Question:

Jade, NRT is a better option with quitting than "tapering" is.  With tapering you’re still smoking.  With NRT, you can work out the behavior modification part while gradually reducing your nicotine intake.  Researchers have been finding out over the last few years that the best chance for success in quitting and staying quit that a person has is a three pronged strategy – 1.) NRT 2.) Support – either one on one counseling or group support 3) Changing behavior Most general doctors don’t have a clue about dealing with addictions of any kind, including nicotine addiction.  NRT has become a reasonable treatment tool for those doctors who are "in the know" and who have a clue and they are generally cooperative when it comes to prescribing either NRTs like the inhalers or nasal sprays or the anti-depressant Zyban, which also has a good effect with many people in helping them quit. Tapering off however, does nothing to change the behavior of smoking and it is too easy to see that delayed cigarette as a "reward" for toughing it out for half a day or whatever time is next on the list. As long as you perceive the cigarette as a "reward" you will continue to smoke. One of the keys in quitting smoking is recognising that there is nothing particularly rewarding from smoking.  Sure, if you’re jonesing the "fix", the nicotine fix will temporarily soothe the addiction jones, but that’s not a reward – that’s entrapment.  I’ve got mild COPD from my 31 years of smoking – I sure don’t count that as a reward.  My quit buddy has terminal stage 4 lung cancer.  I don’t think he considers that a reward for smoking and it really sucked to get the diagnosis after being quit for a bit over a year.  We quit when we got tired of being enslaved by our addiction to nicotine and long before that had gotten over the idea that smoking was rewarding whether it was a couple cigs a day or a couple packs. Don’t know whether this helps or not, but that’s my .02 worth. Morgan DOF 2 years + smokefree

– Hide quoted text — Show quoted text – Ok, I definately feel that I have a lot less nicotine in my system… I am trying the tapering method…for a few reasons…first NRT has always been something that the doctors have in common…….don’t use it they say….. Ok, cold turkey would cause me to kill someone… to the 12 I usually smoke by 1:00….. I am having a hard time of course, and still don’t know if I want to quit completely……I mean what does one or two cigs a day as a reward hurt? Feedback is appreciated…. Jade

Response:

Dear Jade, It sounds as though you truly do not want to quit or are not ready to quit. I don’t know much about tapering except it never worked for me.  My mother once claimed it worked for her. If you want 1 or 2 cigs a day as a reward you will not be quit.  You will remain a smoker. Stay around this group and you will hear alot about what smoking can do to you. I wish you luck in your decision to stop smoking totally. Best regards, Deb

– Hide quoted text — Show quoted text – Ok, I definately feel that I have a lot less nicotine in my system… I am trying the tapering method…for a few reasons…first NRT has always been something that the doctors have in common…….don’t use it they say….. Ok, cold turkey would cause me to kill someone… the 12 I usually smoke by 1:00….. I am having a hard time of course, and still don’t know if I want to quit completely……I mean what does one or two cigs a day as a reward hurt? Feedback is appreciated…. Jade

Response:

Glad you found something useful, Sally.  I wish I could being a non-smoker to everyone as a gift, because it’s so great not to be an addict anymore. And *you’re* doing great.  Hang in there. Edna Pearl    OF

Response:

It is greatly doubtful that you would be able to smoke one or two a day. Penny Not even a single solitary puff in Two weeks, one day, 2 hours, 23 minutes and 55 seconds. 377 cigarettes not smoked, saving $60.40. Life saved: 1 day, 7 hours, 25 minutes. And feeling better every day that goes by.

– Hide quoted text — Show quoted text – Ok, I definately feel that I have a lot less nicotine in my system… I am trying the tapering method…for a few reasons…first NRT has always been something that the doctors have in common…….don’t use it they say….. Ok, cold turkey would cause me to kill someone… the 12 I usually smoke by 1:00….. I am having a hard time of course, and still don’t know if I want to quit completely……I mean what does one or two cigs a day as a reward hurt? Feedback is appreciated…. Jade

Response:

I agree with this so strongly, I feel compelled to repeat it:

Damn.  Hold my hand Edna.  This is Quitting! Three weeks, five days, 21 hours, 31 minutes and 18 fnord seconds. 1344 cigarettes not smoked, saving

Question:

The Cormiers wrote: > Hi, > I have a 15 yr old who is on Dexedrine for ADD and Allegra for sinus and > asthma symptoms.  She has been on these meds for years.  Recently, about a > year now she has been going through two week cycles of complete insomnia. > We have tried reducing and changing meds.  She insists it is not the meds. > We have done all the other usual suggestions but nothing is working.  This > child needs her  rest.  What’s a family to do?  Any ideas??

Have you discussed this with her doctor?  If she is only 15 and has been on these meds for years, have you considered that the hormonal changes with puberty can disrupt the meds? Regards Lee in Toronto —–= Posted via Newsfeeds.Com, Uncensored Usenet News =—– http://www.newsfeeds.com – The #1 Newsgroup Service in the World! —–==  Over 80,000 Newsgroups – 16 Different Servers! =—–

Response:

Hi Just wondering if you have thought about the insomnia being a PMS ( pre and/or post menstrual symptom). Can you figure out when in her cycle she has insomnia and when not, and if there is a connection, you can bring this up with your physician. – Hide quoted text — Show quoted text -The Cormiers wrote: > Hi, > I have a 15 yr old who is on Dexedrine for ADD and Allegra for sinus and > asthma symptoms.  She has been on these meds for years.  Recently, about a > year now she has been going through two week cycles of complete insomnia. > We have tried reducing and changing meds.  She insists it is not the meds. > We have done all the other usual suggestions but nothing is working.  This > child needs her  rest.  What’s a family to do?  Any ideas??

Response:

> Insomnia can also be the result of too many thoughts going through your > head, some people find it helps to have a notepad by the bed, tell her to > write down the things that are going through her head, then they’re "dealt > with" and she no longer needs to dwell on them.

What a great idea! Occasionally I suffer from insomnia and it’s usually because I have too many things I’m thinking of. I just placed a pen and pad on my nightstand (Next to the CPAP ;<) and I’ll see how it works! — Robert (perform an exorcism for e-mail reply)

Response:

Robert wrote: > > Insomnia can also be the result of too many thoughts going through your > > head, some people find it helps to have a notepad by the bed, tell her to > > write down the things that are going through her head, then they’re "dealt > > with" and she no longer needs to dwell on them. > What a great idea! Occasionally I suffer from insomnia and it’s usually > because I have too many things I’m thinking of. I just placed a pen and pad > on my nightstand (Next to the CPAP ;<) and I’ll see how it works!

Try a little analog voice recorder or an even smaller digital voice recorder.  Then you can do it in the dark.  You probably wont need much memory, because just knowing it is there if you think of something important, will put you to sleep ‘inajiffy’. HTH > (perform an exorcism for e-mail reply)

– Sleep well/eat well/be well Norm To email replace nospam with rr

Response:

In article <3E0F98BF.593FD…@socal.nospam.com>, NormC <no…@socal.nospam.com> wrote: > Try a little analog voice recorder or an even smaller digital voice > recorder.  Then you can do it in the dark.  You probably wont need much > memory, because just knowing it is there if you think of something > important, will put you to sleep ‘inajiffy’.

