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Among children and teenagers with asthma, those who also have peanut allergies may have more or more-severe asthma attacks, a new study suggests.

Researchers found that among 160 5- to 18-year-olds with asthma seen at their center, the 46 with peanut allergies generally had more hospitalizations for asthma exacerbations than children without the food allergy. They also had a higher rate of treatment with oral corticosteroids — anti-inflammatory drugs given for a short period to control severe asthma symptoms.

Of children and teens with peanut allergy, 23 percent had ever been hospitalized for asthma after the age of 3. That compared with 16 percent of those without peanut allergy.

When it came oral steroids, only 28 percent of kids with peanut allergy had never needed treatment after age 3. That figure was 37 percent among those without the food allergy, according to lead researcher Dr. Alyson Simpson, of Alfred I. duPont Hospital for Children in Wilmington, Delaware.

When she and her colleagues accounted for other factors — like family history of asthma and any other allergies the children had — peanut allergy remained linked to higher risks of hospitalizations and oral steroid use.

The goal in children’s asthma care is to avoid hospitalizations and oral steroids whenever possible, Simpson noted in an interview with Reuters Health, so any increase in those rates is concerning.

She said that parents of children with both asthma and peanut allergy should be particularly sure to work with their child’s doctor to keep the asthma well-controlled. That typically means minimizing kids’ exposure to their particular asthma triggers, helping them maintain a healthy weight and, often, giving them medications that prevent asthma attacks.

Simpson and her colleagues report the findings in the Journal of Pediatrics.

Asthma symptoms arise when the airways become inflamed; that inflammation is most commonly triggered by exposure to allergens, such as pollen, mold or animal dander. Food allergies can also spur asthma symptoms.

It is not clear, however, why study patients with peanut allergy tended to have more problems with asthma control, according to Simpson. Her team’s findings point to an association between peanut allergy and more asthma exacerbations, but do not prove that the food allergy is the cause.

“The exact link is still being studied,” Simpson said.

Understanding the connection is important, she and her colleagues note, as recent studies suggest that both peanut allergy and asthma are on the rise among children — for reasons that are unclear.

It’s estimated that just over 1 percent of U.S. children have peanut allergy, while roughly 9 percent have asthma, according to the American Academy of Asthma, Allergy & Immunology.

SOURCE: Journal of Pediatrics, online.

Cell phones, televisions and computer games aren’t giving teenagers headaches, researchers say, but listening to one or two hours of music daily may make their heads throb.

The authors of a study published online Feb. 9 in the journal BMC Neurology looked at a group of 13- to 17-year olds — 489 who said they had headaches and 536 who didn’t. No association was seen between electronic media devices and headaches.

“Excessive use of electronic media is often reported to be associated with long-lasting adverse effects on health, like obesity or lack of regular exercise, or unspecific symptoms like tiredness, stress, concentration difficulties and sleep disturbances,” said study co-author Astrid Milde-Busch of Ludwig-Maximilians-University Munich in Germany. “Studies into the occurrence of headaches have had mixed results and for some types of media, in particular computer games, are completely lacking”.

As for a link between music-listening and headaches, it’s not clear if listening to music causes the headaches or is something teens do to soothe themselves when they get a headache.

SOURCE: BioMed Central

A few months of moderate aerobic exercise may not rev up obese teenagers’ ability to burn calories, even though it may increase thinner teens’ ability to burn dietary fat, new research suggests.

In a study of 28 obese and normal-weight teenagers, researchers found that after 12 weeks of treadmill and exercise-bike sessions, the heavier teens showed no changes in their bodies’ calorie- and fat-burning throughout the day.

Their thinner peers likewise showed no changes in daily calorie expenditure. However, their dietary-fat metabolism did increase, on average.

The findings, reported in the American Journal of Clinical Nutrition, do not mean obese kids should throw in the towel on exercise, given previous research. In an earlier study of the same workout regimen, the researchers found improvements in obese teenagers’ sensitivity to the blood-sugar-regulating hormone insulin; decreased insulin sensitivity often occurs before type 2 diabetes.

