tag:blogger.com,1999:blog-61030308658955288502024-03-10T12:13:11.145-07:00Allergy Dude's Allergy and Asthma AssortmentsAllergic diseases are very common and include allergic rhinitis (hay fever), atopic dermatitis (eczema), urticaria (hives), chronic sinusitis (infections), asthma, food allergies, drug allergies, insect allergies, and anaphylaxis (life-threatening allergic reactions). If people knew what they were allergic to, and took proper preventative measures, they would not have nearly the amount of suffering or medication use. Here are ideas to help people understand how they can live healthier lives.Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.comBlogger412125tag:blogger.com,1999:blog-6103030865895528850.post-10704987090591899082012-12-31T09:44:00.003-08:002013-01-02T07:52:01.371-08:00Drug Update: New Medications 2012<!--[if gte mso 9]><xml>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">1.<span style="font: 7.0pt "Times New Roman";"> <a href="http://www.proairhfa.com/">
</a></span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; line-height: 115%;"><a href="http://www.proairhfa.com/">ProAir HFA</a> will begin to become available
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actuator during January of 2013.</span></div>
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</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">I
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burning postnasal drip I experienced with Astelin.</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: Arial;"><span style="mso-list: Ignore;">3.<span style="font: 7.0pt "Times New Roman";">
</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><a href="http://www.combivent.com/respimat/index.html">Combivent Respimat</a> will
replace Combivent inhalers.<span style="mso-spacerun: yes;"> </span>The new
device does not use a propellent.</span></div>
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will be activated when the cover is removed. The cost has not been announced yet</span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">. Insurance coverage during the first year will not likely be good. For comparison, Epi-pen 2-pack retails for $309 at CVS, when I checked last week. My inspection showed a well designed product.</span></div>
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</span></span></span><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">Consumers
may have noticed when they go to pick up Singulair at the drug store or
receive mail order, they are given its generic montelukast.</span></div>
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is an oral preparation of cromolyn sodium and is indicated for
mastocytosis.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>This is a disease where mast cells release histamine
in potentially fatal amounts.<span style="mso-spacerun: yes;"> </span>The cost for
a group of 96 unit dose ampules ranges from $459-1,000. I did not know the cost previously.</span></div>
<div class="MsoListParagraphCxSpLast" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; margin-left: .75in; margin-right: 0in; margin-top: 0in; mso-add-space: auto; mso-layout-grid-align: none; mso-list: l0 level1 lfo1; mso-pagination: none; text-autospace: none; text-indent: -.5in;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">7. Aerospan is flunisolide HFA 80 mcg and indicated for "maintenance treatment of asthma as prophylactic therapy in adult and pediatric patients 6 years of age and older". <a href="http://www.fda.gov/Drugs/InformationOnDrugs/ucm090164.htm">This Forest Pharmaceutical product was approved 1/26/06 by the FDA</a>. The label change was approved on 11/16/12. No word currently from the new owner Action Pharmaceuticals.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">8. <a href="http://news.frx.com/press-release/corporate-news/forest-laboratories-and-almirall-announce-fda-approval-tudorza-pressair"> Tudorza is an orally inhaled dry powder of aclidinium</a> which was <a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm313052.htm">approved by the FDA on 7/23/2012</a>. Aclidinium inhibits the M3 receptor so it is classified as an antimuscarinic, which are in turn grouped as anticholinergic. This compound produces long-acting bronchodilation in patients with COPD. Tudorza has not been launched yet.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">9. <a href="http://www.dddmag.com/news/2012/07/fda-approves-generic-clarinex-lithobid">Generic Clarinex (desloratadine) was approved during the summer</a>. I just got confirmation from some patients that this given to them for refills, not the name brand. Even recently, insurance companies have been pushing back to have the patient switched to a generic medication. Note this means that there no oral name-brand only antihistamines available by either OTC or prescription now.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;">10. <a href="http://flucelvax.com/">Flucelvax</a> is the first vaccine approved that uses a mammalian cell line not chicken eggs to grow the influenza virus. <a href="http://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm328629.htm">Flucelvax was approved on 11/20/12 for both types A & B in patients <u>></u>18 years old</a>.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><br /></span>
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt;"><i>The Allergy Dude</i> wishes you a Happy New Year!!</span></div>
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com37tag:blogger.com,1999:blog-6103030865895528850.post-14476765702661370782012-11-04T16:27:00.000-08:002012-11-04T16:27:15.201-08:00What do I need to know about Lice?This post was prompted first by my wife, who works as a school nurse, and told me about seeing a boy who had to be treated for both lice and scabies at the same time, and next by a patient I saw, primarily for allergies, but then his mother asked me to look carefully at his hair. There was a high suspicion of lice in my mind. <br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaQsAlw0EkOImBFn5fL9HVhr-NmIAEndsJyxqiOH5Nbz7idqaSCY4zL_yWiIl6DdKXn-_VtIXgjAi9MJUcPcBjIgNCNU5JnDbCuC5iWAL_2FilHvDRoQfztVeJdG66ysOECHKioHy_3Rs/s1600/louse2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaQsAlw0EkOImBFn5fL9HVhr-NmIAEndsJyxqiOH5Nbz7idqaSCY4zL_yWiIl6DdKXn-_VtIXgjAi9MJUcPcBjIgNCNU5JnDbCuC5iWAL_2FilHvDRoQfztVeJdG66ysOECHKioHy_3Rs/s320/louse2.jpg" width="320" /></a></div>
(<a href="http://www.nitcontrol.com/untitled1.html">Photo 1</a>) <a href="https://www.google.com/search?q=lice&oe=utf-8&aq=t&rls=org.mozilla:en-US:official&client=firefox-a&channel=np&um=1&ie=UTF-8&hl=en&tbm=isch&source=og&sa=N&tab=wi&ei=DvyWUI3CGoXk8gT_u4DgDA&biw=1280&bih=707&sei=EPyWUJeRH4-m8QT-2oHQAw">More good photos are online</a>. We discussed the treatments: over-the-counter meds and prescription meds. <a href="http://www.cdc.gov/parasites/lice/head/treatment.html">A good summary can be found at the CDC's website</a> (although this site was last updated 11/2/10). His mom asked me about using mayonnaise, which I never heard of. The idea here is to suffocate the lice. Some research led me to the <a href="http://www.health.state.mn.us/divs/idepc/diseases/headlice/treatment.html">Minnesota Department of Health's website</a>. I want to stress that any medication or home remedy must not be left on the person's scalp, because of the risk of irritating the skin, or causing a chemical burn. The third and final thing that prompted me to write this post an announcement of a new prescription medication for lice: ivermectin. You have to <a href="http://www.medscape.com/viewarticle/773810?src=mpnews">login to MEdscape to read the article</a>, so if you can't then here's a <a href="http://www.wfaa.com/news/health/kids-doctor/176970671.html">pretty good summary on an open website</a>.<br />
<br />
Now for 2 obvious trivia questions: can anyone guess the origin of the phrases "to nit pick" and "to use a fine tooth comb"?<br />
<br />
If you have questions about lice, ask your doctor....<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com17tag:blogger.com,1999:blog-6103030865895528850.post-73359858904352626252012-06-03T18:03:00.002-07:002012-06-03T18:03:45.281-07:00What do I need to know about buying the best bread?<br />
<div style="font-family: Arial,Helvetica,sans-serif;">
99% of my
patients eat bread almost daily, which itself is not surprising, since
we live in a westernized area with a very low percentage of Asians. Yet
no one I've asked understands the facts about their bread. It is a
complicated problem. This article is an attempt to educate all of us,
including myself.</div>
<div style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<div style="font-family: Arial,Helvetica,sans-serif;">
What is the definition of "Whole grains"? This depends on who you ask. I'll go with the <a href="http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/DGAC/Report/E-Appendix-E-2-Glossary.pdf">U.S.D.A.'s definition</a> in the <a href="http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/PolicyDoc.pdf">"Dietary Guidelines for Americans 2010</a>" listed in the <a href="http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Appendices.pdf">Appendix page 36</a>:
"Grains and grain products made from the entire grain seed, usually
called the kernel, which consists of the bran, germ, and endosperm. If
the kernel has been cracked, crushed, or flaked, it must retain nearly
the same relative proportions of bran, germ, and endosperm as the
original grain in order to be called <a href="http://en.wikipedia.org/wiki/Whole_grain">whole grain</a> (here's a picture)." For a short list of whole grains, I refer you to <a href="http://www.cnpp.usda.gov/Publications/DietaryGuidelines/2010/PolicyDoc/Appendices.pdf">Table A4-3 on page 16</a> (and <a href="http://www.ers.usda.gov/publications/err31/err31.pdf">here in 2006</a> page 20). For longer lists, I refer you to a list from the <a href="http://healthymeals.nal.usda.gov/hsmrs/Idaho/HUSSCManual/goalf.pdf">state of Idaho</a> and <a href="http://en.wikipedia.org/wiki/Whole_grain">Wikipedia</a>. In a <a href="http://www.ers.usda.gov/publications/err31/err31.pdf">2006 U.S.D.A. report</a>, they concluded that the average American should increase their consumption of whole grains by 248% (page 19) to fulfill the <i>Dietary Guidelines</i>. The <a href="http://abcnews.go.com/blogs/health/2012/02/07/companies-not-telling-the-whole-truth-about-whole-grains/">percentage of wheat in the product is not legally defined</a>. </div>