I have an Olympus DM-1, one of the best purchases I ever made. http://www.olympusamerica.com/cpg_section/cpg_product_lobbypage.asp?l… It takes removable smart media and connects to a PC. When I attend a conference, I burn a CD of the tracks I make. Great stuff. — _Deirdre                                             http://deirdre.net "Ideally pacing should look like the stock market for the year 1999, up and up and up, but with lots of little dips downwards…."                                      – Wen Spencer on plotting a novel

Response:

like Tal said good sleep hygiene is the best way to start, try to follow the same routine before going to bed each night, ie. getting into pjs, washing up, brushing teeth, etc. and then it gives ur body the signal that it’s time to wind down. being 15 she most likely has a million things on her mind (i’m 18 going on 19 in 4 mnths, believe me, i know what its like to be a teenager!!!) , and at night its sometimes the easiest time to think about stuff as she has no one interrupting her, and nothing else to distract her (ie. tv, computer, telephone etc.).  being her parents she most likely won’t talk to you if theres anything on her mind, but encourage her to talk to a close friend, keep a notebook/diary/journal etc. by her bed, and when she has stuff going through her head encourage her to write down how she feels, whether it be thoughts, words, phrases, pictures etc. it doesn’t have to make sense, or be in a logical format, but just to put it on paper usually helps. engaging in some sort of physical activity during the day often helps ppl ’sleep like a baby’ at night. but make sure its not to close to bedtime… if she ever needs someone to talk to send me an email and id be happy to help out…!! sara :0)

Response:

my ADD child takes additional meds in the evening to slow him down and allow him to sleep talk to your Dr about what options are available and as suggested, she may be suffering from a sleep disorder too http://www.newtechpub.com/phantom/question/quiz.html take the answers to that questionnaire to your Dr when she sees him good luck "The Cormiers" <cormie…@attbi.com> wrote in message

news:qcFP9.154633$qF3.11287@sccrnsc04… – Hide quoted text — Show quoted text -> Hi, > I have a 15 yr old who is on Dexedrine for ADD and Allegra for sinus and > asthma symptoms.  She has been on these meds for years.  Recently, about a > year now she has been going through two week cycles of complete insomnia. > We have tried reducing and changing meds.  She insists it is not the meds. > We have done all the other usual suggestions but nothing is working.  This > child needs her  rest.  What’s a family to do?  Any ideas??

Response:

Hi, I have a 15 yr old who is on Dexedrine for ADD and Allegra for sinus and asthma symptoms.  She has been on these meds for years.  Recently, about a year now she has been going through two week cycles of complete insomnia. We have tried reducing and changing meds.  She insists it is not the meds. We have done all the other usual suggestions but nothing is working.  This child needs her  rest.  What’s a family to do?  Any ideas??

Response:

> I have a 15 yr old who is on Dexedrine for ADD and Allegra for sinus and > asthma symptoms.  She has been on these meds for years.  Recently, about a > year now she has been going through two week cycles of complete insomnia. > We have tried reducing and changing meds.  She insists it is not the meds. > We have done all the other usual suggestions but nothing is working.  This > child needs her  rest.  What’s a family to do?  Any ideas??

I would suggest you speak to a sleep doctor….there may be more going on than just insomnia.  It seems that sometimes, in children, sleep apnea is misdiagnosed as ADD… i’m not saying this is the case with your daughter, but it’s a possibility that should be brought up with a certified sleep doc if possible.  (Insomnia can be a result of sleep apnea in some people) Other than that, I woudl recommend she practice good "sleep hygiene" which means:  try and go to bed same time each night, get up same time too if possible. Don’t drink caffine in the afternoon. Don’t excercise late in the day, excercise earlier in the day is useful. Use the bed only for sleeping. Try white noise in the room ….something like a fan – this could be set on a timer swich so it’s not running all night A lot of people acutally have their bedroom too warm at night, apparently, we need less heat during the night. I find personaly, listening to quite music (might be hard to find quite music that interests a 15 year old LOL) will also help. Make sure (again, hard for a teenager) that the bedroom is kept tidy and that it’s dark at night – bright lights outside can make the room too light to induce sleep. If after tying to sleep for a while she is unsucessful, she should get up and do something ( nothing too stimulating – perhaps watching some tv or reading – not in bed though) and then after half an hour, try going back to bed. Insomnia can also be the result of too many thoughts going through your head, some people find it helps to have a notepad by the bed, tell her to write down the things that are going through her head, then they’re "dealt with" and she no longer needs to dwell on them. — Beth in Australia =================== FAQ for alt.support.sleep-disorder can be found here http://www.anchorweb.com.au/sleepdisorders this site is a work in progress – feel free to submit info/articles

Response:

Question:

ants are not (in general) a health problem, unlike cockroaches. Ants are part of the natural ecosystem, and unless they’re being a nuisance (e.g. getting Not that I have a fondness for either, but how is it that ants are part of the ecosystem but roaches aren’t?

Roaches are part of the ecosystem but present major health problems in terms of bacterial transmission, roach feces (which is a major cause of allergy problems and can cause an increase in asthma symptoms, as well as having a distinct odor that you can detect in a second if you walk into a roach-infested apartment), and simple volume of roaches that can live in the typical wall. I did not mean to imply that they were not part of the eco-system, just that they were a public health problem. Ants typically do not present such a public health problem. That was all that I was saying. They also tend to keep down the numbers of various other nuisance critters in the lawn and garden, such as various grubs and termites. Unfortunately, the rather mild-mannered native North American ants are becoming increasingly endangered due to the invasion of the imported fire ants, which have driven the native ants extinct in major swathes of the country.  I would not advise similar tolerance for the fire ants — they present their own health danger (as in, they are very agressive and their stings are painful and can cause death in the case of small children, small pets, or succeptible adults). — Eric Lee Green          GnuPG public key at http://badtux.org/eric/eric.gpg

Response:

Hi, About the landlord thing, searching the web or phone book for "Tenant and Landlord Authority" or something like that for your city or state might give you the applicable regulating body where you could direct your question. With the ants… careful about spraying. For a little while I had a pharaoh ant problem in my apartment (apparently everyone in my bldg did, too.) I sprayed until I learned that can break up one colony into multiple colonies formed by the surviving ants after they scatter to escape the spraying. What did the trick was using ant baits (comes as a gel or in discrete metal cannisters) and placing them along their trails and at their entry points. Good luck! – Hide quoted text — Show quoted text – Hi Folks, I am curious if any recourse exists for a land lord who cannot fix insect problems? I have had ant infestations not for two months, and have called the land lord 9-10 times. They spray and try to kill the ants, but nothing seems to work. Can I contact anyone to report this? Anyone happen to know if I can request/get rent back? Thanks for any insight, Ryan

Response:

ants are not (in general) a health problem, unlike

cockroaches. Ants are part of the natural ecosystem, and unless they’re being a

nuisance (e.g. getting Not that I have a fondness for either, but how is it that ants are part of the ecosystem but roaches aren’t? Just curious, S

Response:

I am curious if any recourse exists for a land lord who cannot fix insect problems? I have had ant infestations not for two months, and have called the land lord 9-10 times. They spray and try to kill the ants, but nothing seems to work. Can I contact anyone to report this? Anyone

This looks as if no one tried boric acid powder, which usually eliminates ants. Ants seem to present no problem to health, even in huge numbers;  but your local public health department can probably tell you if there are grounds for further action. — Don Phillipson Carlsbad Springs (Ottawa, Canada)

Response:

seems to work. Can I contact anyone to report this? Anyone happen to know if I can request/get rent back?

