The Medical Director's Desk

Topics of Interest:

  Preventing Colds and Flu

  Seasonal Allergy Update

Preventing Colds and Flu

“What can I do to avoid getting sick?”

This question is on everyone’s mind as we approach the winter cold and flu season.

Very few popular preventive strategies like Echinacea, zinc lozenges or nasal gel have shown consistent, significant benefits; though, there has been some evidence to support the benefit of taking higher doses of Vitamin C (200mg – 500mg per day) for reducing the frequency of viral upper respiratory infections.

Unfortunately, none of the above has proven effective in shortening the duration or severity of a cold once it begins. So the best strategy to prevent illness is to reduce your direct exposure to the viruses that cause infection.

Unlike common colds, influenza can be treated if caught early, ideally within 48 hours of symptom onset. Specific anti-viral medicines can be prescribed by your doctor. These same medicines can also be used to reduce your risk of catching influenza from a close contact or family member. And remember: getting vaccinated every year against influenza remains one the most effective ways of avoiding this serious and potentially deadly viral illness.

Perhaps the simplest and least expensive way to reduce the risk of contracting colds and flu is to develop an understanding and commitment to hand washing and hygiene.

People with colds and flu carry the virus on their hands. The virus remains alive on the skin and is capable of infecting another person for at least two hours. It can then be transmitted if the person touches their eye, nose or mouth. Some cold viruses can live on surfaces (such as a counter top, door handle, or phone) for several hours. Droplets containing viral particles can be exhaled (blown out) into the air by a person with a cold as the person breathes, coughs, or sneezes.

Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds, then dried with a single use, clean towel. Alcohol-based hand rubs are an excellent alternative for disinfecting hands if a sink is not available. They also cause less drying and irritation of the skin than soap and water with frequent hand cleansing. Carrying an alcohol-based hand gel allows you to disinfect your hands frequently, especially after touching shared objects like phones, pens or door handles.

In addition, always carry tissues and cover your mouth when you cough or sneeze. Then discard the tissue and wash or sanitize your hands right away. If no tissue is available, sneeze or cough into the crease of your elbow so that you won’t spread the virus to your hands. If you are caring for a loved one who is sick, be extra careful to wash or sanitize your hands whenever handling their clothing, bedding or any objects they touch.

While there is no guaranteed way to avoid colds and flu, the best defense truly can be in your own hands – or on them!

For additional information on the topics of “Common cold “and “hand hygiene” from which some of the above information was drawn, follow or paste the following web link:

Seasonal Allergy Update

As the seemingly endless winter of 2010-2011 finally fades away the warm, wet weather will be ushering in the spring allergy season. Small airborne pollen particles that reach the nose, lungs and eyes can activate inflammatory cells producing histamines and other inflammatory chemicals that cause nasal congestion, itching, sneezing and even asthma. Allergy sufferers may show symptoms even before the first visible blooms emerge.

Twenty percent of people of all ages have allergic rhinitis, sometimes known as hay fever. Symptoms can begin at any age but ususally occur in childhood or in the 30's or 40's; and the severity can vary throughout life. For some, seasonal pollens such as trees or grass in the spring or ragweed in the fall are the main trigger; that's why they are called seasonal allergies. For others, triggers like dust mites, mold and animal dander are present all year and cause perennial (year round) allergy symptoms.

Most often, the exact allergy triggers are unknown but can be suspected based on timing. For instance, tree pollens peak before grasses in the spring. Or, in some cases, specific foliage blooming around your home may signal the onset of your symptoms. In most cases, for seasonal allergies, knowing the when is more important than the what; because the treatment will be the same.

In the case of perennial allergies, diagnosing the exact cause may be an important first step toward reducing the symptoms through immunotherapy, often known as "allergy shots". These can also be used in some cases of seasonal allergies, especially when they are severe or when the seasons tend to merge and the symptoms are present more often than not.

Though avoidance of allergy triggers is desirable, it is easier to accomplish for some perenniel allergy sufferers, such as those who react to animal dander, dust mites or mold. Certainly, remaining indoors and using air conditioning can help, especially during peak pollen counts. And, wearing a filtering mask when exposed to extremely high levels such as when mowing the lawn, will have some benefit. But, in the end, seasonal allegens are so widespread and all methods of filtration, including high efficiency particulate air (HEPA)filters are limited in their proven efficacy; so avoidance is rarely sufficient.

Nasal irrigation with saline (salt-water) solutions is gaining popularity, especially among those who wish to avoid or minimize their use of medication. Though saline nose sprays can help, they are generally less effective than using larger volumes. Nasal irrigation (also called lavage) can be performed using a variety of kits purchased over-the counter including bulb syringes, Neti pots and bottle sprayers. Saline solutions can be purchase pre-made or prepared at home.

