Whoever said laughter is the best medicine didn’t know about a “mother’s kiss.” As it turns out, a recent case review study of nasal foreign bodies found that a mother’s kiss is the best and safest way to remove the object from the nose of a small child or infant.
Using this technique an adult known and trusted by the child blocks the unaffected nostril and blows into the child’s mouth. The blowing should be gentle at first until the adult feels the resistance caused by closure of the glottis (the top of the windpipe at the vocal cords). Then the adult blows with more force which will then usually expel the nasal foreign body. If not expelled, the object often moves to the end of the nostril where it can be more easily reached.
The case review study of 154 patients found this technique very successful and worked on a variety of foreign bodies from a doll’s shoe to beads, beans, sausage and a dead bug. It also avoided trauma caused by instruments in a wiggling child, or the need for general anesthesia.
Get an infected cut or sprain an ankle and you will experience the healing benefit of inflammation. However, with the benefit also come the redness, swelling, heat and pain that are inflammation’s hallmarks. Although unpleasant, these symptoms dissipate rapidly and are reassuring that the immune system is doing its job to clear infection and guide repair of damaged tissue.
The journal Science had a recent review of inflammation as it pertains to chronic diseases. The review looked at new research in three major areas: Type 2 diabetes, cardiovascular disease and neurodegenerative disease. A common factor to all three is the inability of the immune system to clear away the stimulus that triggers the inflammation. Hence, there is a chronic inflammatory state that causes the disease to progress. In the case of Type 2 diabetes, obesity with the resultant saturated fatty acids is the “nonclearable” stimulus to inflammation which leads to insulin resistance, and thereby elevated blood sugars. In the case of cardiovascular disease it is apolipoprotein B, containing lipoproteins which can’t be cleared by the immune system. The resulting chronic inflammation can be measured by a test called C-reactive protein, and it leads to laying down of arteryblocking plaque or atherosclerosis. And in the case of the neurodegenerative disease (Alzheimer’s disease, Parkinson’s, prion disease and traumatic brain injury), it is the formation of protein aggregates that can’t be cleared.
In Alzheimer’s the protein that aggregates is B amyloid, and its presence stimulates immune cells unique to the brain called microglial cells. The chronic inflammation leads to loss of brain cells and thus, dementia. Luckily, understanding these mechanisms is leading to fruitful research. One example is altering JNK molecules. These are the enzymes that cause the diabetes-related inflammation. Drugs to modify these JNK enzymes have proven very successful in curing diabetes in mice models.
Dear Dr.: I heard there might be a new flu vaccine that is egg-free.
You’re right. In fact you’re double right as there are two egg-free flu vaccines soon to be available.
The first one is called Flucelvax, produced by Novartis. Canine kidney cells culture is used to grow the virus instead of chicken eggs. Tested in 11,000 patients, this new vaccine was 84 percent effective in preventing influenza.
The second is Flublok, offered by Protein Sciences. This one is produced by taking the gene that encodes for hemagluttinin antigen and injecting it into baculovirus – a virus found in insects – which then produces large amounts of hemagluttinin antigen. (Remember, flu virus has two main targets for vaccination: hemagluttinin and neuraminidase.)
Tested in 4,600 patients, this vaccine was 75 percent effective. Both vaccines are currently recommended only for persons 18 years old or older.
Dear Doc: ACE inhibitors do their job well, but cause big problems for some patients
Angiotensin-converting enzyme (ACE) inhibitors comprise one of the safest and most effective treatments for hypertension (elevated blood pressure). They work by inhibiting conversion of angiotensin I to its active form, angiotensin II (which leads to hypertension). Unfortunately, they also inhibit the conversion of the peptide bradykinin to its inactive form. Hence, in some people this can lead to a build-up of the peptide which can cause angio edema.
It is unclear why only .1 percent of the people taking ACE are prone to this side effect, but in that .1 percent the symptoms can be dramatic. They include shortness of breath, swelling of the lips, tongue and larynx and in some cases, abdominal swelling.
Another aspect of ACE angio edema that is a bit confusing is that the onset can occur at any time after the person has started the medicine. For many people it occurs after two or three years of use, which leads people to mistakenly think that something else caused their acute symptoms, such as a recent meal.
When ACE-induced angio edema was first understood, it was thought that a safe alternative for the ACE would be an ARB (angiotensin-receptor blocker); unfortunately, these, too, seem to have the same potential for causing mischief.
Widely used pesticides and chlorinated water may be contributing to the increased frequency of food allergy. Researchers at Albert Einstein College of Medicine have found a strong correlation between urinary levels of dichlorophenols and the incidence of food allergy. Both children and adults who had measurable levels of the chemicals in their urine were much more likely to have food allergy. Dichlorophenols are commonly found in household pesticides, those used on fruits and vegetables and also in chlorinated tap water. The researchers felt these chlorine chemicals somehow weaken the body’s food tolerance, thus allowing the allergy to develop.