<div style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<div style="font-family: Arial,Helvetica,sans-serif;">
I find the <a href="http://en.wikipedia.org/wiki/Whole_grain">labeling confusing for all the types of whole grain wheat products</a>. The U.S.D.A does not have a definition for "multigrain". This <a href="http://www.fitday.com/fitness-articles/nutrition/healthy-eating/what-is-multigrain-how-is-it-made.html">term has no formal definition anywhere that I can find</a>. Here's a <a href="http://answers.yahoo.com/question/index?qid=20080222144120AABOkYi">commentary which lists other terms that are undefined as misleading, such as stone ground and 100% whole wheat</a>. Do not get up-sold by the words <a href="http://abcnews.go.com/blogs/health/2012/02/07/a-guide-to-decoding-ingredients-on-grain-products/">natural, light, healthy, stone ground</a> or good in the label. On a positive note, <a href="http://en.wikipedia.org/wiki/Groat_%28grain%29">groats</a> "are the hulled grain of various cereals, such as oats and wheat." Think of <a href="http://en.wikipedia.org/wiki/Grain">cereals</a>
are the plants that produce the grains. Which grain is the best to
eat? There is no consensus. In an equally-sized serving, the number of
calories, vitamins and minerals, plus other healthy nutrients varies
widely. Here's <a href="http://www.vrg.org/journal/vj99sep/999grains.htm">one person attempt at rating grains</a>.</div>
<div style="font-family: Arial,Helvetica,sans-serif;">
</div>
<div style="font-family: Arial,Helvetica,sans-serif;">
It
is important to study the label for the ingredients, fiber content,
sodium content, and serving size. You can mislead yourself easily by
making erroneous assumptions. For example, check if the serving size is
1 or 2 slices of bread. What you should know is that your bread is
made from whole grains from whatever grain you like to eat.</div>
<div style="font-family: Arial,Helvetica,sans-serif;">
<br /></div>
<div style="font-family: Arial,Helvetica,sans-serif;">
Of all the grains, <i>The Allergy Dude</i> favors rice and oats. I'll explain why in a future installment.</div><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<i>The Allergy Dude</i> has decided to write
series of articles on healthy eating because the information available
on the web is too scattered and variable, so he will select what he
thinks is the most reliable and important information for his readers to
help them understand his system for healthy eating.<br />
<br />
1. Definitions<br />
Please go to the following link for words defined in <a href="http://healthymeals.nal.usda.gov/hsmrs/Connecticut/Action_Guide_Child_Care/CCAG_Glossary_BackCover.pdf">Connecticut's Action Guide for Child Care Nutrition and Physical Activity Policies</a>.
There are many lists on the web, but this list is the best one I could
find, because it lists all of the terms that are important to my
system. Please read about: added sugars, artificial sweeteners,
carbohydrates, chemically altered fat substitutes, cholesterol, complex
carbohydrates, dietary fiber, enrichment, fiber, fortification,
hydrogenated oils, monosaturated fats, natural cheese, nonnutritive
sweeteners, partially hydrogenated oils, phytonutrients, polyunsaturated
fats, saturated fats,<br />
<br />
We can not have a meaningful
discussion of my system without knowing these definitions. They are
very helpful for improving and maintaining your immunologic health.<br />
<br />
2.The <a href="http://www.fns.usda.gov/ora/menu/Published/snap/FILES/ProgramOperations/FSPFoodRestrictions.pdf">U.S. Department of Agriculture does not have a definition for a good or bad food</a>. On the other hand, it does have <a href="http://fnic.nal.usda.gov/dietary-guidance/dietary-guidelines">Dietary Guidelines for Americans</a>.<br />
<br />
3. In <a href="http://fnic.nal.usda.gov/dietary-guidance/dri-reports/definition-and-review-dietary-antioxidants-and-related-compounds">1998, the U.S.D.A. defined antioxidants</a> and named vitamins A, C, E, and the element selenium for further study.<br />
<br />
The Allergy Dude will use these facts as the building blocks for more Healthy Eating in the next chapter.<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com9tag:blogger.com,1999:blog-6103030865895528850.post-68055863831104627492012-05-26T19:45:00.001-07:002012-05-28T17:21:58.939-07:00Drug update and drug affordability advice<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">There has been a burst of news. Let's get started, including some comments by <i>The Allergy Dude</i>!</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;"> 1. The FDA approved a combination product of azelastine (Astelin or Astepro) and fluticasone (Flonase) named <a href="http://www.dymista.com/" target="_blank">Dymista</a>. Both ingredients are available individually. There is no data supporting synergy. This product could be convenient. <i>The Allergy Dude</i>
predicts that Dymista's success will hinge on the same factor as most
other products, which is its price. This is not known yet. The product
is slated to be launched during August.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">2. <a href="http://www.omnarispro.com/files/Omnaris_Healthcare_Provider_Letter.pdf" target="_blank">Omnaris (AQ) production</a>
continues to be too low, resulting in shortages. There is no end in
sight. So if you want to fill a prescription, be prepared with an
alternative.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">3. A new eyedrop for eye allergies called <a href="http://www.lastacaft.com/" target="_blank">Lastacaft</a> is being marketed. There is no comparative data showing it is superior to other available products.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">4. TEVA has been sampling its "new" nasal steroid product: <a href="http://www.qnasl.com/" target="_blank">Qnasl</a>.
The more things change, the more they remain the same. This is just
like the no-longer-available Beconase and Vancenase sprays, except for
two important differences. First, each spray produces 80 mcg, not 42,
of beclomethasone dipropionate. Hence the dosing is 2 puffs once per
day, not twice per day. Second, the propellent is the same HFA is in
the inhalers for asthma. The Allergy Dude predicts that this product
will have a niche in those patients who do not like the current aqueous
formulations of corticosteroid sprays. The only problems are the
potential cost and the competition below.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">5. <a href="http://www.zetonna.com/" target="_blank">Omnaris HFA</a> (Zetonna) is ciclesonide nasal steroid spray using HFA propellent. Interestingly, no information can be found on <a href="http://www.sunovion.com/util/searchResult.cfm?SearchText=omnaris+hfa&x=0&y=0" target="_blank">Sunovion's</a> nor the <a href="http://google2.fda.gov/search?q=omnaris+hfa&client=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*&sort=date:D:L:d1&entqr=3&entqrm=0&oe=UTF-8&ie=UTF-8&ud=1&site=FDAgov&btnG=Search&ip=96.33.91.142&access=p&start=10" target="_blank">FDA website</a> about the approval date. There have been ads in allergy journals for months. No word on the launch date. </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">6. To the best of <i>The Allergy Dude's</i> research, Singulair will not be available OTC after 8/3/12, but will be going generic.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">7.
When the diagnosis of asthma remains in question after a careful
history, physical exam, labs and spirometry, then a mannitol (Aridol)
challenge would the next and definitive test.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">8. Studies by <a href="http://www.merck.com/licensing/news-and-events/Merck-Investigational-Allergy-Immunotherapy-press-release.html">Merck for its sublingual (under-the-tongue) immunotherapy</a>
are closing and will be submitted for approval soon. This means it is
not available now and will not be available for 1-3 years more depending
on the FDA's review, approval, and product manufacture. </span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">9. <a href="http://www.daliresp.com/">Daliresp</a> is a new oral medication that may reduce the number of exacerbations of COPD in patients with severe COPD.</span><br />
<br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">Affordability advice:</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">1.
Concerning medications, Insurance companies are slowly increasing
copays for medications, requiring prior authorizations, and issuing
denials. Keep track of which medications you have tried already.</span><br />
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">2. At your doctor's office, ask for any coupons or rebates. Within my office, <i>The Allergy Dude</i> is also known as <i>The Coupon King</i>,
because I distribute so many coupons to patients. Don't forget to use
them, or you may be leaving money on the table. If your medication is
tier 2 or 3, you should seriously be searching for a coupon. They are
available more than you think.</span></div>
<span style="font-family: "Arial","sans-serif"; font-size: 10pt;">3.
Here is one example: Xopenex HFA's out of pocket cost is $66 but with a
coupon card worth $75, it can be free. You can't file through
insurance though, because it was out-of-pocket.4.
Another slightly different example: Alvesco's out-of-pocket cost is
$122 but with a coupon card worth $75, you still pay $47. If Alvesco is
tier 3 on your insurance formulary, for which you pay $50, then using
the coupon card gets you the Alvesco for free.
5.
Read the coupons carefully. For example, a Veramyst coupon offers $25
off, which helps, but only once, as is stated on the coupon.
6.
Consider doing a drug study. Often the participants may get paid for
their time and effort, medications, and medical care & tests
during the period of the drug study. It's not a bad option for those
with high deductible insurance, those trying to get a medication they
can't afford, or those wanting to try a new medication.