This depends upon your local landlord-tenant laws. For example, here in Arizona the law includes a "self help" provision. If the landlord cannot or will not solve a problem that will cost under $<x to fix, and you’ve given him time to fix it, you can fix it at your own expense and there are provisions for withholding part of your rent to pay for the cost to fix it. If I were you, I’d just go ahead and exterminate the ants myself rather than rely upon the landlord, and forget the whole issue. Ant baits work very well, and are very effective, while boric acid can be effective under certain circumstances too. I never bothered my landlord about ant problems, because ants are not (in general) a health problem, unlike cockroaches. Ants are part of the natural ecosystem, and unless they’re being a nuisance (e.g. getting into the dishwasher or onto dirty dishes in the sink) my natural inclination is to leave them be. When they were a nuisance, the baits worked great, and were inexpensive. Why bother the landlord? I dunno. — Eric Lee Green          GnuPG public key at http://badtux.org/eric/eric.gpg    http://www.newsfeed.com       The #1 Newsgroup Service in the World! —–= Over 100,000 Newsgroups – Unlimited Fast Downloads – 19 Servers =—–

Response:

– Hide quoted text — Show quoted text – I am curious if any recourse exists for a land lord who cannot fix insect problems? I have had ant infestations not for two months, and have called the land lord 9-10 times. They spray and try to kill the ants, but nothing seems to work. Can I contact anyone to report this? Anyone This looks as if no one tried boric acid powder, which usually eliminates ants. Ants seem to present no problem to health, even in huge numbers;  but your local public health department can probably tell you if there are grounds for further action.

Boric acid is sold as a white powder at pharmacies.  See archives of the homeowners newsgroup for how to use it.  All I do is make sugar water, mix in a few spoonfuls of boric acid powder, and leave wetted twists of cotton wool along ant routes (because ants usually follow particular routes.)  Ants take the sugar water back to the nest to share:  and the boric acid ruins their digestions so that all die. This Message was undeliverable due to the following reason: Each of the following recipients was rejected by a remote mail server. The reasons given by the server are included to help you determine why each recipient was rejected. — Don Phillipson Carlsbad Springs (Ottawa, Canada)

Response:

Hi Folks, I am curious if any recourse exists for a land lord who cannot fix insect problems? I have had ant infestations not for two months, and have called the land lord 9-10 times. They spray and try to kill the ants, but nothing seems to work. Can I contact anyone to report this? Anyone happen to know if I can request/get rent back?

i did my own spraying. seems to work.

Response:

Hi Folks, I am curious if any recourse exists for a land lord who cannot fix insect problems? I have had ant infestations not for two months, and have called the land lord 9-10 times. They spray and try to kill the ants, but nothing seems to work. Can I contact anyone to report this? Anyone happen to know if I can request/get rent back? Thanks for any insight, Ryan

Response:

Question:

If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system?

No; the cold will worsen the asthma so pred will still be needed to treat the asthma. Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Shouldn’t be a problem; however if you are on a short course of prednisone for an asthma exacerbation, it would be better to  wait if possible. According to the bulletin I received from my clinic from the CDC: "If you have a fever or are severly ill at the time the shot is scheduled you should usually wait until you recover before getting influenza vaccine. Talk to your doctor or nurse about whether to reschedule the vaccination." More info at: http://www.cdc.gov/nip/Flu/default.htm Flu Season 2001-02 Ellis

Response:

lso, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Hiya – I’ve been taking daily steroids for years, and always get a flu shot.  No one has ever told me that I couldn’t or that I needed to get another.  Im hoping my doc will have some this week so when I go in, I’ll ask about it. Life is uncertain – eat dessert first. Nancy 8=: )

Response:

– Hide quoted text — Show quoted text – If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? You must be taking prednisone for a good reason, so don’t discontinue it on your own without asking your doctor first. Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot? Yes it can.  You may need to take a booster shot some weeks later. See http://www.rxlist.com/cgi/generic/pred_wcp.htm

I don’t believe it has been shown that corticosteroids, used in therapeutic dosage, affect the efficacy of immunization. I can’t find anything in the link above that speaks directly to that question.     Larry

Response:

I don’t believe a short course of prednisone damages your immune system in any way.  It’s the long term effects that cause concern. -S- – Hide quoted text — Show quoted text – If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Response:

– Hide quoted text — Show quoted text – If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? You must be taking prednisone for a good reason, so don’t discontinue it on your own without asking your doctor first. Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot? Yes it can.  You may need to take a booster shot some weeks later. See http://www.rxlist.com/cgi/generic/pred_wcp.htm I don’t believe it has been shown that corticosteroids, used in therapeutic dosage, affect the efficacy of immunization. I can’t find anything in the link above that speaks directly to that question.    Larry

The issues with corticosteriods are complex with a wide variation in result depending on species investigated and specific steriod used. However, with regard to prednisone specifically, these are the clinical findings. Influenza vaccination in children with chronic rheumatic diseases and long-term immunosuppressive therapy. Kanakoudi-Tsakalidou F, Trachana M, Pratsidou-Gertsi P, Tsitsami E, Kyriazopoulou-Dalaina V. Clin Exp Rheumatol. 2001 Sep-Oct;19(5):589-94. …CONCLUSION: The results of our study indicate that children with CRD receiving long-term immunosuppressive therapy at conventional doses respond to influenza vaccination similarly to healthy children without serious adverse reactions or disease flares regardless of their age, type of CRD or therapeutic regimen. Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy. Park CL, Frank AL, Sullivan M, Jindal P, Baxter BD. Pediatrics. 1996 Aug;98(2 Pt 1):196-200. CONCLUSIONS. Influenza vaccination can be given safely and effectively to asthmatic children regardless of asthma symptoms or concurrent prednisone therapy when necessary. Vaccination of all moderate to severe asthmatic patients visiting clinics or emergency departments would improve the overall vaccination rate significantly.

Response:

If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system?

Your doctor is the person who should answer this question.  People are different and what may be the ‘right’ answer for me may be bad advice for you. Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

IIRC if you are on pred, you need to repeat the flu shot a few weeks later. — We make war so we may live in peace. Aristotle

Response:

If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system?

You must be taking prednisone for a good reason, so don’t discontinue it on your own without asking your doctor first. Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Yes it can.  You may need to take a booster shot some weeks later. See http://www.rxlist.com/cgi/generic/pred_wcp.htm — Steven D. Litvintchouk                   Disclaimer:  As far as I am aware, the opinions expressed herein             are not those of my employer.