Food protein-induced enterocolitis syndrome (FPIES) has recently been reported to occur from orange juice, a previously unrecognized cause. FPIES mimics food allergy, but it is not mediated by IgE (Immunoglobulin E), the usual allergic mechanism. It is an acute inflammation of the GI tract, caused by a food protein that leads to nausea, vomiting and diarrhea. Frequently, affected children become dehydrated and require IV fluids. The condition is often mistaken for a GI flu until the causal association with a food protein is recognized. The most common cause for FPIES is cow milk. The diarrhea seen with cow milk ingestion is often bloody and, hence, quite startling to unsuspecting parents of infants who develop FPIES.
Other well-recognized causes: rice and soy protein. The newly described cause is fruits (including apple, pear and banana) and most recently, orange juice. Unlike with food allergy, children with FPIES have no rash, angioedema or respiratory symptoms. Also, the reaction (unlike with food allergy which tends to be immediate) is generally delayed two-to-four hours after ingestion of the trigger food. Because FPIES is not a classic allergic condition, it cannot be diagnosed by allergy testing. The best method for diagnosis is recognizing the suspected food as an antecedent to the symptoms. Also, oral food challenge tests can be conducted to confirm the diagnosis.
Food ingestion anaphylaxis caused by mites is a newly described syndrome, as detailed by the World Allergy Organization in this month’s Journal of Allergy and Clinical Immunology. Until recently mite allergy was best recognized as a major cause for allergic rhinitis and asthma via the inhalation of the microscopic mites. Millions of allergy sufferers actually receive allergy shots for this mite allergy. Over the years occasional case reports would appear in the medical literature about airway anaphylaxis; that is, sudden and severe closure of the airways due to an inordinate inhalational dose of mite, such as from spilling a vacuum cleaner bag. But until recently, there had never been reports of anaphylaxis from the ingestion of mites.
The new syndrome has been dubbed oral mite anaphylaxis (OMA), or also “pancake syndrome,” because the primary source of ingested mites is from wheat flour contaminated with mites — and for some reason, this occurs most often in pancake mix. The syndrome occurs primarily in warm, tropical or sub-tropical locations where temperature and humidity favor the proliferation of mites in certain foods. In some cases the wheat itself was mistakenly assumed to cause the reaction because the presence of mites was not initially suspected. Also, the patient may live in a northern clime, but have a reaction from wheat or flour mix produced in a tropical area.
Unfortunately, cooking does not inactivate the mites in terms of allergenicity. Other common foods that have been implicated are pizza dough, beignets, polenta, grits and scones.
Taking precautions in known MRSA environments worth it From football locker rooms to ALF patient rooms, there is a surge in the number of otherwise healthy people developing Methicillin-resistant Staphylococcus Aureus, better known as MRSA. The dreaded MRSA is a difficult- to-treat, multi-drug-resistant staph infection.
One way to protect yourself if your school or your mother’s nursing home is having an outbreak is to practice good hand-washing, and to use Mupirocin (Bactroban), anintranasal prescription topical antibiotic that kills MRSA.
Dear Dr. K: With the massive damage still being shown on TV from the flooding by Hurricane Sandy, what illnesses are those residents facing? A timely study recently released by the medical College of Wisconsin recently reported on a study of patients developing Vocal Cord Dysfunction (VCD), a mimic of asthma, due to environmental exposure in water-damaged work environments. Water-damaged environments have long been recognized as a cause for a variety of respiratory illnesses, including infections, rhinitis, sinusitis and asthma. This is due to the indoor dampness and the attendant mold growth, both of which impact the respiratory system. Until now, VCD had not been described in this setting.
VCD is the inappropriate approximation of the vocal cords during inhalation. That is, the vocal cords move together while breathing in, instead of moving apart the way they are supposed to behave. This results in inspiratory wheezing, coughing, hoarseness and chest tightness. Asthma, on the other hand is an expiratory illness – that is, the wheezing and restriction of air movement is primarily during exhalation, not inhalation. This is an important distinction because the various inhalers and medications that benefit asthmatics don’t help people with VCD.
Other recognized causes for VCD include extrinsic irritants, cleaning solutions, machine fluids, cooling fumes, dust, smoke, eucalyptus, the fixative glutaraldehyde, xerographic toner and other chemicals and scents. It can also occur for psychogenic and neurogenic reasons. It is important to recognize VCD as the correct diagnosis, since the primary effective therapy is avoidance of the provoking environment. Speech therapy directed at improving laryngeal control has additional benefit.
• Bothered by scents or perfumes when at
church or the theater? Try using the over-the-counter
nasal spray NasalCrom. It works by stabilizing the
mast cells in your nose that are stimulated by the scent