The teens also showed reductions in the deep layers of abdominal fat that surround the organs — the body fat that is considered especially important in the risk of diabetes and other health problems.

So together, the findings suggest that obese teenagers can get “important health benefits” from aerobic exercise even without changes in their calorie and fat metabolism, according to Dr. Agneta L. Sunehag, an associate professor of pediatrics at Baylor College of Medicine in Houston and the lead researcher on the new study.

In an email, she also pointed out that the study looked at one moderate-exercise regimen alone; the participants did not alter their eating habits or lose weight. It’s possible, Sunehag said, that exercise along with weight loss would affect obese teens’ metabolism.

It’s a common perception that exercise not only burns calories during the workout, but also leads to lasting changes in a person’s metabolism at rest. However, studies suggest that any effects may depend on the type and intensity of exercise, and on a person’s body composition.

Recent research has found, for example, that a few months of strength training may increase resting metabolism and daily calorie- and fat- burning in overweight women. Another study found that any exercise — strength training or aerobic — was related to a higher resting metabolism in women, but only for those who regularly worked out at a high intensity.

Until now, though, little has been known about the effects of exercise on obese teenagers’ calorie- and fat-burning, Sunehag said.

The study included 15 obese and 13 normal-weight Hispanic-American teenagers who completed a 12-week exercise program — walking on a treadmill or using an exercise bike for 30 minutes, four times per week.

At the beginning and end of the study, the researchers measured the teens’ total calorie expenditure over 24 hours. Each participant stayed in a room where a device measured their oxygen consumption and carbon dioxide production; that allows researchers to estimate a person’s calorie expenditure, as well as the proportions of fat, carbohydrates and protein they are burning.

In general, neither obese nor normal-weight teenagers showed changes in their overall calorie expenditure at the end of the study, but the thinner teens did show an increase in fat burning.

The reason for that discrepancy is not clear, according to Sunehag’s team, but studies of adults have had similar findings. One possibility, the researchers suggest, is that obese teenagers have an “impaired metabolic flexibility” that blunts their fat-burning response to exercise.

SOURCE: American Journal of Clinical Nutrition

FDA Updates Earlier Guidance on Respiratory Treatment Spiriva HandiHaler
Current data do not support increased risks for stroke, heart attack, or death

The U.S. Food and Drug Administration today announced that data from a recent review of the Spiriva HandiHaler, a long-acting respiratory treatment for chronic obstructive pulmonary disease (COPD), do not support an increased risk of stroke, heart attack, or death in patients using the medicine.

COPD is a serious and chronic lung disease that restricts air flow in the lungs resulting in shortness of breath. In the United States, COPD includes two main conditions – emphysema and chronic bronchitis. Spiriva HandiHaler consists of capsules and an inhalation device approved for once daily use in COPD.

A March 2008 FDA Early Communication had described data submitted by the manufacturer of Spiriva HandiHaler as suggesting a small increased risk of stroke in patients treated with tiotropium, the medicine’s active ingredient. In October 2008, an Updated Early Communication highlighted two additional publications suggesting an increased risk of stroke, heart attack, and death in patients using tiotropium.

Today’s update of those communications is based on an FDA review of the Understanding the Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) study that compared Spiriva HandiHaler with a placebo in 5,992 COPD patients. In November 2009, the FDA Pulmonary – Allergy Drugs Advisory Committee also reviewed the data and voted that findings from the UPLIFT study resolved the potential safety concerns for Spiriva Handihaler.

The U.S. Food and Drug Administration on Thursday said it found no good evidence that the Spiriva HandiHaler boosts heart risks in patients who use it to help control chronic obstructive pulmonary disease (COPD).

The announcement comes after data released in early 2008 by the drug’s maker, “suggesting a small increased risk of stroke in patients treated with tiotropium [Spiriva], the medicine’s active ingredient,” the FDA noted in a statement.

In October of 2008, the agency released an “Updated Early Communication” that pointed to two other studies suggesting a boost in risk of stroke, heart attack and death among users of the Spiriva HandiHaler.

