Posts for: July, 2012
Allergies are on the rise! No one has quite figured out all the answers at this point. There’s the “hygiene hypothesis”, which we spoke about previously and other areas of intense on-going research beyond the scope of this post.
A parent wondered aloud recently and asked if her 13-month old son could be having nasal allergies? My answer was, Yes. This surprised her and this is why. This parent realized and correctly so that you can only respond with allergy-type symptoms to something you’ve been exposed to and subsequently sensitized to. The baby at 13-months old has barely gone through his first allergy season and presumably his very first exposure to the annual tide of environmental allergens (trees, weeds, grasses) and really unlikely to be reacting now, let alone mount an allergic response barely after the first year of exposure.
This parent is factually correct. The development of allergy symptoms often has many factors and is seldom a singular reason. Features of seasonal allergic rhinitis usually do not occur until the fourth or fifth year of life on the average. A number of exposure cycles are sometimes required before the cascade of bodily changes which eventually manifest as allergy peak. This 13-month old however was having nasal allergy type symptoms with sneezing, clear runny nose and frequent eye-rubbing not from seasonal “outdoor” allergens - but from perennial “indoor” allergens!
Perennial allergic rhinitis sufferers go through an accelerated cycle of exposure and subsequent sensitization easily due to the ubiquitous nature of the offending allergen in their immediate environment at home usually. The body’s allergy cascade could be sufficiently primed and put in effect within the first year of life. House dust mite, pet/ animal dander, mould, cockroach infested environments are common causes. Airway irritants like cigarette smoke are also harmful to the airway structures and can directly cause injury that may manifest with allergy type symptoms in the early stages. My patient referenced above lives in an environment where cigarette smoke is present and a number of pet animals are also present in the home. These factors together present poor air quality around this child and have inevitably led to the evolution of allergic rhinitis at a young age.
There is a direct relationship between allergic rhinitis and asthma symptoms. Both conditions tend to reinforce each other and early control with an “all-of-the-above” approach to controlling symptoms with medications and improving the quality of air in the home are often very helpful.
Smoking cessation is an important component of the treatment plan. Smoking away outdoors as we often see is welcome. We realize in addition that the cigarette smoke irritants stay on the clothing, hair etc and can still be inhaled by the infant. Smoking cessation helplines are available nationwide and we encourage parents who smoke desirous of stopping to avail themselves of the opportunity. It's shockingly more of a challenge when the trigger is the pet animal. I’ve heard of a case though where the family decided to get rid of the Pediatrician rather than the offending pet! - we hope that won’t be the case this time.
'Diji Vaughan, MD
In the words of Frederick Douglas, "It is easier to build strong children, than to repair broken men". While these timeless words from the late elder statesman were conceived in the context of the social and political issues of his time, they ring true to this day more than a century later. Let's build lives and healthy lifestyle choices, let's build safer neighborhoods, let's build stronger educational systems; let's build families.
An old Coca-Cola commercial, chimed the following words in my childhood, " I am the future of the world, I am the hope of my nation, I am tomorrow's people, I am the new inspiration... and we've got a song to sing to you, we've got a message to bring to you, we set a dream for you and for me and tomorrow......."
It's all about tomorrow, and our children, let's build together.
Parental anxiety rises and deservedly so whenever someone shares the discovery of an illness, let alone a communicable one in their child with another parent. The words: hand-foot-and-mouth disease linked together in that sequence certainly evokes a suite of reactions from respect to bounding fear in the other parent listening. “Will my child catch it?”, “Oh! he had a fever last night too- he probably has caught it already!”. We want to address concerns like this in this post and share recent trends and disease patterns with this condition as we approach the fall season.
The town of Coxsackie NY will forever be embellished in the medical literature. This community of 9,000 people has the distinct recognition of being the discovery place of the family of viruses responsible for most forms of the hand-foot-and-mouth disease(HFAMD). These viruses are called Coxsackie viruses and have different numbers tethered to their names to reflect their many different types.
Humans are the only known reservoir for these viruses and their transmission from person to person is possible year round, but gets to epidemic proportions in the summer/fall seasons. Most of the transmission occurs through close contact through the respiratory airways, fecal-oral route, within families, daycare center, summer camps etc. The Coxsackie virus can survive outside a human host and this confers an advantage to the germ making environmental surfaces contamination and subsequent spread easy. Wet soil, swimming pools etc are possible sources of spread too although less common.
Children aged less than 5-years are more readily affected, though infection in all age groups is possible. The affected child develops fever (temp=100.4F or higher) usually, cases without a fever accompanying presentation are not uncommon. The mouth cavity has reddish shallow lesions on the tongue and lining of the mouth cavity, this is often accompanied with the apperance of fluid-filled or tiny pustule-like painful lesions on the back of the hands and feet. These lesions sometimes occur on the palm and soles too. Affected children often begin to eat less and less from the painful oral lesions and severe cases may tip them towards dehydration. Medical evaluation and assessment is recommended.These skin lesions resolve in about a week and the signs gradually fade away subsequently. Complications following hand-foot-and-mouth disease can occur though rarely and it is usually a self-limited condition where therapeutic efforts are largely supportive with comfort measures under the supervision of your medical provider.
Universal infection control precautions, especially with appropriate hand washing, and avoidance of overcrowded situations have been shown to reduce transmission and control outbreaks. The CDC reports in March 2012, the emergence of unusually severe cases of HFAMD caused by a different member of the Coxsackie virus family which has now been isolated from every geographic region of the USA. The vast majority of cases of HFAMD seen so far still follow the typical course described above. The CDC affirms, “HFMD is spread from person to person by contact with saliva, respiratory secretions, fluid in vesicles, and feces. Transmission of HFMD can be reduced by maintaining good hygiene, including handwashing and disinfection of surfaces in child care settings”.