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Month: December 2020

Dear Dr. K; Are you personally going to take the coronavirus vaccine?

Dear Dr. K; Are you personally going to take the coronavirus vaccine?

Yes. And let me tell you why.  In 1720 the average life expectancy in this country was 25.  A hundred years later in 1820 it was 41.  Then in 1920 it hit 54.  Currently it is in the mid-70’s.  Despite all the marvels of modern medicine from antibiotics, to trans-vascular heart surgery, to organ transplantation, the major reasons for this improvement in life expectancy boil down to the big three S’s:  sanitation, shoes, and shots.

It is hard to believe but the “why didn’t I think of that” realization that the sources of drinking water should be kept separate from human and animal waste is very recent.  It came with the scientific discovery of microbes (viruses and bacteria) and how they are transmitted.

Then the universal use of footwear came into play.  Prior to that innovation a majority of humans went bare-footed for at least part of the year depending on climate.  As a result, most humans picked up worm infestations through their bare feet that found their way to the intestinal tract: hookworms primarily, but also other species.  Once the worms set up housekeeping in the GI tract, they were there to stay (until the person died).  Their presence affected health in two ways: reducing available calories and vitamins from food intake, and by causing chronic anemia. 

The final “S” is shots, as in vaccines.  In 1798 Edward Jenner developed smallpox vaccination.  About 90 years later Louis Pasteur, often called the father of immunotherapy, developed anthrax and rabies vaccines.  It wasn’t until 1924 that Emil Von Behring developed the tetanus vaccine.  The polio pandemic was stopped in 1955 when Jonas Salk developed the polio vaccine.  Prior to vaccines, those five diseases killed countless millions of children and adults. 

It all comes down to the old adage of “an ounce of prevention is worth a pound of cure”.  Sanitation, shoes, and shots all work by preventing illness.  So, yes, I will get the coronavirus vaccine. 

Covid-19 and Allergy

Covid-19 and Allergy

Harvard researchers recently published their findings regarding allergic disorders and susceptibility to Covid-19.  The study was conducted on 220,000 people between January and May of this year. 

Previous to this study it has been known that people at greater risk for and from this virus include those: over 65, with pre-existing lung disease, with chronic kidney disease, with diabetes, with hypertension, with heart disease, obesity, with cancer, smokers, with immune compromising illnesses, with organ transplants and with HIV.  Now it appears that underlying allergy also confers greater risk. 

It has been known for many years that underlying allergic respiratory problems predispose to other types of respiratory infections from colds, to ear and sinus infections to bronchitis and pneumonia.  It has also been known for years that treating the underlying allergy reduces this risk.  Now, it seems that allergy predisposes to both catching Covid-19 and having a more serious outcome.  People with either allergic rhinitis or asthma have this increased risk.  The scientists feel the increased risk from allergy is probably multifactorial, but one aspect recently discovered is an increase in one of the cellular attachment proteins: TMPRSS2.

In order to enter the human body Covid-19 has to use certain available “doors” called cell receptors.  The more “doors” available, the more readily the virus can enter.  Allergic inflammation increases the number of TMPRSS2 doors.

The researchers went on to speculate that having good control of the allergic condition (and thereby reducing the inflammation) should help reduce this increased risk. 



The recently published Journal of Allergy and Clinical Immunology had an update on rhinitis.  Rhinitis incorporates two Greek words:  rhinos, meaning nose, and itis, meaning disease or inflammation.  The condition falls into two categories; allergic rhinitis or non-allergic rhinitis.  The former is pretty straightforward in that it is caused primarily by airborne allergens such as pollen, dust mites and animal dander but to a lesser degree (and not quite as obviously) due to food allergy.  Despite the nasal focus of the name, the condition itself often impacts other connected structures including the sinuses, the eyes, the ears, and the lungs (where the most common feature is cough).

Non-allergic rhinitis (NAR) includes a diverse parcel of conditions.  One of the most common is non-allergic rhinitis with eosinophils (NARES) which is a quirky condition.  It has all the symptoms seen in allergic rhinitis and is caused by eosinophils (the white blood cells that cause allergies) but the individuals have no positive test responses to any type of allergens. 

Another type of NAR is infectious rhinitis which can be either acute or chronic.  The acute form is typically caused by cold viruses. The latter form is often caused by chronic colonization of the nose with bacteria or fungus. 

Cerebrospinal fluid rhinorrhea is another cause for NAR.  What happens here is that a tear or rent in the meninges (the fabric covering of the brain and spinal cord) allows cerebrospinal fluid to slowly leak out of the nose.  The tear in the meninges can occur from surgery or from an injury such as a motor vehicle accident or a fall.  If not properly diagnosed, it could lead to meningitis. 

Vasomotor rhinitis is another NAR that is a bit peculiar.  It’s a kind of neuropathy of the nose in that, the autonomic nerves subserving nasal function misbehave.  Since all bodily functions including nasal functions are under neurologic control mishaps can occur.  It’s important for our brain to micro-manage nasal function so we can adapt and live in the diverse global and climatic conditions of our planet. 

People living in the Gobi Desert need their nose to produce lots more mucus than inhabitants of the Brazilian rain forest.  With proper neural control the nose adapts properly.  But in vasomotor rhinitis the adaptation is both hyperbolic and sometimes inappropriate.  Going from a cool house to a warm outdoors, or having the air conditioner kicking on, or going from a darker room to a brighter lit room shouldn’t cause the nose to congest and run profusely, but in vasomotor rhinitis it does. 

A variation on the vasomotor theme is gustatory rhinitis. This too is a “neuropathy”.  In this case the nose runs every time the individual eats (regardless of the meal content).  Gustation

means to taste.  What happens here is that as the individual is tasting (eating) food the normal messaging from the brain is to properly digest the food.  Unfortunately, it also includes a totally unnecessary messaging to the nose “to run”.   

Atrophic rhinitis is one of the few conditions where the nose doesn’t run.  In fact, the main problem is nasal dryness which leads to chronic congestion.  Often there will be scabs that develop in the nostrils.  These individuals have a paucity of mucus glands in the nose.  It can develop from living or working in very dry environments.  It can also occur from repeated nasal/sinus surgery with removal of too much of the mucus membranes. 

Drug-induced rhinitis is definitely a mixed-bag.  But many drugs exert their effect by impacting the sympathetic or parasympathetic nerves that control nasal function.  Examples include:  clonidine, methyldopa, sildenafil, risperidone, lisinopril, amlodipine, and oxybutynin.  Still a myriad of other drugs can cause rhinitis including eye drops, female hormones and oral contraceptives, gabapentin and other drugs used for treating neuropathy.  A particularly severe form of drug-induced rhinitis is due to over use (with resultant addiction) to topical decongestants such as Afrin and 4-way nasal sprays. 

Although it’s not a drug per se, alcohol can often produce rhinitis symptoms including congestion and nose running.  Alcohol exerts its effect because it’s a vasodilator (dilates blood vessels).  As in all things, some individuals are more alcohol sensitive than others.  Asians are particularly prone to this buffeting.  Also, people with the facial skin condition rosacea are often more alcohol sensitive. 

Finally, there is hormonal rhinitis.  Some women’s noses are impacted by changing levels of hormones as seen during the monthly cycle or during pregnancy.  Other endocrine conditions can also cause rhinitis most commonly hypothyroidism and acromegaly.