That's the news and views from <i>The Allergy Dude</i> aka <i>The Coupon King.</i></span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com8tag:blogger.com,1999:blog-6103030865895528850.post-68060772920341872222012-05-24T12:39:00.000-07:002012-05-24T13:33:19.539-07:00Olive oil points in favor<i>The Allergy Dude</i> was going to summarize some of his reading about olive oil, when he realized that once again wikipedia has beaten him to the punch again. No matter, <a href="http://en.wikipedia.org/wiki/Olive_oil">give credit where credit is due</a>. The retail grades of olive oil should be scrutinized. The <a href="http://www.oliveoiltimes.com/olive-oil-basics/olive-oil-grades/understanding-usda-olive-oil-standards/6320">labels can be very confusing and vary from nation to nation</a>. Nevertheless, <i>The Allergy Dude</i> endorses using monounsaturated fats in your cooking as a step towards a healthier diet. Olive oil contains by far the highest amount of <a href="http://en.wikipedia.org/wiki/Monounsaturated_fat">monounsaturated fats by weight (75%)</a> of all vegetable oils available. <a href="http://en.wikipedia.org/wiki/Sunflower_oil">Sunflower oil and peanut oils come close</a> depending on the variety, which alters the content of monounsaturated and polyunsaturated fats.<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com5tag:blogger.com,1999:blog-6103030865895528850.post-78785537850415136372012-05-10T15:12:00.000-07:002012-05-10T15:12:20.580-07:00Are there anti-oxidant vitamins to treat allergies or asthma?<span style="font-family: Arial,Helvetica,sans-serif;">My father asked <i>The Allergy Dude</i> recently this question. What about vitamin E? Some small trials and retrospective studies have been done to investigate if vitamins can reduce the signs or symptoms of allergic diseases. The short answer is NO, unfortunately. In some other diseases, the answer can be yes sometimes. For example, in age-related macular degeneration (AMD), in moderate and severe cases, the vitamins and mineral zinc helped to prevent further losses. </span><a href="http://www.masseyeandear.org/for-patients/patient-guide/patient-education/diseases-and-conditions/macular-degeneration/macular-degeneration-dietary-supplements/" style="font-family: Arial,Helvetica,sans-serif;">This link explains the findings of a multi-center trial very well</a><span style="font-family: Arial,Helvetica,sans-serif;">. AMD involves the retina, which is located in the back of the eye. Cataracts are located in the lens of the eye, which is in the front, to clarify. Cataracts are not prevented or slowed in development by any vitamins or minerals. If you know some one with AMD, please share this fact with them.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com14tag:blogger.com,1999:blog-6103030865895528850.post-90133734331937014812012-04-19T08:51:00.000-07:002012-04-19T08:51:48.098-07:00Do hypoallergic pets exist?<span style="font-family: Arial,Helvetica,sans-serif;">Today's article is completely based on an article by Butt, Rashid and Lockey (in Ann Allergy Asthma Immunol 2012; 108: 74-6) titled "Do hypoallergenic cats and dogs exist?" </span><i style="font-family: Arial,Helvetica,sans-serif;">The Allergy Dude</i><span style="font-family: Arial,Helvetica,sans-serif;"> gets asked about this frequently and he apologizes for not having an posting about this until now. (</span><a href="http://www.ncbi.nlm.nih.gov/pubmed/22289723" style="font-family: Arial,Helvetica,sans-serif;">No summary is available on PubMed</a><span style="font-family: Arial,Helvetica,sans-serif;">.) Their article reviewed the scientific evidence available about hypoallergenic dogs and cats. First, why is this important? 17% of cat owners and 5% of dog owners are sensitized to their pets' dander. We recognize that cat dander is generally more likely to cause allergies than dog dander. Daily exposure to dander can significantly contribute to an increase in a patients' signs and symptoms of allergies both perennially and seasonally. The vast majority of pet owners keep their pets despite being advised by their allergists to keep the pets outside of the house. Many let the animals sleep in the bedroom. Pet owners ask about available measures to reduce the accumulation of dander in the house. No measures for bathing pets, or house cleaning, even using a vacuum cleaner with a HEPA filter, or having multiple HEPA air filtration devices can remove all of the dander shed by their pets. The amounts of dander can be reduced. My analogy is it's like walking up an endless sand dune. It's hard to get ahead and it's a good bit of constant work in our already-too-busy lives. Back to the article, despite the claims and endorsements on some companies website, </span><b style="font-family: Arial,Helvetica,sans-serif;">multiple allergy associations have concluded that no evidence for hypoallergenic exists. </b><span style="font-family: Arial,Helvetica,sans-serif;"><i>The Allergy Dude</i> completely agrees with this conclusion. Sorry pet owners. If this changes, as in incontrovertible evidence does become available, after <i>The Allergy Dude</i> invests heavily in said company then he will update this blog.</span> <div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com23tag:blogger.com,1999:blog-6103030865895528850.post-75242755151539635282012-03-20T17:46:00.000-07:002012-03-20T17:46:18.487-07:00National Health Interview Survey, United States, 1998--2009: Percentage of Children Aged less than 18 Years with Reported Food, Skin, or Hay Fever or Respiratory Allergies<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzelFyIs8pf_gqa11IVeYO3_aAx1S_O8X7gDbPWVX_8nVG5K3xpYjRUnYuRbYT-RJX3JjnR1ECwMdG0eiAc6pgiVuv2cuqIxnCEPqOXHX6-AXJnuLpALsDnN7xOp5VS5DhPFZ-Kky5hZs/s1600/Food+skin+resp+allergy.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="396" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgzelFyIs8pf_gqa11IVeYO3_aAx1S_O8X7gDbPWVX_8nVG5K3xpYjRUnYuRbYT-RJX3JjnR1ECwMdG0eiAc6pgiVuv2cuqIxnCEPqOXHX6-AXJnuLpALsDnN7xOp5VS5DhPFZ-Kky5hZs/s640/Food+skin+resp+allergy.gif" width="640" /></a></div>I am copying the <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6011a7.htm?s_cid=mm6011a7_w">image and wording directly from the CDC's website</a>. Households were randomly contacted and asked three questions: "During the past 12 months, has your child had any kind of food or digestive allergy?" and "During the past 12 months, has your child had eczema or any kind of skin allergy?" and a positive response to either "During the past 12 months, has your child had hay fever?" or "During the past 12 months, has your child had any kind of respiratory allergy?"<br />
<br />
"From 1998--2000 to 2007--2009, the percentage of children who were reported to have a food allergy during the preceding 12 months increased from 3.5% to 4.6%, and the percentage who were reported to have a skin allergy increased from 7.3% to 10.7%. The percentage of children reported to have hay fever and/or respiratory allergy was 16.6% during 2007--2009, a level that did not differ substantially from earlier years." Food and skin allergies are increasing.<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com0tag:blogger.com,1999:blog-6103030865895528850.post-35064709356636459282012-03-20T17:37:00.001-07:002012-03-20T17:46:36.499-07:00National Health Interview Survey, United States, 2000-2010: Percentage of Children Aged ≤17 Years with Eczema or Any Kind of Skin AllergyI am copying the image and wording <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6044a9.htm?s_cid=mm6044a9_w">directly from the CDC's website</a>. Households were randomly selected and asked the following question: "During the past 12 months, has [child] had eczema or any kind of skin allergy?" The graphed results are below. The prevalence of eczema or skin allergies has nearly doubled in the 3 ethnic groups interviewed: black, Hispanic and white.<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCZ_9j8UH40khZBbvszVOEsdS1cr4zZsh2IvMd2Ssq86rvuiNppxY5H6IksQwiIwzVvIqZwnQmkKeiNaYDdxri3MBuGrm6vFDcuIekdT5URinEHb83fdF7n82LhyphenhyphenDmvNVf0P0XE9f4EIc/s1600/eczema.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="380" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjCZ_9j8UH40khZBbvszVOEsdS1cr4zZsh2IvMd2Ssq86rvuiNppxY5H6IksQwiIwzVvIqZwnQmkKeiNaYDdxri3MBuGrm6vFDcuIekdT5URinEHb83fdF7n82LhyphenhyphenDmvNVf0P0XE9f4EIc/s640/eczema.gif" width="640" /></a></div>"From 2000 to 2010, the prevalence of eczema or any kind of skin allergy increased among non-Hispanic black, non-Hispanic white, and Hispanic children in the United States. The prevalence of eczema or skin allergy increased from 8.6% to 17.1% among non-Hispanic black children, from 5.0% to 9.9% among Hispanic children, and from 7.6% to 12.6% among non-Hispanic white children."<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-46087403368350583152012-01-05T09:21:00.000-08:002012-01-05T09:21:04.211-08:00Drug Update: Patent expirations of Levaquin, Singulair, Avelox and Xyzal<div style="font-family: Arial,Helvetica,sans-serif;">Happy New Year to all of the Allergy Dude's readers!</div><div style="font-family: Arial,Helvetica,sans-serif;">Let's review 2011 first. No branded products were removed from the market, which is good. Due to an earlier decision by the F.D.A., generic combinations of antihistamines and decongestants will not be available by prescription in the U.S. The Allergy Dude can not vouch for medications bought outside of the U.S. since there may be issues about "who is responsible quality control of the product?".