Archive for April, 2014

All About Seasonal Allergies

If you are among the 40 million Americans who have seasonal allergens, you know all too well that springtime means higher pollen counts.

I described the typical causes and treatments for seasonal allergies, as well as dispelled some allergy myths, in the April 2014 issue of American Legion magazine.

Here’s the gist of the article in the magazines “Living Well” section below:

Seasonal allergies such as hay fever are the most common type of an allergy, which is an overreaction of your immune system to a foreign substance (“allergen”).

This immune overreaction can result in symptoms, such as coughing, sneezing, itchy eyes, runny nose, and scratchy throat.

In severe cases of skin, food, latex, insect, or eye allergies, it can lead to rashes, hives, lower blood pressure, difficulty breathing, asthma attacks, and even death.

Knowing exactly what you are allergic to can help you lessen or prevent exposure, and treat your reactions.

Allergy skin testing, considered the most sensitive testing method, provides rapid results.

The most common test involves pricking the skin with the extract of a specific allergen, then observing the skin’s reaction.

Blood tests can also provide similar information to allergy skin testing.

Treatment

The best treatment for allergies is to avoid the offending allergens.

If you are allergic to a specific food like peanuts, remove them from your diet (be careful for hidden peanuts in foods).

That’s not so easy when you are allergic to ragweed pollen in the air.

Various over-the-counter or prescription medications can relieve the common symptoms of hay fever.

Antihistamines

These medications counter the effects of histamine, the substance that makes your eyes water, nose itch, and causes you to sneeze.

Newer antihistamines do not cause the sleepiness that was a problem with older versions.

Nasal steroids

These anti-inflammatory sprays help decrease inflammation, swelling, and mucus production.

They work well alone or in combination with antihistamines, and are relatively free of side effects.

Cromolyn sodium

This nasal spray also helps stop hay fever, perhaps by blocking release of histamine and other symptom-producing chemicals.

It has few side effects.

Decongestants

Available in capsule and spray form, these drugs may reduce swelling and sinus discomfort.

They are intended for short-term use, and usually are used along with antihistamines.

Be aware that long-term use of decongestant sprays can make your symptoms worse.

Allergy shots

Also known as immunotherapy, these might help if you don’t get relief with antihistamines or nasal steroids.

These shots alter the body’s immune response and help to prevent allergic reactions.

They are the only form of treatment that induces long-lasting protection.

But immunotherapy treatments are limited because of potential allergic reactions, which can be severe.

Allergy Myths and Misconceptions

Common myths and misconceptions about allergies persist due to false information in the media and online.

David Stukus, MD, an allergist at Nationwide Children’s Hospital in Columbus, OH, outlines some of the greatest myths.

1. “I’m Allergic to Artificial Dyes” – There is no scientific evidence to support a link between exposure to artificial coloring and allergies.

2. “I Cannot Have Vaccines Due to an Egg Allergy” – Egg embryos are used to grow viruses for vaccines such as the flu, yellow fever, and rabies shots. But it’s safe to get a flu shot, which can help prevent serious illness.

3. “At-Home Blood Tests Reveal All You Are Allergic To” – These tests might reveal sensitization, for example, to milk, but that doesn’t mean you are necessarily allergic to it.

4. “I’m Allergic to Cats and Dogs, but Can Have a Hypoallergenic Breed” – There is no such thing as a truly hypoallergenic cat or dog.

It’s not the fur you may be allergic to but the allergens released in saliva and glands.

5. “I’m Allergic to Shellfish and Cannot Have Iodine Imaging” – Some physicians have linked a reaction to iodine dye used in imaging tests to a shellfish allergy.

But iodine cannot be an allergen since it is found in the human body.

6. “I Can’t have Bread, I’m Allergic to Gluten” – Many people claim to have a gluten allergy.

You may have gluten intolerance, but it’s extremely rare to have a true allergy to wheat-based foods.

If you think you may have an allergy, Dr. Stukus recommends that you see a board-certified allergist for proper evaluation, testing, diagnosis, and treatment.