But a study published in the January 2010 issue of Chest found the opposite: that tiotropium might lower users’ risk of heart problems and death.

Spiriva is one of the most commonly prescribed daily treatments for COPD, a progressive respiratory illness combining bronchitis and emphysema that is often linked to smoking. COPD is the fourth-largest killer in the United States.

The Spiriva HandiHaler consists of a capsule used with an inhaler, to be taken once daily. Spiriva is from the class of drugs known as anticholinergics, which also includes the widely used ipratropium bromide (Atrovent).

Thursday’s FDA announcement should come as a relief to COPD patients who rely on the Spiriva HandiHaler. In its statement, the FDA said its review of the data does “not support an increased risk of stroke, heart attack, or death in patients using the medicine.”

“Today’s update is based on an FDA review of the Understanding the Potential Long-Term Impacts on Function with Tiotropium [UPLIFT] study that compared Spiriva HandiHaler with a placebo in 5,992 COPD patients,” the agency said. “In November 2009, the FDA Pulmonary-Allergy Drugs Advisory Committee also reviewed the data and voted that findings from the UPLIFT study resolved the potential safety concerns for Spiriva HandiHaler.”

The safety status of Atrovent remains unclear, however, because research released Jan. 7 suggested that the drug raises patients’ risk for heart attack and heart failure.

“The short-acting form [Atrovent] seems to increase cardiovascular risk, while the long-acting form [Spiriva] seems to decrease it,” Dr. Norman H. Edelman, chief medical officer of the American Lung Association, told HealthDay at the time. “It is important to point out, however, that the difference is an indirect inference,” he added.

“To prove beyond scientific doubt that the two forms of anticholinergic drugs are different in this or other ways there would have to be a head-to-head comparison; a study which is not likely to be done,” Edelman said.

In one of the two studies in Chest, researchers led by Todd A. Lee, from the Hines VA Hospital in Illinois, collected data on almost 83,000 U.S. veterans with COPD. Among these patients, 44 percent were using Atrovent at some point during the study.

Those patients were followed until they had a cardiovascular event, died or until the study’s end in September 2004. During the follow-up, more than 6,200 patients had a cardiovascular event: 44 percent suffered heart failure, 28 percent had heart attacks or chest pain, and 28 percent had irregular heart rhythms, the researchers reported.

Lee’s team also found that during the first six months of Atrovent therapy, patients were at an increased risk for these cardiovascular events, although those who took the drug for more than six months without an incident did not have an increased risk of heart attack or heart failure.

“These findings are consistent with previous concerns raised about the cardiovascular safety of ipratropium bromide,” the researchers concluded.

Boehringer Ingelheim, the makers of Atrovent, said the drug is safe and the latest findings do not prove there is an increased risk of heart failure or other heart-related problems associated with the drug.

“Atrovent has been widely used in the U.S. for more than 20 years,” said company spokeswoman Susan Holz. “The findings described in the paper are not consistent with the Boehringer Ingelheim clinical trial and safety database for Atrovent, which do not support evidence of an increased risk for cardiovascular events among patients using Atrovent.”

In the second paper, Dr. Bartolome Celli, from Caritas-St. Elizabeth’s Medical Center in Boston, and colleagues looked at the results of 30 clinical trials that included more than 19,500 patients, some of whom received Spiriva while others were given a placebo.

The researchers found patients taking Spiriva had a lower risk of dying compared with patients receiving placebo. In addition, those taking Spiriva had fewer respiratory events. This study was funded by the pharmaceutical giants Boehringer Ingelheim and Pfizer.

“There is a benefit of tiotropium in terms of mortality when data from all of the trials with tiotropium are pooled together. This is in contrast to a previous scare that anticholinergics could be associated with poor outcomes,” Celli said at the time of the study’s release. “Tiotropium is by and large a safe medication that can really help most patients with COPD.”

Inhaled anticholinergics ease breathing in patients with COPD by preventing the airways from constricting.