</div><div style="font-family: Arial,Helvetica,sans-serif;">Two quiet changes are that first Levaquin's patent expired on 6/20/11. This is now available as a generic. Second, Avelox's patent expired on 12/18/11. This is not available as a generic to my research as of today yet. This may change.</div><div style="font-family: Arial,Helvetica,sans-serif;">A reminder that Xyzal has been available as a generic in the 5mg pill (only) since December of 2010. So this left only Clarinex as the only branded antihistamine on the market.</div><div style="font-family: Arial,Helvetica,sans-serif;">A gigantic change is coming in 2012 because <a href="http://kaoallergyasthma.blogspot.com/2008/09/when-will-generics-become-available-for.html">Singulair's final patent will be expiring on 8/3/12, as I outlined in an earlier post</a>. This is spell financial relief for many patients and their families. Note there has been no discussion about Singulair going over-the-counter.</div><div style="font-family: Arial,Helvetica,sans-serif;">One final note, Xopenex will be a branded product until the last of its 5 patents expires in 8/13.</div><span style="font-family: Arial,Helvetica,sans-serif;">Have a good year!!!</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com0tag:blogger.com,1999:blog-6103030865895528850.post-58344921766902430512011-12-13T17:20:00.001-08:002016-04-23T11:30:15.824-07:00Greenville (South Carolina's) Rank as an Allergy Capital Spring 2012<span style="font-family: "arial";">Here is how Greenville, South Carolina has been ranked in the <a href="http://www.aafa.org/pdfs/FINAL%20public%20LIST%20Spring_2010.pdf">Asthma and Allergy Foundation of America's</a> lists of the top 100 most challenging places to live in the U.S. for: Spring Allergies, Fall Allergies, or Asthma.</span><br />
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<br />
<table border="5"><tbody>
<tr> <td>Year</td> <td>Spring Allergy rank</td> <td>Fall Allergy rank</td> <td>Asthma rank</td></tr>
<tr> <td>2003</td> <td>13</td> <td>24</td> <td>not done</td></tr>
<tr> <td>2004</td> <td>19</td> <td>34</td> <td>54</td></tr>
<tr> <td>2005</td> <td>6</td> <td>32</td> <td>58</td></tr>
<tr> <td>2006*</td> <td><span style="color: red;">2</span></td> <td><span style="color: red;">1</span></td> <td>68</td></tr>
<tr> <td>2007</td> <td>53</td> <td>45</td> <td>34</td></tr>
<tr> <td>2008</td> <td>17</td><td><span style="color: red;">2</span></td><td>8</td></tr>
<tr> <td>2009</td> <td>25</td> <td>96</td> <td>49</td></tr>
<tr> <td>2010</td> <td>28</td> <td>44</td> <td>59</td></tr>
<tr> <td>2011</td> <td>20</td> <td>31</td> <td>83</td></tr>
<tr> <td>2012</td> <td>21</td> <td>37</td> <td>97</td></tr>
<tr> <td>2013</td> <td>19</td> <td>30</td> <td>89</td></tr>
<tr> <td>2014</td> <td>46</td> <td>100</td> <td>69</td></tr>
<tr> <td>2015</td> <td>21</td> <td>76</td> <td>55</td></tr>
<tr> <td>2016</td> <td>32</td> <td></td> <td></td></tr>
</tbody></table>
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<div style="font-family: Arial,Helvetica,sans-serif;">
updated 4/23/16</div>
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* = A good or bad year for us, depending on your perspective!</div>
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<div style="font-family: Arial,Helvetica,sans-serif;">
Commentary: Most of the top 50 cities in the Allergy Capitals lists are in the Southeastern U.S. The likely explanation is the highest pollen counts occur in the Southeastern U.S., because of the longer and warmer climate + greater vegetation which cause more allergies and so more medication use. These are two of three criteria used to determine the rankings. The table above can not be found in this format anywhere else on the internet.</div>
<br />
<span style="font-family: "arial";">If you are curious about how other cities were ranked this year only, go to the <a href="http://aafa.org/pdfs/FINAL%20public%20LIST%20Spring_2011.pdf">Allergy and Asthma Foundation of America's website</a> or click on the link in the top left corner of this website. Prior year's rankings can be found by searching the internet. To see graphs of this years' pollen and mold counts, click <a href="http://kaoallergyasthma.blogspot.com/search/label/SC%202008">here</a>.</span><br />
<br />
<span style="font-family: "arial";">Addendum: 4/24/11</span><br />
<span style="font-family: "arial";">I disagree with the 3 measurements used to determine their rankings of Allergy Capitals: </span><br />
<ul>
<li><div class="MsoNormal">
<span style="font-family: "arial" , "helvetica"; font-size: x-small;">Pollen scores (airborne grass/tree/weed pollen and mold spores)*</span></div>
</li>
<li><div class="MsoNormal">
<span style="font-family: "arial" , "helvetica"; font-size: x-small;">Number of allergy medications used per patient</span></div>
</li>
<li><div class="MsoNormal">
<span style="font-family: "arial" , "helvetica"; font-size: x-small;">Number of allergy specialists per patient.</span></div>
</li>
</ul>
<span style="font-family: "arial";">Many of the cities in the rankings do not have any pollen counting stations. How then are their pollen scores calculated? They must be estimated. This is 33% of their score. This greatly affects the rankings. Physicians are humans also and so tend to live in larger cities and nicer areas. This may boost the rankings of these cities.</span><br />
<span style="font-family: "arial";">Separately, Greenville ranks about 20th in the spring and about 42nd in the fall fairly consistently.The pollen counts are higher in the spring than in the fall, as it is for most of the SE US.</span><br />
<span style="font-family: "arial";">12/13/11 My other objection to the list is: how are the pollen and mold counts determined? My office has been responsible for the pollen counts in Greenville since 2000. We don't publish mold counts, because we use a Rotorod sampler, which does not count mold spores accurately. Almost every site listed in the National Allergy Bureau's website uses the same sampler (private communication). I also know the NAB does not monitor 100 other pollen and mold counting stations. So where does the certified data come from? I happen to have lived in Dayton, OH and I know the pollen counts weren't as high as Greenville's. Perhaps the climate and vegetation has changed.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com2tag:blogger.com,1999:blog-6103030865895528850.post-40645234271777345642011-10-23T15:18:00.000-07:002011-10-23T15:18:16.808-07:00Influenza Vaccination for the 2011-12 Season<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhW6-xZipN5RfzDdGFqOt9ubXTbhXZDP9-luGOJfTOqnJ38R0oRQxo2rYc3c5OyQ6lNgN7gLOY-4IkYUsDgPK0h7ynmen3RzpPl_nZBLJVjJFaVhXIhYWwfnPCkU___2lXeJFWGOI1Lgfk/s1600/IMG_1471.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhW6-xZipN5RfzDdGFqOt9ubXTbhXZDP9-luGOJfTOqnJ38R0oRQxo2rYc3c5OyQ6lNgN7gLOY-4IkYUsDgPK0h7ynmen3RzpPl_nZBLJVjJFaVhXIhYWwfnPCkU___2lXeJFWGOI1Lgfk/s200/IMG_1471.JPG" width="200" /></a></div><div style="font-family: Arial,Helvetica,sans-serif;">The <a href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6033a3.htm">Centers for Disease Control and Prevention published their guidelines for administration of the influenza vaccination for the 2011-2 season</a>. So The Allergy Dude will just summarize.</div><div style="font-family: Arial,Helvetica,sans-serif;">1. The vaccine is the same as the vaccine from 2010-1, because they thought the flu strains were going to be the same.</div><div style="font-family: Arial,Helvetica,sans-serif;">2. The vaccine contains 3 strains of influenza, one of which is H1N1 or swine flu.</div><div style="font-family: Arial,Helvetica,sans-serif;">3. One vaccination is expected to provide immunologic protection for the entire flu season, so a booster is not necessary.</div><div style="font-family: Arial,Helvetica,sans-serif;">4. Any patient aged 6 months old or more should consider receiving the vaccine, unless they previously had a life-threatening adverse reaction to a prior flu vaccine.</div><div style="font-family: Arial,Helvetica,sans-serif;">5. Patients with a history of an egg allergy should have the diagnosis confirmed. The influenza vaccine may still be given, however the setting must be where the medical staff can provide medications needed for life-threatening reactions. The odds of a life-threatening allergic reaction to the very tiny amounts of egg protein in influenza vaccines is very low.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><span style="font-family: Arial,Helvetica,sans-serif;">Just in case you are wondering if I practice what I preach, here I am getting my own medical advice.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-31250051980463032512011-10-13T14:05:00.000-07:002011-10-16T17:06:28.309-07:00Food Allergy and Adverse Reactions: More Information<div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: "Arial","sans-serif"; font-size: small;">The combination of seeing some patients recently with suspected allergies to additives and recently published articles have led me to dedicate this entry to further education about food allergies.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: small;">1. What is "natural"? The <a href="http://www.fsis.usda.gov/factsheets/meat_&_poultry_labeling_terms/index.asp">United States Department of Agriculture Food Safety and Information Service have a <span style="font-family: Arial,Helvetica,sans-serif;">good list of definitions</span></a><span style="font-family: Arial,Helvetica,sans-serif;">. For meat and poultry</span><span style="font-family: Arial,Helvetica,sans-serif;">, "</span></span><span style="font-family: Arial,Helvetica,sans-serif; font-size: small;">A product containing no artificial ingredient or added color and is only minimally processed.</span><span style="font-family: "Arial","sans-serif"; font-size: small;">"</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><br />
