infections that seem to fade away by school age. Children that continue or begin to wheeze after age 5 show more signs of allergic disease and have more persistent asthma into adulthood, though as many as half of these cases will improve in puberty or early adult years. Several studies have shown that the severity of childhood asthma from ages 5-10 tends to predict the severity of asthma that persists into adulthood, with lung function remaining relatively stable over time.

Adult Onset Asthma, another subgroup, shows less chance of improving; it tends to be more severe and more progressive in terms of lung function decline. While Adult Onset Asthma can show the typical allergic characteristics of childhood asthma, many cases are non-allergic and are typified by either 1) an increase in eosinophils (a white blood cell common with allergies), nasal polyps and aspirin sensitivity or 2) wheezing that is made worse by gastroesophageal reflux (GERD). These two subgroups of Adult Onset Asthma are different from the typical allergic childhood form of the disease in both physical and genetic characteristics.

The current feeling is that asthma is a syndrome much like high blood pressure, with multiple genetic causes that interact with an individual's environment to produce different aspects of this disease. These different aspects or clinical variants determine severity, progression and response to treatment. However, we are just beginning to determine precisely these different genetic-based forms of asthma. The current classifications of asthma are based on a model of severity that takes into account the level of symptoms, lung function and risk of exacerbations or flares. This is useful in determining the level of initial treatment necessary for symptom relief, but leaves us short in predicting the natural progression of asthma or the response to treatment, in other words, will the patient improve?

Another problem with the current classification scheme is that it is based on studies performed in older children or adults with results carried over into the younger age groups. Since kids under age 5 have the highest incidence of asthma onset and there seems to be quite a bit of difference compared to adult asthma, one has to ask is this extrapolation rational or even appropriate? The current asthma classification and treatment guidelines are the best evidence-based models we have and while there may be major changes later as more research is done, we have to work with what we know, not with what we don't know.

Dr. Herrscher continues by discussing the current asthma classification scheme divided into four subgroups determined by a patient's symptoms, as well as commenting on endoscopic sinus surgery to improve allergy symptoms.

Asthma patients can use special devices to help measure lung function or to help take their medications. These devices include peak flow meters, spacers and nebulizers.

A Peak Flow Meter is used by both adults and kids to measure breathing; it can detect breathing difficulties even before other symptoms of an asthma flare occurs. In fact, a first sign of an asthma flare-up is a drop in the peak flow reading, which is why it's so important to have and use a PFM. A peak flow meter will help you to stay compliant with your medication plan — if used correctly.

Devices differ but each has 3 color "zones" indicating how open the airways are: Green = airways are open, the patient feels well and can perform all normal activities; Yellow = airways are blocking, the patient doesn't feel very well, activity is slowed down and it may mean using additional medications; Red = danger! This means the airways are closed; the patient feels very ill, has great difficulty breathing and may even have blue lips or fingertips. Immediate help, more medications and perhaps emergency care is required. Every patient has a "best number" or benchmark - the biggest, fastest breath blown into the meter when the patient feels well and has no asthma symptoms.

Some doctors may recommend using the PFM twice a day for a few weeks, especially when beginning new medications; some recommend using it in the morning before taking medications, or both before and after taking medicine to see how effective the prescribed medications are in controlling the patient's asthma.

Many asthma medications are delivered by inhaler, a hand-held tube used to hold a medicine cartridge. A propellant gas directs a spray of medicine into the lungs. Usually adults or kids over six years of age use inhalers but some younger kids may be able to learn how to use one. Younger children may use syrup, liquid or pill medications instead.

A spacer is a tube device that's attached to an inhaler focusing the medication into the lungs so most or more of the prescribed dose is inhaled. Without a spacer medication often escapes into the air, not into the lungs. To use, gently shake the inhaler, then hook it into the spacer; place the spacer mouthpiece into your mouth, push the inhaler once to put one dose of medicine into the spacer holding chamber, inhale slowly and hold your breathe for 5-10 seconds then slowly exhale..

A nebulizer is a machine driven by compressed air converting medicine into a mist to be breathed through a tube or mask. Kids under age 5 or patients who have problems using a metered dose inhaler or patients with severe asthma will often use nebulizers. These machines ensure the patient gets the right dosage of medication. To learn how to use and maintain these asthma devices, refer to this newsletter issue.