Speaking earlier this month, Dr. Neil Schachter, a professor of pulmonary medicine at Mount Sinai Medical Center in New York City, said that he currently prescribes Spiriva more often than Atrovent.

“Spiriva is certainly a very useful drug,” he said. “My personal experience is that it has relatively few side effects. It is generally well-tolerated, and patients seem to have a good response to it.”

SOURCES: Bartolome Celli, M.D., Caritas-St. Elizabeth’s Medical Center, Boston; Norman H. Edelman, M.D., chief medical officer, American Lung Association; Susan Holz, spokeswoman, Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Conn.; Neil Schachter, M.D., professor, pulmonary medicine, Mount Sinai Medical Center, and director, Mount Sinai COPD Program, New York City; January 2010, Chest; Jan. 14, 2010, statement, U.S. Food and Drug Administration

Diabetic nephropathy is damage to the kidneys caused by complications of diabetes. In cases of diabetic nephropathy, the kidneys don’t function properly, and may even stop working completely, the American Academy of Family Physicians warns.

The academy offers this list of possible warning signs:
Having swollen ankles and feet.
Feeling weak.
Having loss of appetite.
Having nausea or stomach upset.
Having problems getting to sleep or staying asleep.
Having difficulty concentrating, or feeling confused.

Average life expectancy in the United States has reached almost 78 years, a record high, federal health officials said Wednesday.

From birth in 2007, women can expect to live to 80.4 years on average and men to 75.3 years, according to the report from the U.S. Centers for Disease Control and Prevention.

But even though Americans can expect to live longer than their parents, life expectancy in the United States is still lower than in many other industrialized countries, including Canada and Japan.

Along with increased life expectancy, the report notes the death rate has dropped to an all-time low of 760.3 deaths per 100,000 people, continuing a long-term trend.

“The risk of dying has dropped to a record low level, and life expectancy has reached a record high,” said report co-author Arialdi M. Minino, a statistician at the CDC’s Center for Health Statistics, Division of Vital Statistics.

“Ever since the 1960s, the death rate has been decreasing in the United States,” he said. Fewer deaths from heart disease, stroke and cancer are driving the trend, he said.

The report is based on data from nearly 90 percent of U.S. death certificates.

According to the report, life expectancy in 2007 increased to 77.9 years — or 77 years and 11 months — up from 77.7 years in 2006. Since 2000, life expectancy has increased 1.4 years.

The five leading causes of death, accounting for 64 percent of all deaths, are heart disease, cancer, stroke, chronic lower respiratory diseases and accidents.

Other findings include:
Death rates in the United States vary by region and state, with the Southeast leading the nation. West Virginia’s death rate is 25 percent higher than average, while Hawaii has the lowest death rate.
White women have the longest life expectancy (80.7 years) followed by black women (77 years).
At age 65, life expectancy was 18.6 years in 2007, an increase of 6 percent since 2000.
Since 1989, the gap in life expectancy between whites and blacks has dropped 35 percent, to 4.6 years.

“This is great news,” Dr. William O’Neill, executive dean for clinical affairs at the University of Miami Miller School of Medicine, said of the overall findings.

Many people say the United States health care system is broken, O’Neill said. “But, this is kind of great evidence to show there has actually been some dramatic improvements in the health of Americans over the last 20 years.”

However, living longer will also have unforeseen effects on the country, he said.

“We are going to have many people 80 to 90 years old,” O’Neill said. “So how is the U.S. going to handle this huge increase?”

People living 20 years or more than their predecessors will have to rethink retirement planning, O’Neill said.

Also, the nation will see a significant drain on Social Security and Medicare benefits, he said. These programs weren’t designed to support people for that long, he said, noting people typically lived five to 10 years after retiring, he said.

Increased life expectancy is largely the result of better treatment for heart disease, he said.

“The biggest reason people are living longer is that we have done a fantastic job in dealing with coronary artery disease,” O’Neill said. In time, cancer may overtake heart disease as the nation’s number one killer, the report noted.

