Passive Smoke Exposure Increases the Incidence of Sinusitis in Children

Persons who smoke cigarettes demonstrate dramatic increases in their levels of nicotine and nicotine metabolites; however, it is now clear that others who are exposed to the exhaled smoke (so-called "passive smokers") can also demonstrate nicotine levels that may affect their health and well-being. This health risk is particularly important in children. Research to date indicates that children exposed to passive cigarette smoke have elevated rates of otitis media, bronchiolitis, and diminished pulmonary function, as well as more frequent exacerbations of asthma.

A direct correlation has been observed between the extent of exposure to passive smoke and urine cotinine values. Cotinine is a metabolic by-product of nicotine that is readily measured in the urine. Numerous investigators have concluded that there is a correlation between the frequency of symptoms and signs of respiratory illness, such as nasal symptoms and even asthma, and levels of cotinine in the urine.

To further define what effect passive cigarette smoke may have on the health of children, Steven Stryk and colleagues from the St. Louis University Health Sciences Center asked parents to complete a detailed questionnaire about their smoking habits. They also collected urine samples from children in these households and periodically analyzed the cotinine/creatinine ratio (CCR), which serves as a highly reliable measure of exposure to nicotine. They are now following these children prospectively under double-blind conditions to determine their rates of sinusitis.

Previous studies have indicated that a CCR of 30 mg/mL or higher reflected significant exposure to nicotine through passive smoke inhalation. For example, Dr. Stryk noted that in smokers, one cigarette can increase the urine cotinine levels by about 135 ng/mL, and some smokers have urine cotinine levels of up to 1,000 ng/mL. In the twenty children (aged 3--18 years) studied to date, Stryk and his team have identified five children with urine cotinine levels higher than 30 ng/mL. One 5-year-old had a urine cotinine level of 298 ng/mL! Among these twenty children, there have been eight cases of sinusitis. Key to these findings is that all of the infections have occurred in the five highly exposed children.

In addition, the investigators found that whether or not their mother was a smoker was very highly correlated with the children's urine cotinine levels. Such findings suggest that when a mother smokes, the child may absorb clinically important levels of nicotine, and that these levels in many cases can affect the respiratory health of these children. source:AAAAI

Encasing Mattresses Improves Asthma in Children

According to some investigations, up to half of the cases of childhood asthma are exacerbated by the presence of allergens found in the excrement of the common house dust mite. Consequently, one way to combat asthma is to limit the exposure of children to these dust mite allergens. Removing carpeting and washing bedding are good ways to reduce the dust mite load in homes. New research also confirms that encasing the pillow and mattress of asthmatic children can have a dramatic benefit for their asthma status.

Dr. S Halken and colleagues evaluated the benefits of using a semipermeable mattress cover (Allergy Control brand) designed to prevent the passage of dust mite allergens. Sixty asthmatic children were given either the test covers or simple cotton covers, through which dust mite allergens could penetrate. The children were followed for 1 year. In the groups of children who used semipermeable covers, the concentrations of house dust mites decreased almost 10-fold, compared to only a 50% drop in the control group. Furthermore, the mean dose of inhaled corticosteroid decreased by about 50% in the semipermeable cover group (p = 0.003 compared to baseline) but only by about 25% in the control group . Morning and evening peak flows increased significantly in the semipermeable cover group, but only evening peak flow improved significantly in the control group.

These findings suggest that the use of a semipermeable mattress and pillow cover was associated with:

• a decrease in the concentration of house dust mites in the mattress

• a drop in the dose of inhaled steroid

• a decrease in allergen-specific bronchial hyperreactivity

• a decrease in nighttime asthma symptoms, and

• an increase in morning and evening peak flow measurements.

source:AAAAI

controlling allergy symptoms for children

Managing symptoms of allergy
Managing allergies properly should be an important part of your child's training and preparation for competition.

Classic allergy symptoms — such as a stuffy nose, watery eyes, sneezing and sinus pain — can affect your child's performance and most importantly, enjoyment of the activity. Allergy symptoms can make it difficult for your child to sleep at night.

Enlisting the help of your physician and getting an early start in controlling allergies can help prevent these problems. "As in sports, the best defense against allergies is a good offense," says Dr. Li. "Don't wait until the middle of the season to recognize there's a problem and to start treating it."

Before the season starts, ask your physician about your child's allergies and how they might affect his or her chosen activity. Tell your physician if your child is having trouble this year with any new symptoms. If your child isn't taking a medication, your physician might recommend one. If your child is taking a medication, ask your physician to evaluate both it and its dosage.

This might be especially important if your child is competing at the top levels of his or her sport. Some medications, such as oral decongestants, might be considered stimulants and athletes might be banned from using them.

As the beginning of the sports activity draws closer, Dr. Li recommends making sure that your child is taking the medication on schedule and isn't skipping doses. "Allergy medications work best when used early and regularly," he says.

You might also wish to add your child's coach to your allergy-management team. On days when allergies might be particularly troublesome for your child and others with allergies, the coach might be able to modify practice routines to prevent allergies from affecting athletes. Chances are, your child won't be the only one on the team with allergies.