Response:

If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Response:

one never knows do one ? – Hide quoted text — Show quoted text – If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Response:

Question:

If one is on a short course of prednisone and catches a cold, should one discontinue using it while one has the cold, due to its suppression of the immune system? Also, is there a problem with taking a flu shot while on prednisone? Would the immunosuppression interfere with the body’s antibody creation from the flu shot?

Response:

one never knows do one ? – Hide quoted text — Show quoted text -MS wrote in message … >If one is on a short course of prednisone and catches a cold, should one >discontinue using it while one has the cold, due to its suppression of the >immune system? >Also, is there a problem with taking a flu shot while on prednisone? Would >the immunosuppression interfere with the body’s antibody creation from the >flu shot?

Response:

MS wrote: > If one is on a short course of prednisone and catches a cold, should one > discontinue using it while one has the cold, due to its suppression of the > immune system?

You must be taking prednisone for a good reason, so don’t discontinue it on your own without asking your doctor first. > Also, is there a problem with taking a flu shot while on prednisone? Would > the immunosuppression interfere with the body’s antibody creation from the > flu shot?

Yes it can.  You may need to take a booster shot some weeks later. See http://www.rxlist.com/cgi/generic/pred_wcp.htm — Steven D. Litvintchouk                   Email:  s…@mitre.org                 Disclaimer:  As far as I am aware, the opinions expressed herein             are not those of my employer.

Response:

In article <3BF2C153.B77FD…@mitre.org>, Steven D. Litvintchouk – Hide quoted text — Show quoted text -<s…@mitre.org> wrote: > MS wrote: > > If one is on a short course of prednisone and catches a cold, should one > > discontinue using it while one has the cold, due to its suppression of the > > immune system? > You must be taking prednisone for a good reason, so don’t discontinue it > on your own without asking your doctor first. > > Also, is there a problem with taking a flu shot while on prednisone? Would > > the immunosuppression interfere with the body’s antibody creation from the > > flu shot? > Yes it can.  You may need to take a booster shot some weeks later. > See > http://www.rxlist.com/cgi/generic/pred_wcp.htm

I don’t believe it has been shown that corticosteroids, used in therapeutic dosage, affect the efficacy of immunization. I can’t find anything in the link above that speaks directly to that question.     Larry

Response:

I don’t believe a short course of prednisone damages your immune system in any way.  It’s the long term effects that cause concern. -S- – Hide quoted text — Show quoted text -MS wrote: > If one is on a short course of prednisone and catches a cold, should one > discontinue using it while one has the cold, due to its suppression of the > immune system? > Also, is there a problem with taking a flu shot while on prednisone? Would > the immunosuppression interfere with the body’s antibody creation from the > flu shot?

Response:

On Wed, 14 Nov 2001 14:20:48 -0500, Larry Preuss <LPre…@provide.net> wrote: – Hide quoted text — Show quoted text ->In article <3BF2C153.B77FD…@mitre.org>, Steven D. Litvintchouk ><s…@mitre.org> wrote: >> MS wrote: >> > If one is on a short course of prednisone and catches a cold, should one >> > discontinue using it while one has the cold, due to its suppression of the >> > immune system? >> You must be taking prednisone for a good reason, so don’t discontinue it >> on your own without asking your doctor first. >> > Also, is there a problem with taking a flu shot while on prednisone? Would >> > the immunosuppression interfere with the body’s antibody creation from the >> > flu shot? >> Yes it can.  You may need to take a booster shot some weeks later. >> See >> http://www.rxlist.com/cgi/generic/pred_wcp.htm >I don’t believe it has been shown that corticosteroids, used in >therapeutic dosage, affect the efficacy of immunization. I can’t find >anything in the link above that speaks directly to that question. >    Larry

The issues with corticosteriods are complex with a wide variation in result depending on species investigated and specific steriod used. However, with regard to prednisone specifically, these are the clinical findings. Influenza vaccination in children with chronic rheumatic diseases and long-term immunosuppressive therapy. Kanakoudi-Tsakalidou F, Trachana M, Pratsidou-Gertsi P, Tsitsami E, Kyriazopoulou-Dalaina V. Clin Exp Rheumatol. 2001 Sep-Oct;19(5):589-94. …CONCLUSION: The results of our study indicate that children with CRD receiving long-term immunosuppressive therapy at conventional doses respond to influenza vaccination similarly to healthy children without serious adverse reactions or disease flares regardless of their age, type of CRD or therapeutic regimen. Influenza vaccination of children during acute asthma exacerbation and concurrent prednisone therapy. Park CL, Frank AL, Sullivan M, Jindal P, Baxter BD. Pediatrics. 1996 Aug;98(2 Pt 1):196-200. CONCLUSIONS. Influenza vaccination can be given safely and effectively to asthmatic children regardless of asthma symptoms or concurrent prednisone therapy when necessary. Vaccination of all moderate to severe asthmatic patients visiting clinics or emergency departments would improve the overall vaccination rate significantly.

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MS wrote: > If one is on a short course of prednisone and catches a cold, should one > discontinue using it while one has the cold, due to its suppression of the > immune system?

No; the cold will worsen the asthma so pred will still be needed to treat the asthma. > Also, is there a problem with taking a flu shot while on prednisone? Would > the immunosuppression interfere with the body’s antibody creation from the > flu shot?

Shouldn’t be a problem; however if you are on a short course of prednisone for an asthma exacerbation, it would be better to  wait if possible. According to the bulletin I received from my clinic from the CDC: "If you have a fever or are severly ill at the time the shot is scheduled you should usually wait until you recover before getting influenza vaccine. Talk to your doctor or nurse about whether to reschedule the vaccination." More info at: http://www.cdc.gov/nip/Flu/default.htm Flu Season 2001-02 Ellis

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Question:

Below… Dan Rhea "Loyalty is for family, friends and country, not operating systems, compilers and computers"   – Dan Rhea, 1986

– Hide quoted text — Show quoted text – hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the coughing starts  which is  mainly aII night and day it hurts—    my  MD is giving  me  many  different  meds, but  what lm  QUESTIONING  IS For HYCODAN—– THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS please My advice is to find another doctor.  Ask for a referral to an asthma specialist. Nighttime asthma symptoms are an indication that your asthma is not under proper control.  The cough is not the asthma – it is a symptom of the asthma and treating the symptoms is not treating the disease.