</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;">2. What about "hypoallergenic"? The <a href="http://www.fda.gov/Cosmetics/ResourcesForYou/Consumers/CosmeticsQA/ucm167202.htm">F.D.A.'s only statement on its definition applies to cosmetics</a>, not foods. There are "no Federal standards or definitions. "The term means whatever a particular company wants it to mean</span><span style="font-size: small;">." So the careful reader should become wary when reading this term.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
<span style="font-size: small;">3. Can I rely on food labels? Short answer: no, may be. <a href="http://www.fda.gov/food/guidancecomplianceregulatoryinformation/guidancedocuments/foodlabelingnutrition/foodlabelingguide/ucm064880.htm#spices">The FDA does have general guidelines</a>. In <a href="http://www.fda.gov/food/resourcesforyou/consumers/ucm079311.htm">2006, the Food Allergen Labeling and Consumer Protection Act became in effect</a>. Eight of the commonest allergens were required to be listed on the labels if those eight allergens were even potentially present at any stage in the manufacturing of any ingredient in that food. The intent was to help patients avoid them. The eight allergens are: milk, eggs, fish, shellfish, tree nuts, nuts, wheat, and soybeans. This has been effective. BUT if a patient is allergic or has adverse reactions to other substances in foods, food labels can NOT be relied on. Items for food processing, such as <a href="http://www.gmap-gelatin.com/faq.html">gelatin</a>, <a href="http://www.foodinsight.org/Resources/Detail.aspx?topic=Questions_and_Anwers_about_Processing_Aids_Used_in_Modern_Food_Production">do NOT have to be listed on labels, per the FDA, because they are deemed to have no effect on the food or be present in only trace amounts</a>. Unfortunately, trace amounts can be enough to trigger allergic reactions in highly sensitive individuals.<br />
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<span style="font-size: small;"> This is not to say that processing aids are not regulated. They are and are defined clearly by such bodies as the <a href="http://www.gmo-compass.org/eng/glossary/">European Union</a>, <a href="http://www.fsis.usda.gov/PDF/Determination_of_Processing_Aids.pdf">FDA</a>, and the <a href="http://www.hc-sc.gc.ca/fn-an/pubs/policy_fa-pa-eng.php">Canadian government</a>.<br />
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</span></div><div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">4. What else are in foods, besides foods? Lots. <a href="http://www.fda.gov/food/foodingredientspackaging/ucm094211.htm">The FDA maintains a list of over 3,000 approved ingredients</a>. The categories include: preservatives, sweeteners, color additives (commonly called dyes), flavors and spices, flavor enhancers, fat replacers, nutrients, emulsifiers, stabilizers and thickeners, binders, texturizers, pH control agents and acidulants, levening agents, anti-caking agents, humectants, yeast nutrients, dough strengtheners and conditioners, firming agents, enzyme preparations, and gases. <br />
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</span></div><span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">5. Have food dyes been linked to behavior problems in kids? The short: no, but suspected. This is a common topic in the media. </span><a href="http://www.npr.org/2011/03/30/134962888/fda-probes-link-between-food-dyes-kids-behavior#chart" style="font-family: Arial,Helvetica,sans-serif;">Here's a story on National Public Radio</a><span style="font-family: Arial,Helvetica,sans-serif;">. The </span><a href="http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm048951.htm" style="font-family: Arial,Helvetica,sans-serif;">FDA's stance is that food dyes, for they refer to them as color additives, are regulated and generally very safe</a><span style="font-family: Arial,Helvetica,sans-serif;">. In researching this, I learned some interesting facts. There are </span><a href="http://en.wikipedia.org/wiki/Food_coloring" style="font-family: Arial,Helvetica,sans-serif;">only 7 artificial colorings approved plus 2 more for limited indications, in foods</a><span style="font-family: Arial,Helvetica,sans-serif;">. </span><a href="http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=3f6c9146ba54b1b84f17046e27197926&tpl=/ecfrbrowse/Title21/21cfr74_main_02.tpl" style="font-family: Arial,Helvetica,sans-serif;">There are 2-3 dozen approved color additives for drugs, cosmetics, and medical devices</a><span style="font-family: Arial,Helvetica,sans-serif;">.</span></span><br />
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<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;">6. Is it completely safe to eat in restaurants if they post or list all of their ingredients? No, and this is not a knock against restaurants or food preparers. The issue is called <a href="http://www.fda.gov/Food/FoodSafety/RetailFoodProtection/ManagingFoodSafetyHACCPPrinciples/Operators/ucm078052.htm">cross contamination</a>, which means the transfer of harmful substances to foods. This is inadvertent, but still a risk that depending on the severity of reactions must be considered.<br />
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com0tag:blogger.com,1999:blog-6103030865895528850.post-44486960168881708032011-10-09T13:07:00.000-07:002011-10-09T18:53:31.190-07:00What is the Difference between the Cold Desserts: Ice Cream, Gelato, Sorbet, Sherbet, Italian Ice?<div style="font-family: Arial,Helvetica,sans-serif;">The Allergy Dude was asked by the mother of a patient today since he has egg and milk allergies what kind of cold desserts he could eat? What about gelato? Good questions. The Allergy Dude confessed he did not know the exact differences between cold desserts (ice cream, gelato, sorbet, sherbet, Italian ice). Do you?</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">Here's the answers, courtesy of Wikipedia:</div><div style="font-family: Arial,Helvetica,sans-serif;">Let's start with what is (1) <a href="http://en.wikipedia.org/wiki/Ice_cream"><u>ice cream</u></a>. It is a mixture of milk and cream, salt, flavors, sweeteners, sometimes fruits, a small amount of egg yolks. Note, the exact definitions of each dessert depends on the country. For example, in the U.S., the <a href="http://edocket.access.gpo.gov/cfr_2003/aprqtr/21cfr135.110.htm">Food and Drug Adminstration has a strict guideline</a> to distinguish between ice cream and (2) <a href="http://en.wikipedia.org/wiki/Frozen_custard">frozen <u>custard</u></a>. (Yes, believe it!) The latter "must contain at least 10 percent fat milk fat and 1.4 percent egg yolk solids. If it has fewer egg yolk solid, then it is considered ice cream."</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">Now for the rest of the field. (3) <a href="http://en.wikipedia.org/wiki/Gelato">Gelato</a> originated from Italy and is similar to ice cream. Two differences are gelato typically contains lower 4–8% butterfat, versus 14% for ice cream in the United States, and dairy based gelato contains 16–24% sugar whereas most ice cream in the United States contains 12-16% sugar. </div><div style="font-family: Arial,Helvetica,sans-serif;">(4) <a href="http://en.wikipedia.org/wiki/Sorbet">Sorbet</a> contains the same ingredients as gelato except no diary products.</div><div style="font-family: Arial,Helvetica,sans-serif;">(5) <a href="http://en.wikipedia.org/wiki/Granita">Granita</a> is a "semi-frozen Italian dessert made from sugar, water, and various toppings". It is very similar to </div><div style="font-family: Arial,Helvetica,sans-serif;">(6) <a href="http://en.wikipedia.org/wiki/Sherbet_%28powder%29">Sherbet</a> is "a fizzy powder, containing sugar and flavoring, and an edible acidic and base." When the powder comes into contact with water from a mixing or from saliva, the acid and base react and produce the gassy bubbles. Examples on the U.S. include Pixy Stix and Pop Rocks.</div><div style="font-family: Arial,Helvetica,sans-serif;">(7) "<a href="http://en.wikipedia.org/wiki/Italian_ice">Italian ice</a>, or water ice, is a sweetened frozen dessert made with fruit (often from concentrates, juices or purées) or other natural or artificial food flavorings." The ingredients are frozen while mixing them, like ice cream. It does not contain diary or egg yolk, which sherbet may.</div><div style="font-family: Arial,Helvetica,sans-serif;">(8) <a href="http://en.wikipedia.org/wiki/Shaved_ice">Shaved ice</a> is fine ice crystals with a topping added . In North America, this is also called a (9) <a href="http://en.wikipedia.org/wiki/Snow_cone">snow cone</a>.</div><div style="font-family: Arial,Helvetica,sans-serif;">(10) <a href="http://en.wikipedia.org/wiki/Slush_%28beverage%29">Slush is "a flavored frozen drink"</a>. It is a name for a group of desserts made by freezing a liquid. Examples include Slurpee and ICEE.</div><div style="font-family: Arial,Helvetica,sans-serif;">(11) "<a href="http://en.wikipedia.org/wiki/Semifreddo">Semifreddo</a> (<a href="http://en.wikipedia.org/wiki/Italian_language" title="Italian language">Italian</a>: "half cold") is a class of semi-frozen <a href="http://en.wikipedia.org/wiki/Dessert" title="Dessert">desserts</a>, typically ice-cream cakes, semi-frozen <a href="http://en.wikipedia.org/wiki/Custard" title="Custard">custards</a>, and certain fruit tarts." Gelato is often used.