There may be an additional step that children and adults with allergies or asthma should follow to help reduce their allergy and asthma symptoms and the number of asthma flare-ups, other than eliminating their allergens and following the right medication plan: they could adopt a healthy diet of the right foods to help reduce exacerbations and symptoms.

According to some physicians, eating a nutritious diet helps alleviate or perhaps even prevents allergy and asthma symptoms for several reasons. Eating certain foods controls the underlying causes for inflammation of the airway passages; eating certain healthy foods can dilate the airway passages; certain healthy foods may thin the mucus in the lungs; a healthy diet consisting of the right foods may prevent food-allergy reactions that can trigger asthma flare-ups; obesity affects asthma and the best way to reduce weight is to eat healthy foods, eat less and exercise more.

Overweight/obese children and adolescents have more severe asthma then asthma patients who have a normal Body Mass Index. Obesity statistics are shocking. In 2002, 10 million or 63% of adult Texans were overweight or obese compared to the national rate of 33%. The Texas Department of Health states 33% of Texas children (6-11) and adolescents (12-19) are overweight or obese compared with the national average of 15.5%. These numbers nationwide have doubled over the past 25 years and they're still growing. A serious side effect of childhood obesity is more serve asthma.

Eating healthy means avoiding empty-calorie foods, fast-foods loaded with bad fats or eating an excess of meat protein. Healthy eating means eating more fruits, veggies, whole grains, fish, dairy, beans, lentils and soy proteins.

What specifically are these good foods? Foods containing the good fat, Omega-3 Essential fatty acids, that are natural anti-inflammatory agents; fruit juices that are loaded with antioxidants and which clear inflammation from the body; high-fiber foods that are good for the gut, boosting our immune system; eating large quantities of "live active culture" yogurt daily to restore the balance between good and bad bacteria in the gut where most of our immune system is located.

Read more about the super foods which should become part of your healthy diet to help control asthma and allergy symptoms.

Allergic Rhinitis, commonly referred to as runny nose, is an inflammation in the nose caused by exposure to an allergen. There may be other symptoms besides a runny nose such as sneezing, congestion, or an itchy feeling in the nose, throat, or on the roof of the mouth, or even watery or itchy eyes and blurred vision and a general "lousy" feeling, or a combination of these symptoms. The symptoms can vary each day and from person to person, too. Some have what is referred to as seasonal allergic rhinitis, or Hay Fever, which occurs at certain times of the year and is usually triggered by pollens. This seasonal rhinitis may last only a few months until the first frost kills the pollens. But if you have symptoms all year round, then you have perennial allergic rhinitis and this is generally caused by environmental allergens including but not limited to dust mites, mold, animal dander, cockroaches or chemical irritants.

Most rhinitis patients treat the symptoms with over-the-counter medications; some ignore the symptoms hoping they'll go away; others don't even recognize that the symptoms they're experiencing are an allergic response and not a cold. Ignoring rhinitis or under-treating it can lead to other health problems. Our nose, throat and ears are all inter-related, and sometimes chronic rhinitis symptoms lead to other long-term medical problems, some with serious results, especially for young children.

Untreated allergic rhinitis can provoke middle ear infections, post-nasal drip, sinus infections, chronic congestion, headaches and even sleep apnea. Learn the signs and symptoms of rhinitis and how to help avoid these complications.

Asthma varies from patient to patient. Most (approximately 70%) have asthma symptoms that are triggered by allergies and/or irritants; some have asthma triggered by exercise; some will have asthma symptoms triggered by allergens, irritants and exercise. Some have very mild occasional asthma symptoms; some have more frequent symptoms but still moderate in severity; they might need to use more medications to control their asthma. Yet they can control their asthma. But approximately 10% of all patients have very severe asthma and control is difficult.

There are possible explanations why someone gets to the point where they have severe asthma. One possibility is that the asthma was misdiagnosed, under-diagnosed or un-diagnosed in the beginning when control was more attainable. Or it may not have been treated properly with the right medications. Many times severe asthma is the result of lack of compliance by the patient. The patient may have the right medications but doesn't take them, or doesn't use them as prescribed as often as is necessary.