Children, allergies and sports

If your child has hay fever, does that mean outdoor sports are off limits? Not at all, according to James Li, M.D., a specialist in allergy, asthma and immunology at Mayo Clinic in Rochester, Minn.

"Any athlete, from preschooler to pro, can have allergies and participate in sports," says Dr. Li. "Some professional athletes even compete when their allergies should be at their worst. With the right treatment, your child can compete in any sport he or she wants."

Considering options
Although it's true that allergies don't have to be an athletic roadblock, it's important to note that there might be better sports for your child to choose if he or she has severe allergies to outdoor pollens or molds.

If your child is just beginning to compete, consider taking a closer look at indoor sports or ones in which competitions take place during winter months. The reason? Your child likely will encounter fewer outdoor airborne allergens, such as pollen.

James Li, M.D."Good choices include swimming, basketball, ice hockey or indoor volleyball," says Dr. Li. On the other hand, indoor sports might aggravate allergies to indoor molds or dust mites.

levels of prolactin in blood

Question : I have high levels of prolactin in my blood. What does it mean?

Prolactin is a hormone from the pituitary gland that regulates the production of breast milk following childbirth. It also may suppress ovulation. The pituitary may produce too much prolactin as a result of use of certain drugs such as tranquilizers or oral contraceptives or — rarely — as a result of a pituitary tumor called a prolactinoma.

Prolactinomas occur in both women and men. In women, the prolactin may cause a milky discharge from the nipple, infertility or irregular or absent menstrual cycles. In men, it may lead to decreased interest in sex, impotence or infertility.

Elevated levels of prolactin in the blood (in the absence of medication known to cause it) warrants follow-up if the level remains elevated. Imaging of the pituitary with a CT or MRI scan may reveal a tumor. If a tumor is detected, treatment options include the medication bromocriptine or surgical removal of the tumor. The decision regarding the best option is based on specific findings. Usually, consultation with an endocrinologist is warranted.

Airplane travel with infants

Question: How old should a newborn/infant be before it is safe to take him on an airplane? What, if any, are the possible detrimental effects of taking an infant on board a plane?

There are both medical and safety aspects to your question.

Because newborn's bodies are rapidly adjusting after birth and because signs of illness in newborns may be subtle, neonatologists may advise against unnecessary air travel during the first 2 weeks of an infant's life.

The two most common related questions from parents are: "Does flying affect the child's ears?" and "Does flying increase the risk of sudden infant death syndrome (SIDS)?"

Flying affects infants' ears in the same way it affects adults' — changing cabin pressure causes changing middle ear pressure, which can distend the ear drum and result in pain and crying. Infants should nurse from the breast or take a bottle on the ascent and descent to equalize ear pressure. Infants with a recent ear infection might be more uncomfortable during the flight — check with your child's doctor before the trip if you have concerns. Your doctor can provide you with analgesic ear drops to use in case pain develops.

Little is known about the effects of changing altitude on young infants and whether the risk of SIDS is affected by air travel. At this time SIDS researchers believe that the risk of SIDS seems to be little altered by airplane travel.

According to the Federal Aviation Administration (FAA), "Flying is very safe, and mile for mile a child is safer flying unrestrained in an airplane than riding restrained in a motor vehicle."

Calculating Dietary Exposures of Children

To estimate potential exposure to pesticide residues, EPA uses food consumption data gathered as part of the U.S. Department of Agriculture's Nationwide Food Consumption Survey. The survey profiles the types and amounts of food consumed over several days for all Americans, as well as subgroups.

All foods are analyzed by their separate ingredients using EPA standard "recipe files" for 300 different foods. For example, the amount of wheat flour, tomato, cheese, oregano, and other ingredients are estimated for a serving of pizza. All foods in a person's daily diet are analyzed, and the amounts of similar food components are added (e.g., total amount of wheat flour consumed from various foods in a day). These data, in turn, are used along with information on pesticide residues on individual foods to estimate overall dietary exposure to a pesticide.

EPA also has developed a special data base known as the Dietary Risk Evaluation System (DRES). This system allows the agency to refine its exposure estimates for pesticides in the diets of infants, children and other potentially sensitive subgroups. The DRES system provides information on food consumption for more than 300 food commodities for 22 different subpopulations.

According to William Farland, Ph.D., director of EPA's Office of Health and Environment Assessment, "If the DRES analysis indicates that exposure to a subgroup is so high that adverse effects may occur, then EPA will not approve a tolerance even if the estimated risks to the overall population are acceptable."

One case in which EPA did not approve a tolerance because of specific dietary concerns for infants and children involved the pesticide pydrin in 1985. New uses of the chemical on alfalfa and sorghum were requested to be allowed. However, EPA determined that the potential risks to children from secondary residues in milk from cows eating such grains were unacceptable, and the agency denied the request.

When it comes to food additives, FDA requires the manufacturer or sponsor of a food additive petition to provide an estimate of the anticipated consumption of the substance, based on the food categories in which its use is proposed. Such data include frequency of consumption and amounts consumed by all age groups, based on a nationally representative sample of Americans.