</div><div style="font-family: Arial,Helvetica,sans-serif;">(12) "<a href="http://en.wikipedia.org/wiki/Frozen_yogurt">Frozen yogurt</a> is a frozen dessert containing <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Yogurt" title="Yogurt">yogurt</a> or other dairy products. It is slightly more tart than <a href="http://en.wikipedia.org/wiki/Ice_cream" title="Ice cream">ice cream</a>, as well as lower in fat (due to the use of milk (only 0.5-6.0%) instead of cream)." </div><div style="font-family: Arial,Helvetica,sans-serif;">(13) "<a href="http://en.wikipedia.org/wiki/Soft_serve">Soft serve</a> is generally lower in milk-fat (3% to 6%) than <a href="http://en.wikipedia.org/wiki/Ice_cream" title="Ice cream">ice cream</a> (10% to 18%) and is produced at a temperature of about −4 °C compared to ice cream, which is <a href="http://en.wikipedia.org/wiki/Refrigeration" title="Refrigeration">stored</a> at −15 °C. Soft serve contains air, between 33% and 45% of volume, introduced at the time of freezing and which affects the taste of the finished product. More than this and the product loses taste, tends to shrink as it loses air and melts more quickly than that with less air."</div><div style="font-family: Arial,Helvetica,sans-serif;">(14) "<a href="http://en.wikipedia.org/wiki/Mousse">Dessert mousse</a> is a form of dessert typically made from egg and cream (classically no cream, separated eggs, sugar, and chocolate or other flavorings), usually in combination with other flavors such as chocolate or <a href="http://en.wikipedia.org/wiki/Pur%C3%A9e" title="Purée">puréed</a> <a href="http://en.wikipedia.org/wiki/Fruit" title="Fruit">fruit</a>."</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">For me, fine dining will never be the same. As for the mom, she and her daughter will have to be careful about which cold dessert she eats. Are you ready for the Allergy Dude's quiz?</div><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com2tag:blogger.com,1999:blog-6103030865895528850.post-61173975901616342802011-09-02T11:58:00.000-07:002011-09-02T11:58:51.165-07:00Nasal endoscopy<div style="font-family: Arial,Helvetica,sans-serif;">The Allergy Dude may recommend nasal endoscopy for some patients to better examine the nasal cavity and throat. Some times directly looking with the eye and a small magnifying glass is insufficient. Having a brighter light that can be directed around corners is very useful. The nasal endoscope is about the size of a small black spaghetti noodle. About 10-15 minutes after an anesthetic and decongestant is sprayed into the nose (read Afrin + Lidocaine), the endoscope can be easily introduced into the noses of most people. It's quite tolerable. I should know. I was the guinea pig for my allergy program that every one practiced on. I even had to practice on myself. The Allergy Dude has found two good videos on youtube that demonstrate nasal endoscopy <a href="http://www.youtube.com/watch?v=wjRsa77u6OU&feature=relmfu">1</a>, <a href="http://www.youtube.com/watch?v=ajbcJiYhFKY&feature=related">2</a>. </div><span style="font-family: Arial,Helvetica,sans-serif;">(Endoscopes are very useful and come in larger sizes. They may also be used to look inside of the stomach or into the colon.) Endoscopes also allow us to look at the throat and vocal cords. Hypothetically, you should have a nasopharyngeal endoscopy at least at the initial visit and at followup visits when needed. Why are they done? Patients refuse or the physicians do not think the detailed exam is indicated. But keep this in mind if regular medical treatments fail to provide relief.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-10060680236480473792011-08-29T12:39:00.000-07:002011-08-29T12:39:32.155-07:00What does it mean to be Red Flagged for a Prescription?<div style="font-family: Arial,Helvetica,sans-serif;">Today, the Allergy Dude will write about a potentially delicate topic: being red flagged for a prescription at your pharmacy. Since 2002, the <a href="http://www.deadiversion.usdoj.gov/faq/rx_monitor.htm">U.S. Department of Justice has offered a grant to states to support the planning, implementation, and enhancement of a prescription drug monitoring program (PDMP)</a>. According to the Drug Enforcement Agency (DEA), as of May of 2011, 35 states have established their own PDMP and the remaining states territories are planning to have a PDMP. South Carolina happens to be in the former group. The website providing information is part of the <a href="http://www.scdhec.gov/administration/drugcontrol/pmp.htm">Department of Health and Environmental Control</a>. The express purpose is to monitor prescriptions of controlled medications. Pharmacies and physicians now have a source to check that patients who request prescriptions of controlled substances, especially for either large quantities or frequent refills, are not abusing the health care system. If there is suspicion, then those patients have a "red flag" placed next to their name, to warn the providers and pharmacists. This is not literal, since every one uses computers these days. Unfortunately, abuse of controlled medications is a fact of life. This mechanism helps to reduce this unpleasant problem. Even in my office, an allergist's, there is occasional need to access that website to check up the patient's history of prescriptions and from which doctor and pharmacy.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><span style="font-family: Arial,Helvetica,sans-serif;">The purpose of Allergy Dude's entry today is to provide more facts to those that are searching for answers on the internet about "red flags". I had to do some searching myself for documented answers.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com3tag:blogger.com,1999:blog-6103030865895528850.post-14250725433408158482011-08-28T16:58:00.000-07:002011-08-28T16:58:53.982-07:00Should I eat white rice or brown rice?<div style="font-family: Arial,Helvetica,sans-serif;">The Allergy Dude will write about which kind of rice is preferred to eat: white or brown. First, I'll tell you what I do not think you should eat: any fried rice from restaurants. Normally restaurants use animal lard for the cooking oil. This overwhelms any nutritional benefit from eating rice.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">Next what is <a href="http://en.wikipedia.org/wiki/Brown_rice">brown rice</a>? Starting with a rice grain, once the husk is removed, you have brown rice. Then after the bran and germ are removed, what remains is the white endosperm. This is the white rice you buy in stores and eat. The endosperm has nutritional value, however so do the bran and germ. The nutrients in the latter include rice bran oil, fiber, vitamins, and minerals. Thus brown rice has more nutritional value than white rice. If you compare labels, remember that white rice has nutrients added back into the package.</div><div style="font-family: Arial,Helvetica,sans-serif;">A <a href="http://www.ncbi.nlm.nih.gov/pubmed/20548009">large study of almost 200,000 people in the U.S. by Qi Sun</a> concluded that "eating two or more servings of brown rice weekly seems to be associated with a lower risk of developing type 2 diabetes". On the other hand, they reported, "eating five or more servings of white rice per week is associated with an increased risk." White rice has a higher glycemic index than brown rice, which means that blood sugar levels rise faster after eating white rice than brown rice. This is thought to be from the greater fiber content of brown rice. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21795429">2011 small study from China</a> did not find any difference in rate of developing metabolic risk factors for type 2 diabetes.</div><div style="font-family: Arial,Helvetica,sans-serif;">Here are some other aspects of brown rice. Since brown rice contains more grain than white rice, brown rice takes longer to cook. Brown rice has to be stored more carefully, because the oil in the husk can age and produce a rancid taste. Brown rice has more calories than white rice, but remember the calories come from higher fiber content.</div><div style="font-family: Arial,Helvetica,sans-serif;"> </div><div style="font-family: Arial,Helvetica,sans-serif;">Lastly, brown rice costs paradoxically about twice as much as white rice. You might think that since brown rice is less processed than white rice, which also has nutrients artificially added, that brown rice should cost less than white rice. The simple reason is economics and habits. Just like with white bread and wheat bread, nearly the entire universe prefers to eat white rice, so the demand has shaped the system to produce white rice inexpensively.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><span style="font-family: Arial,Helvetica,sans-serif;">The Allergy Dude therefore recommends his readers avoid eating fried rice from restaurants and when possible try to eat brown rice versus white rice. And yes the Allergy Dude puts his money where his mouth is and also tries to eat brown rice whenever possible rather than white rice. It is not easy, since the Allergy Dude was raised eating white rice, but free will and intelligence decide that active energy must be expended to have a better outcome.