Lifestyle Measures Cut Cardiovascular Deaths in Prediabetes

Weight loss and other lifestyle interventions can reduce the risk of long-term cardiovascular consequences of diabetes, according to the results of a clinical trial.

This is the first randomized clinical trial to show that lifestyle intervention in those with impaired glucose tolerance reduces all-cause and cardiovascular disease mortality.

Lifestyle intervention delays the onset of diabetes and reduces the incidence of diabetes.

We had assessed how mortality was affected by the time free from diabetes, which was defined as the time between randomization and onset of diabetes.

We found that the increased delay in the onset of diabetes was associated with significantly lower all-cause and cardiovascular disease mortality,” said lead author Professor Guangwei Li of the China-Japan Friendship Hospital, Beijing, China.

“After inclusion of time to onset of diabetes in the multivariable models the intervention variable was no longer statistically significant, suggesting that the reduction in mortality associated with the intervention is mediated by its effect in delaying the onset of diabetes,” he noted.

The researchers published their results online on April 3, 2014 in The Lancet Diabetes & Endocrinology.

LIFESTYLE INTERVENTIONS PREVENT DEATHS

Many research studies have shown that lifestyle interventions, such as exercise programs or weight loss, in persons with impaired glucose tolerance can prevent progression to overt type 2 diabetes.

However, until now, there has been a lack of high-quality, randomized controlled trial evidence to prove that lifestyle interventions prevent deaths from cardiovascular disease, such as heart attacks and stroke, in these patients.

Dr. Li and colleagues enrolled 438 patients assigned to the intervention arm and 138 patients who were assigned to the control arm.

The study intervention lasted for 6 years, and patients were then monitored for 23 years.

At the end of the follow-up period, cumulative incidence of death from cardiovascular disease was 11.9% in the lifestyle intervention group versus 19.6% in the control group.

Death from all causes was 28.1% in the lifestyle group versus 38.4% in the control group.

The difference between groups for both outcomes was statistically significant.

“Although the association between duration of diabetes and mortality is well established, serious chronic complications and excess mortality typically only occur after at least 10 years of having diabetes,” Dr. Li said.

“In the present study, a difference in mortality between the intervention and control group started to emerge 12 years after the study began, slowly increased to a 17% difference by the 20-year follow-up, but became statistically significant only after 23 years.”

“TYPE 2 DIABETES CAN BE PREVENTED”

Dr. Li noted that a key difference between previous other studies and the Da Qing Diabetes Prevention Study is the length of follow-up.

In previous studies, the length of follow-up might have been insufficient to detect an effect of intervention on mortality.

Dr. Li’s bottom-line message: “Type 2 diabetes can be prevented.

Group-based lifestyle interventions over a 6-year period have long-term effects on prevention of diabetes beyond the period of active intervention.

The benefits of the intervention extended to a significantly favorable reduction of mortality.

These results emphasize the long-term benefits of the intervention and reinforce the overall value and importance of lifestyle interventions as public health strategies to prevent diabetes.”

Relaxation Followed by Stress Triggers Migraines

If you have migraine headaches, they may increase significantly after you relax and then experience heightened stress, according to the results of a new study.

“People with migraine are thought to inherit a predisposition to headaches.

Attacks of migraine headache are initiated in vulnerable individuals when they are exposed to a broad range of triggers,” said study co-author Dawn C. Buse, PhD, Director of Behavioral Medicine, Montefiore Headache Center, and Associate Professor, Clinical Neurology, at the Albert Einstein College of Medicine in New York.

“Our study results support the ‘letdown phenomenon,’” she said.

“That is, relaxation following high perceived stress is a powerful predictor of migraine onset.”

The researchers published their results online on March 26, 2014 in the journal Neurology.

MIGRAINE DIARIES COLLECT TRIGGERS

Dr. Buse and colleagues asked 17 patients with migraine to keep electronic diaries for 3 months to examine the relationship of perceptions of stress and relaxation after stress with increased probability of a migraine attack, yielding more than 2000 diary entries, including 110 eligible migraine attacks.

Data were collected using a custom-programmed electronic diary.