Hi Colin, Along with my normal meds (Advair, Comblivent (when needed), Nasarel, Singulair and Allegra D), I also take Tesselon pearls. We (myself and several doctors over the years) have discovered that when I discontinue the Tesselon, within three to four days I’m hitting the emergency inhaler two to three times a day (Yes, I had inhalers before being diagnosed as having Asthma… Something that still baffles me… It’s like they knew I had Asthma, but didn’t want to treat it or tell me I had it). The muscous I normally cough up gets a lot thicker, I wheeze and my chest muscles get very sore… It’s goes downhill from there (usually to prednisone after an ER visit). This may just be for me, but the addition of the cough suppressant seems to help a great deal in keeping my Asthma under control. On the other hand <grin, I have not tried removing the Tesselon while monitoring my peak flows (the last time we tried removing the tesselon, I didn’t even know what a peak flow meter was and my Asthma was undiagnosed). At some point I’m going to discuss trying to remove the Tessselon with my new Pulmonologist and monitor my peak flows at the same time to see if there really is a connection to my Asthma (no experiments unless the doctor says it’s ok) and the cough. I have a lot of problems with post nasal drip (allergy and iritation from Nasal CPAP for sleep apnea) which was why the cough supressant was first introduced several years ago. They perscribed Tussionex at the time, then a different narcotic supessant and finally Tesselon (my current GP changed this)… oddly the tesselon works better for me than any of the codine based stuff ever did. Just some food for thought. I would appreciate your comments on this if you have any (I highly value and appreciate your opinions and healthy skepticism by the way). Dan  Rhea – Hide quoted text — Show quoted text – "They laughed at Galileo. They laughed at Newton But they also laughed at Bozo the Clown." Carl Sagan

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hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

Hydrocodone is prescribed along with another drug, often acetomiophen [Tylenol]. It’s usually prescribed on a short term basis [days] for pain. It can help control coughing. Disadvantages are: *can be habit forming for maintenance *depresses the breathing reflex, which could be dangerous for asthmatics. Link: http://www.rxlist.com/cgi/generic/hydrocod.htm hydrocodone Each tablet contains: hydrocodone bitartrate* 5 mg and  acetaminophen 500 mg. * Warning: May be habit forming http://www.rxlist.com/cgi/generic/hydrocod_ad.htm adverse effects Respiratory Depression: Hydrocodone bitartrate may produce  dose-related respiratory depression by acting directly on the  brain stem respiratory center. Hydrocodone also affects the  center that controls respiratory rhythm and may produce  irregular and periodic breathing. Control of the symptoms of cough-variant asthma include increasing the dose of inhaled steroids and using albuterol as needed, to control symptoms. Also the possibility of sinusitis or GE reflux should be investigated; either can cause body fluids to get into lungs causing coughing. Ellis

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– Hide quoted text — Show quoted text – I have only one more thing to add: If your asthma started only in the last 3 years, and now has suddenly worsened in the last 6 months (i.e., since the winter cold/flu season), it might also be worthwhile to find out whether you picked up some kind of chronic infection.  I only developed asthma AFTER I developed chronic sinusitis. I mention this because in my experience, many asthma specialists seem biased toward allergy as the primary asthma trigger, and tend to neglect the possibility of chronic infection, either in the upper or lower respiratory tract. Steven D. Litvintchouk

That describes my circumstance as well.  I _never_ have asthma symptoms until the sinusitus kicks up.  I’ve had three sinus polyp surgeries, but sinusitus is dismally persistent.

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- Hide quoted text — Show quoted text – I have only one more thing to add: If your asthma started only in the last 3 years, and now has suddenly worsened in the last 6 months (i.e., since the winter cold/flu season), it might also be worthwhile to find out whether you picked up some kind of chronic infection.  I only developed asthma AFTER I developed chronic sinusitis. I mention this because in my experience, many asthma specialists seem biased toward allergy as the primary asthma trigger, and tend to neglect the possibility of chronic infection, either in the upper or lower respiratory tract. Steven D. Litvintchouk That describes my circumstance as well.  I _never_ have asthma symptoms until the sinusitus kicks up.  I’ve had three sinus polyp surgeries, but sinusitus is dismally persistent.

I have also heard that in children, sudden and persistent asthma flares may often be due to undiagnosed sinusitis.  Repeated ear infections are another clue.  (Because the infection in the inner ear may be fed by a sinus infection moving up thru the Eustachian tube toward the inner ear.) — Steven D. Litvintchouk                   Disclaimer:  As far as I am aware, the opinions expressed herein             are not those of my employer.

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- Hide quoted text — Show quoted text – hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS My advice is to find another doctor.  Ask for a referral to an asthma specialist. Nighttime asthma symptoms are an indication that your asthma is not under proper control.  The cough is not the asthma – it is a symptom of the asthma and treating the symptoms is not treating the disease.

I have only one more thing to add: If your asthma started only in the last 3 years, and now has suddenly worsened in the last 6 months (i.e., since the winter cold/flu season), it might also be worthwhile to find out whether you picked up some kind of chronic infection.  I only developed asthma AFTER I developed chronic sinusitis.   I mention this because in my experience, many asthma specialists seem biased toward allergy as the primary asthma trigger, and tend to neglect the possibility of chronic infection, either in the upper or lower respiratory tract. — Steven D. Litvintchouk                   Disclaimer:  As far as I am aware, the opinions expressed herein             are not those of my employer.

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it might also be worthwhile to find out whether you picked up some kind of chronic infection.  I only developed asthma AFTER I developed chronic sinusitis.  

Quite true. I developed asthma after h-pylori.

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hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

My advice is to find another doctor.  Ask for a referral to an asthma specialist. Nighttime asthma symptoms are an indication that your asthma is not under proper control.  The cough is not the asthma – it is a symptom of the asthma and treating the symptoms is not treating the disease. "They laughed at Galileo. They laughed at Newton But they also laughed at Bozo the Clown." Carl Sagan

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hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

Welcome, Carmen. If you would tell us about all of the medicine you are taking for your asthma, as a matter of fact all of your medicines for any purpose, you are sure to get informative comments from this group. Hycodan, given in small quantities and just on occasion, would not be absolutely contraindicated in the presence of asthma, but is not a part of asthma treatment programs.      Larry

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Carmen, Do you have a pulmonologist? Or an allergist specializing in treatment of asthma? Hycodan as a daily adjunct isn’t a real good idea. There are other meds that will reduce/eliminate coughing without the side effects of narcotics (Narcotics are histamine producers, which can actually worsen asthma in some individuals). Personally, when my coughing starts and won’t go away, I have Tessalon to use. Works pretty good. But you need to talk to your doc. If he/she isn’t a pulmonologist, get a referral to one. Renee Roberts – Hide quoted text — Show quoted text – hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

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hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

It is not so much that the hycodan is bad for the asthma as it is that it is not treating the cause of the cough. Suppressing the cough to some extent is fine of you know what is causing it and either cannot fix it or it will fix itself. It would be far better to fix the underlying problem if possible. — CBI, MD

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hi  my name is carmen  l just  found  this  group and admit l need some help and support.  l have  been  dealing with  asthma with the main side effect being very hard coughing and choking—for about 6–months l  have  had asthma—for about three years, but  when  the    coughing starts  which is  mainly aII night and day it hurts—    my  MD  is giving  me  many  different  meds, but  what lm  QUESTIONING  IS  For THIS  IS  FOR  COUGHING  IM  TOLD, BUT I’VE ALSO  HEARD  THIS MED IS

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Question:

Hi! We have some basic information and monitoring tools that may be of help at www.rxlearn.com.  This is a project site from nursing and pharmacy, including students.  Its free. We have a diabetes site and asthma site and tools to monitor blood sugar, peak flow, and other.  There are articles that explain what medications are used and other info. Your sister-in-law should be able to get a free peak flow meter (asking the doctor, nurse or their pharmacist) for monitoring. Check out:  http://www.aaaai.org/ for asthma, and http://www.diabetes.org for more complete information. Best wishes. Dave – Hide quoted text — Show quoted text -My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions? — Matti Narkia

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My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions? I have asthma and had GDM (and am on the watch for t2 DM). My precaution to her is to watch her BGs extra carefully if she ever needs to use steroids for the asthma.