</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-57207769641732307892011-07-26T07:40:00.000-07:002011-07-26T07:43:59.100-07:00Indacterol Approved for COPD<div style="font-family: Arial,Helvetica,sans-serif;">Indacaterol was approved by the U.S. F.D.A. for the treatment of COPD on 7/1/11. The <a href="http://en.wikipedia.org/wiki/Indacaterol">trade name is Arcapta Neohaler</a> (photo). In Europe, the trade name is Onbrez (photo). Functionly, the delivery device is essentially the same as Foradil's delivery device. This should not too surprising, since Foradil was originally a product from the same manufacturer - Novartis. Indacaterol is a once-daily long-acting bronchodilating agent (LABA), which puts it in the same class of drugs including formoterol (Foradil) and salmeterol (Serevent). Recent controversy regarding the safety of LABAs for asthmatics has stalled Novartis' efforts to get Indacaterol approved for asthma. Novartis has optioned Indacaterol's rights for asthma to another pharmaceutical company, however then it will be that company's burden to satisfy the FDA's safety concerns with LABA (see prior posts), before the FDA grants approval. This could be lengthy and definitely expensive hurdle. The Allergy Dude predicts that it will be quite some time until Indacaterol is approved in any product for asthma.</div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCba7Y_0unspnC6hev0056AKvfYY65n4wW3tT3lKNZdnVvQ3lERyjhF1I5VNT3BIZXTPMUdydrcoOYMIj3NDrP8oOCs3oRFz3jYu31S9HGHGRvMBcfQU576jYzqUNA4COgx5kbghkrhrI/s1600/Arcapta.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhCba7Y_0unspnC6hev0056AKvfYY65n4wW3tT3lKNZdnVvQ3lERyjhF1I5VNT3BIZXTPMUdydrcoOYMIj3NDrP8oOCs3oRFz3jYu31S9HGHGRvMBcfQU576jYzqUNA4COgx5kbghkrhrI/s200/Arcapta.jpg" width="152" /></a><br />
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-91931487816233684802011-07-24T14:20:00.000-07:002011-08-01T06:09:35.017-07:00Food Allergy and Adverse Reactions to Foods: a Classification System<div style="font-family: Arial,Helvetica,sans-serif;"><span style="font-size: small;">The Allergy Dude sees so many patients with adverse reactions to foods, he thought it would be a good idea to list his classification of the types of adverse reactions to foods. I want to give credit to both the <a href="http://kaoallergyasthma.blogspot.com/2011/02/food-allergy-guidelines-2011.html">Guidelines on the Diagnosis and Management of Food Allergies in the U.S.</a> and <a href="http://www.worldallergy.org/professional/allergic_diseases_center/foodallergy/">World Allergy Organization</a>, whose classification systems the Allergy Dude has modified. I think for the better (below). Comments and examples are in parenthesis.</span></div><span style="font-size: small;"><br />
</span><br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";">I. Food Allergy</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> A. IgE-mediated: urticaria, angioedema, oral allergy syndrome, acute rhinitis, acute asthma, anaphylaxis</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> B. Mixed IgE-mediated and non-IgE-mediated: atopic dermatitis, eosinophilic esophagitis, eosinophilic gastroenteritis</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> C. non-IgE-mediated: contact dermatitis, protocolitis, food protein-induced enteropathy syndrome, celiac disease, Heiner's syndrome</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";">II. Food Intolerance (not an allergy nor immune mediated)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> A. Food characteristics</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 1. Pharmacologic (caffeine, tyramine)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 2. Toxin (bacterial, scromboid fish poisoning)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> B. Host characteristics</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 1. Metabolic (lactase or fructase deficiency)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> a. Congenital</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> b. Environmental (temporary following GI infection)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 2. Psychological (aversion, panic disorder)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> C. Idiopathic/undefined (sulphites)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> D. Excessive intake </span></span><span style="font-family: "Arial","sans-serif"; font-size: 10pt;"><span style="font-size: small;"> (from excess intake: greasy, spicy, hot foods) </span></span><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";">[D-F = NK modifications]</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> E. GI disease (all may affect normal functioning)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> F. GI dysfunction (not outright nor clear cut disease)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 1. Congenital (Irritable bowel syndrome)</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: small;"><span style="font-family: "Arial","sans-serif";"> 2. Senile (old age)</span></span></div><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com0tag:blogger.com,1999:blog-6103030865895528850.post-57213153732942212322011-07-09T16:59:00.000-07:002011-07-09T16:59:26.332-07:00Are Blueberries a Good Source of Antioxidants?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBUNME3L1mYoD3Pd01Mr0bbS6xZENIjyfRbMfNg9ROzbcGmYSBAaBtpKxvgTPDNs8s2A3DJXvP0EECztaVVnXqx72861Sv6FdP1BdWF-u1judsh1A_TSijGzrnRRwd4pXMNtwCKwDWKXM/s1600/IMG_4456.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBUNME3L1mYoD3Pd01Mr0bbS6xZENIjyfRbMfNg9ROzbcGmYSBAaBtpKxvgTPDNs8s2A3DJXvP0EECztaVVnXqx72861Sv6FdP1BdWF-u1judsh1A_TSijGzrnRRwd4pXMNtwCKwDWKXM/s200/IMG_4456.JPG" width="200" /></a></div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSg0LHT-RKoC7fgOipgqLn9P0chU3BlJiMtZn_6N6RIUVEaxOu2E9SBZF6-cWbuu1EIBz4ulWY5TKtTFfKq71B1i-bkfwp2PbnW9V46xnJ5bNF6NX0iUbaHHRzED0um6vny1C5ZLFRT1o/s1600/IMG_4452.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiSg0LHT-RKoC7fgOipgqLn9P0chU3BlJiMtZn_6N6RIUVEaxOu2E9SBZF6-cWbuu1EIBz4ulWY5TKtTFfKq71B1i-bkfwp2PbnW9V46xnJ5bNF6NX0iUbaHHRzED0um6vny1C5ZLFRT1o/s200/IMG_4452.JPG" width="200" /></a><br />
Your <i>Allergy Dude</i> attended the <a href="http://www.ropermountain.org/Special/SecSat/blueberry_flyer.pdf">Blueberry Festival at Roper Mountain Science Center today</a>. One of the vendors said to me, "Remember, blueberries are a great source of antioxidants." I also remember reading this on a bag of dried fruits. So I asked myself, has this been measured objectively and what does this really mean?<br />
Yes, <a href="http://en.wikipedia.org/wiki/List_of_antioxidants_in_food">blueberries are very high in antioxidants</a>. The highest fruit, and second only to beans. The theory is that aging and diseases result from oxidation of naturally and normally functioning chemicals in the body. So something that reduces or prevents oxidation would be a good thing. The amount of antioxidant activity is measured <i>in vitro</i>, that is, in the laboratory using <a href="http://en.wikipedia.org/wiki/Oxygen_radical_absorbance_capacity">oxygen radical absorbance capacity</a> (ORAC). This sounds good, however, the <i>Allergy Dude</i> must point out that the numbers produced have unfortunately never been shown to be clinically significant. I would like some further justification for trying to eat a healthy diet.<br />
Photo 2 reminded me, in their garden, but not their spice garden because I forgot to take a picture there, that spices have been measured using ORAC to have antioxidant activity also. However the minute amounts used in regular cooking translate into little net antioxidant activity.<br />
Like your <i>Allergy Dude</i> has said before, eat a healthy diet, because you are what you eat.<div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com2tag:blogger.com,1999:blog-6103030865895528850.post-69371054541919173622011-07-05T17:29:00.000-07:002011-07-05T17:29:26.157-07:00New Sunscreen Labeling by the FDA<div style="font-family: Arial,Helvetica,sans-serif;">Because the <i>Allergy Dude</i> want his readers to practice excellent preventative care medicine, I have linked to three websites that provide useful information. Each site makes good points.</div><div style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.medscape.com/viewarticle/745500?src=mp&spon=17">Medscape FDA interview with Dr. Tan</a>: the major points: new labeling is mandatory; and look for products that are broad spectrum, at least SPF 15, and consider water resistant.</div><div style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm239463.htm">FDA Sunscreen</a>: lots of information, may be too much. The range of SPF will now be from 0-50 only. </div><div style="font-family: Arial,Helvetica,sans-serif;"><a href="http://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreens">American Academy of Dermatology Sunscreens</a>: the major points: look for products that are broad spectrum, at least SPF 30 no matter what your skin type, water resistant, use enough volume to cover all exposed skin, and re-apply completely in two hours.</div><div style="font-family: Arial,Helvetica,sans-serif;">The <i>Allergy Dude</i> is very careful about direct sunlight exposure. All of his readers should be careful also.</div><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com1tag:blogger.com,1999:blog-6103030865895528850.post-77174297148766500342011-07-03T13:56:00.000-07:002011-07-03T13:56:43.318-07:00What's difference between jam, jelly, and marmalade?