If the severe asthma patient has been properly diagnosed and is compliant in taking their medications, perhaps the severity is the result of not eliminating the environmental allergens that trigger their asthma. Or, the patient might have a viral infection causing acute and chronic bronchitis or bronchiolitis. Or, the patient may be exposed to air pollution, especially in the form of tobacco smoke. If you have asthma and you smoke or are around smokers, whether cigarettes, pipes or cigars, your asthma will be more serious and you will have more frequent flare-ups. Or, the patient may be overweight or obese, which impacts asthma severity, making it much worse.

Chronic rhinitis, nasal polyps (growths), sinusitis (sinus inflammation that reoccurs frequently) or untreated gastric reflux - GERD (back-up of stomach acids into the esophagus and sometimes into the airways) can also contribute to the severity of asthma. If any of these above conditions are the contributing cause, then once the condition is treated successfully, asthma severity may improve.

Learn about the contra-indications of NSAIDS and beta blockers for those with severe asthma and the ways you can control severe asthma.

A new study examines the likelihood of developing childhood asthma if multiple dogs live in the household. Is this a deterrent to developing asthma in young children or do other factors play a role, too?

Aspirin is recognized as beneficial to heart health in adults but will taking an aspirin every other day help deter adult onset asthma also?

A British study concludes all pillows, whether foam, feather, or synthetic, are miniature ecosystems and breeding grounds for fungus. Learn what you can do to prevent breathing potentially harmful fungal spores.

Will your son be more likely to acquire asthma rather than your daughter? What impact does sexual gender have on asthma and why?

The best way to control your Hay Fever (or seasonal Rhinitis) is to avoid the allergens that trigger it but in Texas that's very difficult. Trees are the earliest pollen-producers and pollen producing trees remain active into November in Texas. Tree pollen is so light winds can carry these pollens many miles from their source. Of the more than 50,000 types of trees, less than 100 types contribute pollen, and most of them are native to Texas. How can you reduce your exposure to these and other pollens that trigger your Hay Fever?

About 20% of us develop hives at some time in our lives. Hives usually just "appear" without warning and generally, individual hives only last for 24 hrs. and most cases of hives disappear in 2-4 hours; yet for many, a bout of hives can last anywhere from a few hours to six weeks.

Some people, however, have hives constantly or their hives may last for years in the form of chronic urticaria. Though it feels like it to those affected, chronic hives aren't life-threatening yet they can cause disability and lots of distress.

Sudden or acute hives are usually caused by an allergic reaction to a normally non-threatening substance or phenomena. Hives can be caused by foods, medications or insect bites or stings, but no one knows with certainly what causes chronic hives. Many physicians think chronic hives may be a reaction to oneself.

Chronic, or continual hives can be aggravated by heat, stress, fatigue or exertion, alcoholic drinks, fever, hyperthyroidism and even PMS. Some people have what is known as "pressure" hives; they occur on the buttock (from sitting in the same position too long) or around the waist if belts are worn too tight. Chronic hives shouldn't be ignored but examined by a physician to determine the cause. It may be a symptom of some other illness or disease triggering the hive reaction. Your physician will want to rule out other diseases that can have hives as a symptom such as hepatitis, hyperthyroidism, Lupus or even possibly (but rarely) cancer. Learn how to best treat hives in this issue.

In the News: there are two primary steps to keep your asthma in control: identify and eliminate contact with your triggers and then develop a good medication plan that works for you, and, most importantly, follow it. But there's a third step to this equation: the time you take your medications. Learn the role circadian rhythms play in asthma and allergy control.

New school-year jitters are common for every child no matter the age. It's always a challenge for both parents and kids to face a new school year if your child has asthma and allergies, but it doesn't have to be a fearful or unpleasant experience if you take a few steps to prepare.

The first step is to make a doctor's appointment before school begins to assess your child's asthma control.

Next, fill any new prescriptions. Check to see all inhalers are full; get an extra peak flow meter to keep at school; mark all medications and devices with your child's name using labels. Texas law allows kids with asthma to carry and self-administer prescription asthma medicine on school property or at a school-related event if the student has written permission from the student's parent and physician. Parents and nurses: ask AAFA-TX for a free form.

Next step, make an appointment with your child's new teacher to: clarify what the teacher knows about asthma and allergies; discuss your child's triggers; if you feel your child is too young to handle their own meds at school, ask where medications will be kept — and how the child accesses them; develop an emergency plan: make sure the teacher knows how to use asthma devices; discuss how exercise and emotions effect the disease and perhaps your child's actions.