O’Neill anticipates the trend toward longer life will continue, especially as cancer treatment improves. “I am seeing people living with cancers that 15 years ago would have been considered hopeless,” he said.

Researchers have developed a tool to predict whether a patient will suffer a second stroke within 90 days of a first stroke.

“This is an important new tool because studies have shown that people who have a second stroke soon after a first stroke are more likely to die or have severe disability,” Dr. Hakan Ay, of Massachusetts General Hospital and Harvard Medical School, said in an American Academy of Neurology news release. “This tool can help doctors identify people who are at high risk of having another stroke and need immediate evaluation based on information typically available at the time of initial evaluation.”

The tool — called the Recurrence Risk Estimator at 90 Days score — uses brain scan results and a number of stroke risk factors to calculate a person’s chances of having another stroke within three months. The risk factors include history of transient ischemic attack (mini-stroke), age and type of first stroke. The higher a patient’s score, the greater their risk for a second stroke.

In a study of 1,458 ischemic stroke patients, Ay and colleagues found that those with four or more risk factors were about 40 times more likely to suffer a second stroke than those with no risk factors. The study also found that more than 96 percent of patients who had a second stroke showed signs of one or more risk factors.

Surprisingly, long-term predictors of stroke — such as smoking, diabetes and hypertension — didn’t predict short-term risk.

“We currently don’t have a well-developed tool for predicting short-term risk of early recurrent stroke, so this tool could help improve stroke care and outcome,” Ay said. “For example, people at high risk of a second stroke can be immediately admitted to specialized stroke centers and given preventive treatment.”

When it comes to vitamin D, consumers are bombarded with mixed messages about the best source for this essential nutrient. While some may argue that small doses of intentional sun exposure are safe, dermatologists point out that the risk of developing skin cancer from ultraviolet (UV) radiation far outweighs the benefit of stimulating vitamin D production – particularly when enriched foods and supplements are safe and effective sources of this vitamin.

Speaking today at the American Academy of Dermatology’s SKIN academy (Academy), Washington, D.C., dermatologist Elizabeth L. Tanzi, MD, FAAD, clinical faculty in the department of dermatology at Johns Hopkins Hospital Center in Baltimore, addressed common myths about sun exposure, sunscreen and vitamin D, and announced the Academy’s increased recommendation on the minimum Sun Protection.

Factor (SPF) of sunscreen.
“Despite years of ongoing public education efforts on the dangers of UV radiation, a number of misconceptions remain as to how to best protect ourselves from this known carcinogen and whether or not we absolutely need sun exposure for vitamin D production,” said Dr. Tanzi. “The fact is these myths are harmful because sun exposure is the leading cause of skin cancer, and the consequences of this misinformation could be potentially fatal.”

Myth: Sun exposure is the best source of vitamin D.
Vitamin D is an essential nutrient that is vital for strong bones and a healthy immune system. Deficiency of vitamin D is associated with bone softening in adults, rickets in children and, more recently, with high blood pressure, arthritis, type I diabetes and certain cancers.

While UV radiation is one source of vitamin D, dermatologists argue that it is not the best source because the benefits of obtaining vitamin D through UV exposure cannot be separated from an increased risk of skin cancer. Instead, the Academy recommends that an adequate amount of vitamin D should be obtained from a healthy diet that includes foods naturally rich in vitamin D (e.g., dairy products and fish), foods/beverages fortified with vitamin D (e.g., fortified milk and fortified cereals), and/or vitamin D supplements.

“Although studies showing the benefits of increased vitamin D intake have caused some to propose ‘sensible sun exposure’ or intentional sun exposure as a cost-effective method for preventing vitamin D deficiency, increased sun exposure is not the answer,” said Dr. Tanzi. “UV radiation is the most preventable risk factor for the development of skin cancer, which is the most common form of cancer in this country. There are more than an estimated 1 million new cases of skin cancer every year. Despite this fact, there remains a tremendous amount of misinformation about UV exposure – especially in relation to vitamin D.”