[snip] Thanks Ester, I’ll pass the info over to my sister-in-law. Best wishes,          -Matti Narkia

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This post not CC’d by email My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions? G’day G’day Matti,  I had asthma for many, many years before being diagnosed first with sleep apnea and then T2 diabetes.  

[snip] Thanks Quentin, I’ll forward your message to my sister-in-law. Best wishes,          -Matti Narkia

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This post not CC’d by email My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions?

G’day G’day Matti,   I had asthma for many, many years before being diagnosed first with sleep apnea and then T2 diabetes.   The asthma appeared to be under control and if anything to be better much better in the period before I was diagnosed with T2 diabetes.  Fortunately I got a thorough work over when diagnosed for T2 diabetes because of the sleep apnea diagnosis.  What was discovered then was that the asthma only appeared to be under control when tested using the standard peak flow device. My peak flow values were higher than any smoker I have ever met but where I came to grief was a graphing flow meter revealed conclusively that the flow rated decayed exponentially with a short time constant instead of the usual linear decay curve. I was getting 60% of the oxygen indicated by the favourable peak flow readings. It was found necessary to use an inhaled steroid, Flixitide as it happens and a slow release bronchodilator.  This works well for me. The long and short of it is that when several chronic conditions interact it isn’t safe to assume the usual measurement techniques will pick up what is really going on. There is no way I’d have oral steroids as they have a reputation of bumping up blood glucose.  Also some spray type inhalers use CFCs as propellants.  Forgetting the ozone layer for a moment CFCs do damage much closer to home.  Sprayed on the back of the throat they inflame the tissues.  Diabetics, if their blood glucose is at all high, are prone to infections.  Most people here have at least heard that high blood glucose predisposes  people to gum disease and in the case of women, vaginal thrush infections.   Well CFC inhalers inflame the back of the throat and if blood glucose is high, throat infection after, throat infection is almost a foregone conclusion. Moral of the story.  For diabetics it may be worth the extra charges to have a spinhaler or CFC free inhaler for asthma meds. Apart from that, there is the question of diet.  In general diet that is good for diabetics is likely to be good for asthmatics.  Both are likely to benefit from weight loss.  Swimming is reported to improve breathing for diabetics and exercise is second only to diet for diabetics wishing to be in control of their lives. When you think about it diets containing anti-inflammatory substances like fish rich in omega-3 are going to benefit both bronchial tubes and arteries. Diabetics are prone to CHD.  The usual strategy is to do any or all of the following. Lower HbA1c preferably below 6.   Reduce triglycerides.   Improve HDL which is often low in diabetics. (The usual recommendation is exercise.) Protect the LDL from becoming oxidized, shriveled up and nasty.   (De factor standard antioxidant is alpha lipoic acid) Decrease fribrinogen to normal. (Turmeric provides some specific help.)   It helps to think of the arterial system and the bronchial system as a partnership.  If one is under strain the other one has to work harder. Oranges and kiwi fruit are reported to reduce the severity of asthma symptoms in children.  Since almost all T2 diabetics need to reduce sugar intake it makes sense that what free sugar they have in their diet should work double time. Best wishes, — Quentin Grady       ^  ^  / New Zealand,       #,#< [                     / /     "… and the blind dog was leading." http://homepages.paradise.net.nz/quentin

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My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions? — Matti Narkia

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My sister-in-law has recently been diagnosed with T2 diabetes and asthma. Does anyone has this combination? Any suggestions or cautions? — Matti Narkia

I have asthma and had GDM (and am on the watch for t2 DM). My precaution to her is to watch her BGs extra carefully if she ever needs to use steroids for the asthma. I took the FloVent inhaler when I got asthmatic bronchitis during my last stint of GDM, and my blood glucose went much higher than ever. She should avoid the steroids for asthma control as much as possible, and be ultra-careful if she ends up needing to use any steroids. Also, asthma flare-ups, in and of themselves, are stressors to the body which can drive the blood glucose up. So, she’ll want to make sure she can control her asthma as best as possible by avoiding triggers and taking the preventative medications that are available. Best wishes to her for a long and happy life with good control of both chronic conditions. Esther

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Question:

CBI reports: Since an important biological function of IL-4 is promotion of IgE isotype switching in B cells, a recombinant humanized monoclonal antibody also has been developed against IgE itself (rhuMAb-E25).

Presumably rhuMAb-E25 is the anti-IGE that was recently in clinical trials?  I find fascinating the IgE link between asthma and the body’s defenses against worm infection.  Perhaps asthma is, as unlikely as it sounds, the malfunction of an ancient mechanism to defend against parasitism?  Could intentional childhood exposure to pinworms help prevent adult-onset asthma? I distinctly remember having pinworms as a child, but since I had asthma almost since birth, it was already too late for me!  I suppose that those of us with childhood asthma must have the TH1/TH2 imbalance in our genes, whereas adult-onset asthmatics may have only inherited a susceptibility. Thanks to CBI for posting this article.  Reading this information along with the _Scientific American_ article someone posted a year or so ago, I feel like I understand the asthma mechanisms a lot better. Having access to the online _Encyclopedia Brittanica_ (www.eb.com, $35 a year) also helps.  There are good articles that explain what cytokines, eosoniphils, etc. are. — (650) 236-2231 [daytime]        http://www.wsrcc.com/alison/ The real puzzle of thermodynamics is not why entropy always increases with time, but why it was ever so low in the first place.  – H. Price

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Your comment about pinworms is intriguing in light of the following paragraph copied from the DEVELOPMENT & EVOLUTION page of www.allergyjournals.com: The evidence for parasites protecting against asthma is conflicting. Although surveys demonstrate more asthma occurring in industrialized areas where there is less parasitic infection, suggesting a protective role for parasites in rural areas, other Western-civilization-type factors may be responsible. It seems paradoxical that the increased allergic-type of immune response found in people with parasitic infection in underdeveloped countries is associated with decreased respiratory inflammation and decreased skin test reactivity to airborne allergens. JACI 2/00, p.205 – Hide quoted text — Show quoted text – CBI reports: Since an important biological function of IL-4 is promotion of IgE isotype switching in B cells, a recombinant humanized monoclonal antibody also has been developed against IgE itself (rhuMAb-E25). Presumably rhuMAb-E25 is the anti-IGE that was recently in clinical trials?  I find fascinating the IgE link between asthma and the body’s defenses against worm infection.  Perhaps asthma is, as unlikely as it sounds, the malfunction of an ancient mechanism to defend against parasitism?  Could intentional childhood exposure to pinworms help prevent adult-onset asthma? I distinctly remember having pinworms as a child, but since I had asthma almost since birth, it was already too late for me!  I suppose that those of us with childhood asthma must have the TH1/TH2 imbalance in our genes, whereas adult-onset asthmatics may have only inherited a susceptibility. Thanks to CBI for posting this article.  Reading this information along with the _Scientific American_ article someone posted a year or so ago, I feel like I understand the asthma mechanisms a lot better. Having access to the online _Encyclopedia Brittanica_ (www.eb.com, $35 a year) also helps.  There are good articles that explain what cytokines, eosoniphils, etc. are.