If the child is at risk for anaphylaxis ask your physician for epinephrine auto-injectors, one to send to school, one to keep at home. Texas law allows a child to carry their own epinephrine devices to school or at school sponsored activities with signed permission. Ask us for a free permission form.

Discuss these allergies with teachers and school staff. Are teachers and staff aware of the symptoms of food allergy? Ask what steps are taken at school to prevent cross-contamination of food allergens. Children, especially little ones, won't or can't verbally express all their symptoms for a severe allergic reaction. Supervising adults have to learn body language and "child-speak" and then act quickly to save a life. If they see any of these signs after a child is exposed to their allergic trigger, teachers must follow emergency procedures. Ask AAFA-TX for a free copy of an anaphylaxis emergency action plan. Empower yourself and your child this school year.

Ninety percent of asthma patients and all of their caregivers sometimes have disturbed sleep because of the disease. Most physicians agree: neither asthma patients nor their caregivers have to suffer from disturbed sleep. The major reason an asthma patient might have a poor night's sleep is uncontrolled or poorly controlled asthma.

Many asthma flare-ups or symptoms occur at night, robbing patients of the rest they need to withstand and recuperate from these same flare-ups. The reasons for these nocturnal flares or symptoms vary. They might be caused by the "morning dip," by other medical issues such as GERD, or even the time medications are taken or daytime stress can affect a patient's ability to sleep well, and sleeping poorly creates a vicious circle of symptomatic daytime asthma as well. Yet there are some simple and easy steps to take that ensure a good night's rest for both patients and caregivers.

Choosing the right childcare facility is a challenge for all parents. Every parent wants a safe facility with qualified instructors, a school where their child can feel welcome and will thrive. Cost and convenience are also considerations for most parents. If your child has allergies or asthma, there are more factors to consider in choosing the right facility including its location, whether the staff has had disease education, how well the facility controls environmental allergens and whether they have anaphylaxis procedures in place, just to name a few areas of concern.

If possible, parents or caregivers should always visit the facility before a decision is made to enroll a child. Parents should interview the director and ask some very important questions to safeguard their children. AAFA-TX recommends some things you might consider in making your selection if your child has asthma or allergies so that you can be an informed advocate for your child.

If you have food allergies or food sensitivities, its normal that you might be concerned that eliminating certain foods from your diet because of your allergies might also mean eliminating nutrients like omega-3 fatty acids, proteins or good carbohydrates required for over-all good health. With careful choices and some new products, eating healthy with food allergies or sensitivities is now easier for those with allergies to fish, eggs or wheat (celiac disease).

We all look for shortcuts to help us with routine chores like cooking, cleaning, gardening, etc. But if you have asthma or allergies, there is something to consider with these shortcuts besides convenience: many of the products we use to speed our housekeeping chores consist of chemicals that irritant asthma or can even cause asthma symptoms. The chemicals most often used in cleaning products, Formaldehyde, Ammonia, Sodium Lauryl Sulphate, D-Limonene and Sodium Hypochlorite, are not true allergens, but they can be irritants and unhealthy for anyone but especially dangerous to those with asthma or allergies. For those with asthma, whose lungs are in an irritated condition under normal circumstances, these strong chemicals found in almost all commercial cleaning products can exacerbate symptoms - even causing a flare-up. Breathing these chemicals can cause symptoms like congestion, rhinitis, red, burning or itchy eyes, wheezing, headaches, coughing or even disorientation. People with eczema might also break out in a rash when coming into contact with these harsh chemicals. As with any irritant, reactions will vary from person to person from mildly annoying to actually debilitating. If you think rushing out to buy "natural," "organic" or "green" cleaning products is the answer to avoiding these chemicals, think again. Many "natural" products contain some of these chemicals because these chemical are found in nature. But there are some non-toxic cleaning substitutes which normally won't cause irritation.

Do asthma and allergies have an effect on pregnancy? Uncontrolled asthma in pregnancy can contribute to complications; controlled asthma during pregnancy poses little problems or risks to either mother or unborn child.

Indoor air pollution is one of the top 5 environmental health risks. Is your homes IAQ (Indoor Air Quality) poor? How can you tell? What can you do to improve your IAQ?