Myth: All sunscreens are created equal.
While on the surface most sunscreens may look the same, they are in fact quite different. One of the things that makes sunscreens different is the level of protection from UV exposure that they provide. Dr. Tanzi explained that a common misconception is that the SPF rates the degree of protection from both UVA rays (which pass through window glass, penetrate into the deepest layer of the skin and are associated with premature aging and melanoma) and UVB rays (the sun’s burning rays, which are blocked by window glass, are the primary cause of sunburn, and also are linked with skin cancer). In fact, the SPF number on sunscreens only reflects the product’s ability to deflect the sun’s burning rays (or UVB). Sunscreens labeled broad-spectrum provide coverage against both UVA and UVB light.

“SPF may create a false sense of security about the level of protection a person is getting, because many sunscreens do not adequately protect against harmful UVA rays,” said Dr. Tanzi. “The main challenge in providing effective protection from UVA rays is that traditional chemicals used in sunscreens that absorb UVA light degrade quickly and become ineffective.”

Fortunately, there are ingredients that can be added to traditional sunscreen ingredients to keep them stable and provide broad-spectrum protection. For example, Dr. Tanzi noted that the ingredient oxybenzone can help stabilize avobenzone (one of the best absorbers of UVA rays that, while highly effective, breaks down quickly), which provides a longer duration of effective protection from UVA rays. Other effective ingredients that help provide broad-spectrum UV coverage include ecamsule, cinoxate, menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, and sulisobenzone.

For those with sensitive skin, sunscreens with non-chemical ingredients work best and will prevent irritation. Dr. Tanzi said the ingredients zinc oxide and titanium dioxide provide both UVA and UVB protection.

Myth: Using a higher SPF will ensure you don’t burn.
Dr. Tanzi explained that those who use sunscreen with a higher SPF may think they will not burn when exposed to UV light, but she said that is not true. In fact, actual sunscreen protection depends on many other factors – including skin type, the amount and frequency of sunscreen application, and the impact of activities (such as swimming and sweating). As a result, sunburn can occur even when wearing a higher SPF sunscreen.

Another important factor Dr. Tanzi emphasized is that UVB protection does not increase proportionately with a designated SPF number. For example, an SPF of 30 screens 97 percent of UVB rays, while an SPF of 15 screens 93 percent of UVB rays and an SPF of 2 screens out 50 percent of UVB rays. However, not applying enough sunscreen or not covering all exposed areas may result in a lower SPF than the product contains.

“For adequate protection, sunscreens are best applied 15-30 minutes prior to going outside, approximately every two hours or immediately after swimming or sweating,” said Dr. Tanzi. “Research demonstrates that most people only apply 25 to 50 percent of the recommended amount of sunscreen, which is one ounce for the entire body or enough to fill a shot glass. Therefore, if only half the proper amount of SPF 15 is applied, the SPF has been reduced to an SPF of approximately 5, which is then inadequate protection. ”

To address the issue of people not using enough sunscreen or reapplying improperly, the Academy recently increased its recommended SPF to a minimum of 30 for proper sun protection. Dr. Tanzi said that while sunscreen is important to protect against skin cancer, it is only one part of what should be an overall sun-protection program. To minimize your risk of skin cancer, the Academy recommends that everyone Be Sun SmartSM :
Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and after swimming or sweating.
Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses, where possible.
Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can increase your chance of sunburn.
Get vitamin D safely through a healthy diet that may include vitamin supplements. Don’t seek the sun.
Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

Welcoming a new baby is a happy and exciting time, but it’s also full of stress. Postpartum depression affects many new moms, and it’s important to recognize the signs and seek treatment.

The American Academy of Family Physicians lists these warning signs of postpartum depression:
Persistent feelings of sadness and crying.
Having little desire to eat.
Significant weight gain or loss.
Irritability, anxiety and restlessness.
Inability to find pleasure or interest in life.
Feeling exhausted or having no motivation to get things done.
Insomnia.
Feelings of hopelessness, worthlessness or guilt.
Having little interest in your newborn.