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From JAMA Vol. 286 No. 4, July 25, 2001 Linking Evidence and Experience Asthma: Prevalence, Pathogenesis, and Prospects for Novel Therapies Prescott G. Woodruff, MD, MPH; John V. Fahy, MD Novel Therapeutic Strategies Therapeutic strategies based on inhibiting TH2 cytokine activity or on redirecting aberrant TH2 responses to allergen to a more normal TH1 response are emerging (Figure 1). For example, a monoclonal antibody against IL-5 that inhibits the activity of TH2 cytokines has been developed and studied in human asthma. Surprisingly, although anti-IL-5 had immediate and long-lasting effects in reducing blood eosinophils after allergen challenge in subjects with asthma, it had no effect on allergen-induced bronchoconstriction.25 These findings suggest that reducing eosinophils may not be an effective treatment for asthma.26 Questions raised by the lack of efficacy of anti-IL-5 in this laboratory model of asthma (allergen challenge) may be resolved by data from a recently completed clinical trial of the effects of anti-IL-5 on asthma symptoms and pulmonary function. A different strategy has been used to inhibit IL-4. Recombinant human receptor for IL-4 (IL-4R) is the soluble, extracellular portion of the full-length human receptor for IL-4; it binds and inactivates naturally occurring IL-4 without causing cell activation. A preliminary short-term study of a single dose of nebulized IL-4R in patients with moderate asthma showed efficacy in preventing asthma symptoms when steroid treatment was withdrawn.27 Long-term studies of this strategy are awaited. Since an important biological function of IL-4 is promotion of IgE isotype switching in B cells, a recombinant humanized monoclonal antibody also has been developed against IgE itself (rhuMAb-E25). RhuMAb-E25 administration neutralizes and eliminates free circulating IgE and any IgE dissociating from cell surface receptors. In this way, rhuMAb-E25 gradually disarms mast cells and basophils, and should prevent IgE-dependent allergic reactions. Because rhuMAb-E25 binds IgE at the same site normally recognized by IgE receptors, IgE already bound to receptors on mast cells and basophils cannot simultaneously be bound by rhuMAb-E25; therefore, mast cells and basophils cannot be activated by rhuMAb-E25. Treatment with rhuMAb-E25 has resulted in significant attenuation of both the early- and late-phase responses to allergen inhalation in bronchoprovocation studies28, 29 and also improved asthma symptoms, exacerbations, and steroid requirements in a clinical trial.30 However, rhuMAb-E25 has not been shown to improve airway obstruction as measured by forced expiratory volume in 1 second (FEV1).30 Thus, although rhuMAb-E25 may soon become available as a once- or twice-monthly subcutaneously administered treatment for asthma, the place and cost-effectiveness of this novel strategy relative to currently available asthma treatments will take several more years to determine. Treatment strategies that are designed to redirect aberrant TH2 responses are less well developed but have the potential to achieve long-lasting or even curative effects in asthma. One approach has been to administer IL-12 in an attempt to inhibit TH2 and promote TH1 immune responses. When IL-12 was tested in patients with asthma, the only evidence that its administration had any effect on T-cell subtypes was a reduction in blood eosinophils.31 However, the reduction in eosinophils was not accompanied by any effect on airway responses to inhaled allergen.31 In addition, IL-12 treatment was associated with significant adverse effects. Other strategies to direct T cells away from allergic responses may be more effective and less toxic. Allergen immunotherapy may involve promotion of TH1 polarized responses32; this action could explain why the beneficial effects of immunotherapy in allergic rhinitis can last for years after treatment is stopped.33 Although immunotherapy is not as effective in asthma as in allergic rhinitis,34 improving immunotherapy so that it is more immunogenic and less allergenic may render it more effective in asthma. Strategies to achieve this improvement center on modification of the injected allergen in at least 2 ways. One modification strategy is to conjugate allergens with immunostimulatory DNA. This strategy is based on the observation that bacterial DNA promotes a TH1-biased immune response. The structural characteristic of bacterial DNA that confers this effect is a relatively high frequency of unmethylated cytosine guanine (CpG) dinucleotide motifs. In mice, when synthetic oligodeoxynucleotides (ODN) rich in unmethylated CpG dinucleotide motifs have been conjugated to aeroallergen such as ragweed, they promote a TH1 immune response. In contrast, unconjugated ragweed allergen promotes a TH2 response.35 Clinical trials of the efficacy of CpG-conjugated immunotherapy are now under way in ameliorating allergic responses. The construction of a cytokine fusion protein consisting of allergen fused to IL-12 has been used as another strategy for modification of the injected allergen.36 DNA vaccines composed of allergen complementary DNA (cDNA) fused to IL-18 cDNA have also been proposed. In animal studies, these strategies have been shown to convert TH2 immune responses to TH1-dominated responses in an allergen-specific manner.37 However, they have not yet been tested in humans. Conclusion The prevalence of asthma is increasing around the world, especially in affluent and developed countries. Hypotheses that attempt to explain the rising prevalence have been advanced but remain unproven, and uncertainty about the root cause of increasing asthma prevalence is a source of unease. Meanwhile, significant advances in understanding the immunologic basis of asthma are being translated into specific therapies, some of which may be available soon that hold promise for disease modification. Author/Article Information Author Affiliations: The Cardiovascular Research Institute and the Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco. Corresponding Author and Reprints: John V. Fahy, MD, University of California, San Francisco, 505 Parnassus Ave, Box 0111, San Francisco, CA Funding/Support: Dr Woodruff was supported by grant HL-07185 and Dr Fahy by grants RO1 HL-61662 and SCOR/PPG P01 HL-56385 from the National Institutes of Health Multidisciplinary Training Program in Lung Disease. Acknowledgment: We thank Mimi Zeiger, MA, for her assistance in editing the manuscript. Financial Disclosure: Dr Fahy received research funding from GlaxoSmithKline and Novartis. Contempo Updates Section Editor: Alice T. D. Hughes, MD, Fishbein Fellow. REFERENCES 1. Mannino DM, Homa DM, Pertowski CA, Ashizawa A, Nixon LL, Johnson CA, Ball LB, Jack E, Kang DS. Surveillance for asthmaUnited States, 1960-1995. Mor Mortal Wkly Rep CDC Surveill Summ. 1998;47:1-27. MEDLINE 2. Grant EN, Wagner R, Weiss KB. Observations on emerging patterns of asthma in our society. J Allergy Clin Immunol. 1999;104:S1-S9. MEDLINE 3. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. Lancet. 1998;351:1225-1232. MEDLINE 4. Sly RM. Decreases in asthma mortality in the United States. Ann Allergy Asthma Immunol. 2000;85:121-127. MEDLINE 5. Homa DM, Mannino DM, Lara M. Asthma mortality in US Hispanics of Mexican, Puerto Rican, and Cuban heritage: 1990-1995. Am J Respir Crit Care Med. 2000;161:504-509. MEDLINE 6. Boushey HA, Corry DB, Fahy JV. Asthma. In: Murray JF, Nadel JA, eds. Textbook of Respiratory Medicine. 3rd ed. Philadelphia, Pa: WB Saunders; 2000:1247-1289. 7. Los H, Koppelman GH, Postma DS. The importance of genetic influences in asthma. Eur Respir J. 1999;14:1210-1227. MEDLINE 8. Wills-Karp M. Murine models of asthma in understanding immune dysregulation in human asthma. Immunopharmacology. 2000;48:263-268. MEDLINE 9. Busse WW, Lemanske RF. Asthma. N Engl J Med. 2001;344:350-362. MEDLINE 10. Wegmann TG, Lin H, Guilbert L, Mosmann TR. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon? Immunol Today. 1993;14:353-356. MEDLINE 11. Prescott SL, Macaubas C, Smallacombe T, Holt BJ, Sly PD, Holt PG. Development of allergen-specific T-cell memory in atopic and normal children. Lancet. 1999;353:196-200. MEDLINE 12. Ray A, Cohn L. TH2 cells and GATA-3 in asthma: new insights into the regulation of airway inflammation. J Clin Invest. 1999;104:985-993. MEDLINE 13. Peat JK, Tovey E, Mellis CM, Leeder SR, Woolcock AJ. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin Exp Allergy. 1993;23:812-820. MEDLINE 14. Ronmark E, Jonsson E, Platts-Mills T, Lundback B. Incidence and remission of asthma in schoolchildren: report from the obstructive lung disease in northern Sweden studies. Pediatrics. 2001;107:E37. MEDLINE 15. Litonjua AA, Carey VJ, Burge HA, Weiss ST, Gold DR. Exposure to cockroach allergen in the home is associated with incident doctor-diagnosed asthma and recurrent wheezing. J Allergy Clin Immunol. 2001;107:41-47. MEDLINE 16. Lau S, Illi S, Sommerfeld C, et al. Early exposure to house-dust mite and cat allergens and development of childhood asthma: a cohort study. Lancet. 2000;356:1392-1397. MEDLINE 17. Platts-Mills T, Vaughan J, Squillace S, Woodfolk J, Sporik R. Sensitization, asthma, and a modified TH2 response in children exposed to cat allergen: a population-based cross-sectional study. Lancet. 2001;357:752-756. MEDLINE 18. Custovic A, Simpson BM, Simpson A, et al. Manchester Asthma and Allergy Study: low-allergen environment can be achieved and maintained during … read more »