The treatment helps both to rinse out allergen particles and to clean out the nasal passages from excess mucous. That may be especially useful in preparation for some nasal spray medications. One such method can be found at the following WebMD site: www.webmd.com/allergies/sinus-pain-pressure-9/neti-pots (just copy and paste the web address into your browser).

For most seasonal allergy sufferers though, medications, both over the counter and prescribed, remain the mainstay of treatment. There are several medication types that can help with different symptoms and, often, they complement each other in their benefit. Many effective medications that once required a prescription are now available over-the-counter. Unfortunately, there is no one perfect solution and the most effective choices still require a doctor's prescription.

The current recommended first-line treatment for allergic rhinitis is nasal steroids. These prescription medicines have fewer side effects and are thought to be more effective than oral antihistamines. Most can be taken once daily. Unlike oral or inhaled steroids (used for asthma) the dose of nasal steroids is so low that studies have shown them to be safe after years of use. The most common side effects include local irritation and, rarely, nasal infection; and therefore periodic nasal examination is recommended.

It is important to know that nasal steroids do not work immediately; they usually take several days or even a week to reach maximum benefit. Therefore, it is best to begin them before allergy season starts or, at least, at the first sign of allergy symptoms.  Multiple formulations exist, all with comparable efficacy. In general aqueous (water-based) solutions are less drying and irritating. Combined with oral antihistamines, these two medication classes represent the most common approach to seasonal allergies.

Antihistamine pills have been available for decades. Though the newer generation medications tend to have fewer side effects (especially less drowsiness) and offer more convenient, once-daily dosing, they are usually no more effective than the older choices like diphenhydramine (Benadryl) or chlorpheniramine (Chlor-Trimeton). Still, medications like loratadine (Claritin, Alavert), fexofenadine (Allegra),  or cetirizine (Zyrtec) can offer some relief. Prescription alternatives like desloratidine (Clarinex) or levocetrizine (Xyzal) are also available.

Newer nasal spray antihistamines like Astelin, Astepro and Patanase are also effective at relieving post-nasal drip, congestion and sneezing but can have some side effects including nsasl irritation, bad taste and still can cause some drowsiness.

Decongestants like pseudoephedrine and phenylephrine were often combined with antihistamines in allergy drugs. Though they help with the mucous menbrane swelling and pressure, they have many side effects, including elevating blood pressure and heart rate (which can be especially problematic for people with high blood pressure or heart disease). Further, pseudoephedrine, the most effective oral decongestant, was removed from most medications due to its diversion and misuse in manufacturing illegal drugs. Medications containing pseudoephedrine can still be obtained directly from the pharmacist though.

Topical decongestants like oxymetazoline (Afrin) or phenylephrine (Neo-synephrine) can be very effective at relieving nasal congestion quickly; but extended use (more than three days) can lead to rebound congestion that is very hard to relieve. Still, they can be very useful during the first few days of symptoms, especially when first starting nasal steroid use, as they allow better delivery of the steroid medication. In addition, they can be extremely helpful during air travel to reduce the ear pain and pressure-related ear injury caused by cabin pressure changes. Remember though, use them for a maximum of three days .

There is also a newer type of oral medicine called Singulair, a leukotriene modifiers.  This  medicine was introduced for asthma treatment and can also help allergy symptoms. However, it is generally reserved for those who cannot tolerate nasal steroids, which are more effective.

Finally, Nasalcrom (cromolyn sodium) is a nasal spray, now available over-the-counter, that stabilizes the allergy cells and reduces the inflammatory chemical they release. However, it must be used 3-4 times a day and you must start before the allergens trigger the reaction. Nevertheless, it presents a helpful alternative for those who do not wish to use nasal steroid sprays.

Though allergic rhinitis remains a common problem, recent advances in treatment provide more effective, more convenient alternatives than ever before. If the growing number of over-the-counter remedies are not helping, your doctor has several effective options for you to try. In the most severe or chronic (longstanding) cases, referral to an allergy or sinus specialist may be needed to consider additional measures such as immunotherapy or direct nasal and sinus examination or other procedures.

Though the congestion, runny nose and post nasal drip of allergies and infections can be similar, allergic rhinitis should not cause fever (temperature over 100.5), severe facial pain or thick pus-like mucous for many days. These symptoms are more typical of infections which may be coincident to or a consequence of the allegies.  They should be evaluated by your doctor if they are severe, last more than a week or are worsening rapidly.

For more information from the source of this summary and for related links, please click on the link below.