Each day patients recorded information about migraine attacks, 2 types of stress ratings, and common migraine triggers.

Triggers included hours of sleep; certain foods, drinks, and alcohol consumed; and menstrual cycle.

They also recorded their mood each day, including feeling happy, sad, relaxed, nervous, lively, and bored.

“We found that a reduction in stress from one day to the next was associated with a nearly 5-fold increased risk of migraine onset within 6 hours,” Dr. Buse said.

The biology of stress is complex, including activation of both neuroendocrine and sympathetic mechanisms, she noted.

“Cortisol rises during times of stress.

If cortisol falls in periods of relaxation after stress that may contribute to the triggering of a migraine attack,” said lead author Richard B. Lipton, MD, Director, Montefiore Headache Center, and Professor and Vice Chair of Neurology and the Edwin S. Lowe Chair in Neurology at Einstein.

STRATEGIES TO REDUCE STRESS

“This study highlights the importance of stress management and healthy lifestyle habits for people who live with migraine,” Dr Buse stated.

“It is very important for people to be aware of rising stress levels and attempt to relax during periods of stress rather than allow a major buildup to occur.

Strategies to relax could include exercising, attending a yoga class, taking a walk with your dog, or simply focusing on your breath for a few minutes.”

Behavioral interventions that protect against rising levels of stress also may prevent the peak followed by the valley that leads to an increased risk of migraine attack.

“There are several approaches to stress management with strong scientific support, including cognitive behavioral therapy (CBT), biofeedback, and relaxation therapies,” Dr. Buse said.

“An additional bonus is that these techniques also have scientific evidence for migraine prevention.”

Some approaches require the guidance of a mental health care professional, such as biofeedback and CBT, and some can be self-learned, such as diaphragmatic breathing and guided visual imagery.

“Once learned these techniques can be practiced practically anywhere at any time for the rest of someone’s life,” Dr. Buse noted.

“Based on these findings, we suggest that health care professionals caring for individuals with migraine should incorporating stress management interventions into treatment plans, especially for patients for whom changes in stress levels are triggers for migraine attacks.”

Cardiovascular Fitness May Help Cognitive Function

Good cardiovascular health may help preserve memory and thinking skills into middle age, according to the results of a new study.

“The brain health of young adults shows benefits from cardio fitness activities.

Interestingly, for those who currently have low fitness, even activities at moderate intensity are likely to be beneficial.

For couch potatoes, it’s just getting moving,” said David R. Jacobs, Jr, PhD, Professor, School of Public Health, Division of Epidemiology & Community Health at the University of Minnesota, MN.

“The brain, like all organs, is highly vascularized,” he said.

“Factors that affect the health of the vascular system are likely to affect the health of the brain.

There is substantial evidence that many cardiovascular disease risk factors also reduce chronic low grade inflammatory conditions.”

The researchers published their results online on April 2, 2014 in the journal Neurology.

TREADMILL AND COGNITIVE TESTS

For the study, more than 2700 healthy persons, average age 25 years, underwent treadmill tests in the first year and then again 20 years later.

Cognitive tests conducted 25 years after the start of the study measured verbal memory, psychomotor speed (the relationship between thinking skills and physical movement), and executive function.

Those who had smaller decreases in their time completed on the treadmill test 20 years later were more likely to perform better on the executive function test than those who had bigger decreases.

“Of course, the executive function, memory skill, and speed of processing that we studied in relation to treadmill test–based fitness are not the same as real life situations,” said Dr. Jacobs.

“However, the standardized testing is useful and can be considered to represent ‘thinking skills.’

Other studies in older individuals have shown that these tests are among the strongest predictors of developing dementia in the future.”

Dr. Jacobs noted that many chronic diseases have their roots many years before clinical manifestation.

“It is logical that people who experience mild losses of cognitive function are at risk for dementia,” he said.

“This has been shown at older ages.

However, we do not know whether the ‘thinking skills’ that we measured will lead to the more severe manifestations that are devastating our elderly population.”

He continued: “It will take further follow-up over another 10 to 20 years to discover empirically whether the cognitive losses that we measured are in fact a risk for dementia.

