DermHelpCentral

Exercise and Illness

Gina Kolata had an important article buried in the December 25th New York Times: Don’t Starve a Cold of Exercise.   It turns out that two little-known studies that were published a decade ago in the journal Medicine & Science in Sports & Exercise were so much in favor of exercise that the researchers themselves were surprised. 

There is no down-side to continuing an exercise or training program when one is "down" with an upper respiratory infection. Read this article to be convinced.  See references here: Download Exercise Colds

Nuts!

An important comment piece was published in the British Medical Journal of December 10, 2008.

BMJ 2008;337:a2880

This allergies hysteria is just nuts

Nicholas A Christakis, professor of medical sociology, Harvard Medical School, and attending physician, Mt Auburn Hospital, Cambridge, Massachusetts

The issue is not whether nut allergies exist or whether they can occasionally be serious. Nor is the issue whether reasonable accommodation should be made for the few children who have documented serious allergies. The issue is what accounts for the extreme responses to nut allergies and what to do about the responses and the allergies themselves.

The responses bear many of the hallmarks of mass psychogenic illness (MPI), previously and quaintly known as "epidemic hysteria." MPI is a social network phenomenon involving otherwise healthy people in a cascade of anxiety. Outbreaks typically occur in small towns and in schools, factories, and other institutions, and they are most often prompted by fears of contamination. It does indeed provoke anxiety to imagine a hidden, deadly danger in so innocent a thing as having a snack in kindergarten. And being around others who are anxious heightens one’s own anxiety. 

Read in full: Download Nut Allergy Nuts

Breast Eczemas

Toronto dermatologist, Benjamin Barankin and M. Shirley Gross wrote an important article on nipple and areolar dermatitis in breast feeding women in 2004.  This is of great import.

Abstract.  Eczema of the nipple and areola can occasionally develop in the breastfeeding patient and is associated with sore, burning, and painful areolae and nipples. Management includes elimination of any precipitating allergens and irritant and the judicious use of appropriate topical corticosteroid preparations. Patients must also be offered effective pain control and support. The proper diagnosis and management of eczema of the nipple and areola in breastfeeding patients will prevent premature and iatrogenic weaning.

This is an important area for pregnant and breast feeding women.  Often, eczema is the underlying cause, compounded by secondary infection and/or contact dermatitis. It may be that the immune dysregulation of pregnancy contributes to this subset of eczema.  DJE

The pdf is here for those who need more information see:  Download Nipple and Areolar Eczema i

Food Allergy Research

There was a good article in the December 9 2008, NY Times on Food Allergies.

(Picture from Times article: A DAILY STRUGGLE Sean Batson, 5, who is allergic to soy, eggs and milk, is participating in a large food allergy study.)

Excerpt: "Indeed, with recent data showing a marked increase in the number of food allergies, which cannot be explained by a lack of detection in years past, the national institutes have begun an initiative to address food allergies as an emerging health challenge.

Although it is possible to be allergic to any food, eight foods account for 90 percent of all reactions — milk, eggs, peanuts, fish, shellfish, soy, wheat, and tree nuts like cashews and almonds."

If you have an interest in this subject, this is a good place to begin.  Researchers Put a Microscope on Food Allergies

Brian Maurer, a pediatric physician's assistant in Enfield Connecticut has these comments about this article and food allergies:

"In today’s New York Times we read about the latest emerging healthcare challenge: 4 percent of the general population suffers from food allergies.  Fifteen years ago, clinicians paid little attention to food allergies; they were thought to be relatively rare.  Nowadays, more and more children are being diagnosed with allergic disease triggered by milk, soy, egg, wheat, peanut, tree nuts, fish and shellfish.  The question is: how many of these are bona fide allergies?
 
Certainly, if a child demonstrates clinical signs of an allergic reaction when challenged with a particular food substance—hives, wheezing, dysphagia, angioedema—there is little doubt of the diagnosis.  The clinical waters become murkier when we attempt to arrive at a diagnosis through screening tests.  Many patients who show significant reactions to skin-prick testing demonstrate no problem when challenged with the actual foodstuff in the diet.  As the article points out: “[i]n China…skin-prick testing found that large percentages of one rural population were sensitive to shellfish (16.7 percent) and peanuts (12.3 percent). Yet actual food allergies in that population, as diagnosed by physicians, were all but unheard of: less than 1 percent.”  How reliable is skin-prick testing?
 
Anecdotally, I have had one pediatric allergist—an internationally recognized researcher and clinician—tell me that blanket screening tests are basically useless.  His recommendation is to measure quantitative IgE levels for those substances to which the patient has demonstrated a past sensitivity in order to assess the degree of allergy over time.