<div style="font-family: Arial,Helvetica,sans-serif;">Well, here goes the <i>Allergy Dude</i> again, down another rabbit hole. I was in the store, doing my usual Sunday morning grocery shopping for my family, when I stopped to buy a jar of grape jelly. I noted there were many choices. I realized I did not know the difference between jelly, jam, and a marmalade. Actually, add to that list: (apple) butter, preserves, and spread. So here we go, into the world wide web for information.</div><div style="font-family: Arial,Helvetica,sans-serif;">Next time, I've got to remind myself not to ask these types of questions. </div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">The best summary is on <a href="http://en.wikipedia.org/wiki/Fruit_preserves">wikipedia</a>, again. Surprisingly, there was scant <a href="http://www.chemeurope.com/en/encyclopedia/Fruit_preserves.html">other actual articles with references</a> available. Briefly...</div><div style="font-family: Arial,Helvetica,sans-serif;">Jelly is translucent with pectin added.</div><div style="font-family: Arial,Helvetica,sans-serif;">Jam is fruit juice with pulp and pectin added. Sometimes called preserves. Spreads are jams with no added sugar.</div><div style="font-family: Arial,Helvetica,sans-serif;">Marmalade is a mixture of fruit juice, sometimes pulp, sugar, water, and pectin.</div><div style="font-family: Arial,Helvetica,sans-serif;"><a href="http://en.wikipedia.org/wiki/Apple_butter">Apple butter</a> is a highly concentrated form of apple sauce, from long and slow heating, until the sugar carmelizes. <a href="http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRD3105612">No real butter is added</a>.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div style="font-family: Arial,Helvetica,sans-serif;">That's it, right? Not so fast, the <i>Allergy Dude's</i> interest is piqued. I saw this product in the store - <a href="http://www.welchs.com/products/jams-jellies-and-spreads/jams,-jellies-and-spreads/natural-grape-spread">Welch's Natural Concord Grape Spread</a>. What's this about concord grapes? According to the <a href="http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRD3106140">U.S. Department of Agriculture (USDA)'s Grading Manual for Fruit Jelly Fruit Preserves (dated May 1980)</a>, "Concord jelly is considered the top-of-the-line" (page 11 top). This document lists the standards for the product's essence ( the volatile flavoring materials added to their product to enhance the flavor and odor. It adds a "bouquet."), non-carbohydrate artificial sweeteners, carbohydrate sweeteners, consistency [grade A or B], color, and flavor [grade A or B]. For more on <a href="http://www.ams.usda.gov/AMSv1.0/getfile?dDocName=STELPRDc5061023">grading manuals, go to the USDA's website</a>. The grades do not appear to be listed on the nutritional labels, so the Allergy Dude is not sure if we consumers should hope that we are being sold only grade A food products.</div><div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><span style="font-family: Arial,Helvetica,sans-serif;">So, to get back to the main track, the </span><i style="font-family: Arial,Helvetica,sans-serif;">Allergy Dude</i><span style="font-family: Arial,Helvetica,sans-serif;"> recommends reading those nutritional labels! Avoid all products with high fructose corn syrup and preservatives. It does not have to organic, but may be. Bon appetit!</span><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<script type="text/javascript" src="http://www.google.com/coop/cse/brand?form=cse-search-box&lang=en"></script></div>Neil Kaohttp://www.blogger.com/profile/15569958728044308912noreply@blogger.com0tag:blogger.com,1999:blog-6103030865895528850.post-87476221873186590292011-07-02T16:43:00.000-07:002011-07-02T16:44:03.177-07:00Have a healthy outing to Toccoa Falls, Georgia<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBFkNbOmoK4bkWpuK9wcExvf-x_-2vQRJvS0OZiJwXQK3gF2m_X94C14A7z5vky6rRoPQbArD5k-h8xr_A0EWIEt9hdifRM6tbcfVqqTOdM5w3XbMA27qGSSp_jC9wp2WhM-qRJTK1v4/s1600/IMG_1292.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBFkNbOmoK4bkWpuK9wcExvf-x_-2vQRJvS0OZiJwXQK3gF2m_X94C14A7z5vky6rRoPQbArD5k-h8xr_A0EWIEt9hdifRM6tbcfVqqTOdM5w3XbMA27qGSSp_jC9wp2WhM-qRJTK1v4/s320/IMG_1292.JPG" width="240" /></a><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDuV9hVFXp1r6hE80jpapplijRm1rgRqrHJ4SJuaMtvwrr8yFHH21Govz3vV6whqxbk0ARkfHVqecSg3pV0LkldUZE0uTTXWKirT1P4yPwFikxE4wb7x8HWXvVqKXkAKW4NynC7ss7C8s/s1600/IMG_1264.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiDuV9hVFXp1r6hE80jpapplijRm1rgRqrHJ4SJuaMtvwrr8yFHH21Govz3vV6whqxbk0ARkfHVqecSg3pV0LkldUZE0uTTXWKirT1P4yPwFikxE4wb7x8HWXvVqKXkAKW4NynC7ss7C8s/s320/IMG_1264.JPG" width="240" /></a><span style="font-family: Arial,Helvetica,sans-serif;">This holiday weekend's healthy lifestyle outing was to </span><a href="http://en.wikipedia.org/wiki/Toccoa_Falls" style="font-family: Arial,Helvetica,sans-serif;">Toccoa Falls, GA</a><span style="font-family: Arial,Helvetica,sans-serif;">. Toccoa Falls is 90 minutes away from Greenville. There is a 5 minute walk up to the path from the parking lot. So actually it was easier and faster to go see Toccoa Falls in GA than it was to see Rainbow Falls in SC. For the latter, once you get to Jones Gap's parking lot, there is still a 1-hour hike up a winding path up and another 45-minute hike back down. Toccoa Falls is 186 feet high, whereas Rainbow Falls is about 90-100 feet. Not that I'm putting down the latter. Both are beautiful. It's great getting up to the base of the falls. There's a strong cool breeze and fine mist, while the sun is hot. I felt like I was in the boat visiting Niagra Falls again. Please get out, be active this holiday weekend, and be safe!</span><br />
<div style="font-family: Arial,Helvetica,sans-serif;">From your <i>Allergy Dude</i></div><div class="blogger-post-footer"><form action="http://kaoallergyasthma.blogspot.com" id="cse-search-box">
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<div style="line-height: 200%;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-style: italic;">Allergy Dude</span><span style="font-family: "Arial","sans-serif";">
here. There are times when patients have asked me (and times when they have not)
about places for information on smoking cessation. I recommend several sites
for free assistance about smoking cessation:</span></div>
<span style="font-family: "Arial","sans-serif";">1. <a href="http://www.lungusa.org/stop-smoking/">American Lung Association</a></span><br />
<span style="font-family: "Arial","sans-serif";">2. <a href="http://www.scdhec.gov/health/chcdp/tobacco/quitforkeeps.htm">South
Carolina Department of Health and Environmental Control (SC DHEC)</a></span><br />
<span style="font-family: "Arial","sans-serif";">3. <a href="http://www.cancer.gov/cancertopics/tobacco/smoking">National Cancer
Institute</a></span><br />
<span style="font-family: "Arial","sans-serif";">4. <a href="http://www.cdc.gov/tobacco/quit_smoking/how_to_quit/index.htm">Centers
for Disease Control and Prevention</a></span><br />
<span style="font-family: "Arial","sans-serif";">5. others can be found
by a simple web search</span><br />
<br />
<div class="MsoNormalCxSpFirst" style="line-height: 200%;">
<span style="font-family: "Arial","sans-serif";">When asked for my professional opinion, I always
recommend the same thing: stop smoking. I know this is hard. The bottom line is
that you have to really, really want to quit. I have known people to quit
without any aids (i.e., cold turkey), the dramatic example being those who quit
after having had a heart attack. For obvious reasons, that should be major league
motivation. </span></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<br /></div>
<div class="MsoNormalCxSpMiddle" style="line-height: 200%;">
<span style="font-family: "Arial","sans-serif";">About 80% of people attempt to quit cold turkey. Some
patients ask me about using </span><a href="http://en.wikipedia.org/wiki/Smoking_cessation"><span style="font-family: "Arial","sans-serif";">other methods</span></a><span style="font-family: "Arial","sans-serif";">. I
can't say that my patients have had any greater success with one particular
method. In my practice, I offer choices to smokers, and try to work with
them. When they say they want a medication that will help them stop smoking or
reduce the craving, there is a glaring problem. Meds cost money and are usually
not covered by insurance companies. (Shame on them, but there’s reality for
you.) It is good if your physicians are trying to get the smokers to cease
their unhealthy—and expensive—habit at every opportunity. For example, <span style="mso-bidi-font-style: italic;">Allergy Dude's</span> patients know to
expect that at least one minute of every office visit will be spent discussing
the evils of smoking before being harassed into quitting.<br />
<br />
If you've managed to quit, congratulations. If you are <i style="mso-bidi-font-style: normal;">trying</i> to quit, read up about all the types of cancers, lung
diseases, and heart diseases. Every type of cancer, alone, is more frequent if
you smoke. If that’s not enough motivation, consider how much money you're wasting
every day, for years on end. As of last July, 2013, one pack of cigarettes in
New York was about $14.50/day. Per year, that’s $5,292.50. In one decade,
that’s $52,925. I don’t know about you, but to me, that’s a lot of money. I
personally would rather spend the money on ten years worth of Caribbean
cruises, or maybe a trip (or nine) to New Zealand. Start saving—your money and your
life. Quit now!</span><br />
<br />
<span style="font-family: "Arial","sans-serif";">Updated: April 6, 2014 </span></div>
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