DIMINISHED ‘THINKING SKILL’ IN MIDDLE AGE

At minimum, I speculate that people who suffer less ‘thinking skill’ in middle age do not function as effectively in society as people who remain sharp.”

The study pointed out how middle age (defined as age 43 to 55 years) and elderly chronic disease in the brain may have roots in lifestyle behaviors during youth.

Dr. Jacobs noted that the current study does not address whether improving fitness would reduce the loss of cognitive function.

“Fitness performance on a symptom-limited treadmill test is dependent on many factors, including vigorous activity, musculoskeletal health, general robustness, smoking, adiposity, and social participation,” he said.

“This is not the same as a group activity that requires exercising or just moving around.

However, encouraging patients to exercise and in general to maintain an active, engaged lifestyle may help forestall cognitive loss, among other benefits.”

Mediterranean Diet Reduces Diabetes, Inflammation

Two new studies show the heart-healthy benefits of eating a Mediterranean diet.

One study linked the diet to a lower risk of diabetes, especially among those at high risk for cardiovascular disease.

The other study tied the eating plan to lower levels of platelets and white blood cells, 2 markers of inflammation, which has been associated with a greater risk of heart attack and stroke.

The Mediterranean diet frequently emphasizes fresh fruits and vegetables, whole grains, beans, nuts, fish, olive oil, and even a glass of red wine.the_mediterranean_diet_

Eating an anti-inflammatory, Mediterranean style diet has been shown to not only be a delicious and enjoyable way to eat, but also is wonderful for your health.

Earlier research has shown that following the traditional Mediterranean diet also is linked to weight loss, a reduced risk of heart disease and related death, and lower blood pressure and blood cholesterol levels.

Mediterranean Diet Reduces Risk of Diabetes

In the first pooled analysis of studies evaluating the possible role of the Mediterranean diet in diabetes development, adherence to this diet was associated with a 21% reduced risk of diabetes compared with the control dietary groups.

The likelihood of developing diabetes was almost 27% less in those at high risk for cardiovascular disease than in controls.

“Adherence to the Mediterranean diet may prevent the development of diabetes irrespective of age, sex, race, or culture,” said lead investigator Demosthenes Panagiotakos, PhD, professor at Harokopio University, Athens, Greece.

“This diet has a beneficial effect, even in high risk groups, and speaks to the fact that it is never too late to start eating a healthy diet.”

Dr. Panagiotakos and colleagues systematically reviewed 19 original research studies that followed more than 162,000 participants for an average of 5.5 years.

These studies spanned European and non-European populations, which is important because most of the published studies have been European-based and there has been some question of possible confounding factors in these regions, including genetics, the environment, lifestyle, and lower stress levels.

Dr. Panagiotakos said he believes the Mediterranean diet lowers the risk of diabetes by helping guard against obesity.

He presented his study on March 27, 2014 at the American College of Cardiology’s 63rd Annual Scientific Session in Washington, DC.

Mediterranean Diet Lowers Inflammation

To understand whether a Mediterranean diet might favorably influence platelet and white blood cell levels, Italian researchers conducted an analysis of the eating habits of nearly 15,000 healthy Italian men and women aged 35 years or older as part of a large epidemiological study.

The investigators observed that consumption of the Mediterranean diet was directly related to lower levels of platelets and white blood cells, which in turn correlated to lower levels of inflammation.

Those who strictly followed a traditional Mediterranean diet were less likely to belong to study cohorts with relatively high platelet counts and were more likely to belong to cohorts with relatively low white blood cell counts.

“Because the study included healthy participants, the lower levels of platelets and white blood cells in those who were more strictly consuming a Mediterranean diet indicate that this eating plan could account for substantial changes within normal ranges of variability,” said lead author Marialaura Bonaccio, PhD.

“This is an important finding that has implications for how these anti-inflammatory markers are tracked among the general population.”

Dr Bonaccio is with the Department of Epidemiology and Prevention at the IRCCS Istituto Neurologico Mediterraneo NEUROMED in Italy.

The results of her study were published online in the March 31, 2014 issue of Blood.