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With asthma you don’t need to be a hypochondriac. do yuh?

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Another confounding factor is that both respiratory infections, and symptomatic asthma are both more common in children of smokers thus it would be easier to see a correlation between the infections and asthma given the linkage to smoking. Further, asthmatics are more likely to be symptomatic when infections while the non-asthmatics just tough it out at home without many symptoms when they get infected. This too would lead one to see association at a doctor’s office or ER. – Hide quoted text — Show quoted text – Our doctor believes there is a correlation between babies who have chronic respiratory problems such as croup and kids who develop asthma. When my youngest son was diagnosed with asthma, and our doctor found out that my older son had croup as a baby, he said it was probably just a matter of time before my older son showed asthma symptoms–and he was right. (I had croup and asthma as a baby.) Mary I remember when my daughter was very small, she had repeated episodes of croup.  To this day, I feel that croup is a forerunner of asthma.  She had her first croup episode when she was four months old.  We had a wonderful Dr. who not only had respect for what can happen when a child has croup, but also had respect for me, and my experience as the oldest of nine children, all of whom were croupers.  And being the only daughter of a severely asthmatic mother, I pretty much have been there, done that.  When my daughter was two we moved to a new town, a new state, a new Dr.  The first time she had an episode, I called for an appointment with the Dr.  I was given an appointment several days later.  So I took her to emergency, where the Dr. had to meet me.  He informed me that "there is no such thing as croup" and that I was going to turn my daughter into a hypochondriac by running to emergency with her all of the time.  Of course he did prescribe amoxicillin, I took her home and put together a croup tent.  Anyone else have the same croup to asthma theory?  My son and daughters were all croupers, now one daughter and my son have mild asthma.  Other daughter does the hives and exema thing.  Now I am the severely asthmatic Mother,  Ah Yes, my Mom did leave a legacy didn’t she?  Oh, none of us are hypochonriacs! )

– Don Elton Columbia, SC http://www.midcarolina.org

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I remember when my daughter was very small, she had repeated episodes of croup.  To this day, I feel that croup is a forerunner of asthma.  She had her first croup episode when she was four months old.

I was described as having croup as a child.  Later it was determined that I had asthma which was misdiagnosed as croup. "Being responsible sometimes means pissing people off."    General Colin Powell

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Croup definitely exists and is also known as laryngo-tracheo-bronchitis (LTB). It’s caused by a viral infection of the upper airway and results in narrowing of the trachea just below the vocal cords caused by edema. Antibiotics are not helpful for this though another bacterial infection elsewhere could cause them to be indicated. Croup does seem to increase airway secretions and it’s not uncommon to see/hear wheezing in patients with croup. In some cases the extra secretions probably cause an exacerbation of asthma that already existed while in other cases the same infection causing the edema and symptoms of croup may also affect the lungs thus causing an asthma exacerbation. I personally doubt that croup causes asthma per se – I think RSV (respiratory syncytial virus) is a far more likely cause of asthma among available potential infectious culprits but it’s possible here too that we only really diagnose the cases of RSV that occur in asthmatics as the others may stay home with minimal symptoms – hard to say at this point. – Hide quoted text — Show quoted text – I remember when my daughter was very small, she had repeated episodes of croup.  To this day, I feel that croup is a forerunner of asthma.  She had her first croup episode when she was four months old.  We had a wonderful Dr. who not only had respect for what can happen when a child has croup, but also had respect for me, and my experience as the oldest of nine children, all of whom were croupers.  And being the only daughter of a severely asthmatic mother, I pretty much have been there, done that.  When my daughter was two we moved to a new town, a new state, a new Dr.  The first time she had an episode, I called for an appointment with the Dr.  I was given an appointment several days later.  So I took her to emergency, where the Dr. had to meet me.  He informed me that "there is no such thing as croup" and that I was going to turn my daughter into a hypochondriac by running to emergency with her all of the time.  Of course he did prescribe amoxicillin, I took her home and put together a croup tent.  Anyone else have the same croup to asthma theory?  My son and daughters were all croupers, now one daughter and my son have mild asthma.  Other daughter does the hives and exema thing.  Now I am the severely asthmatic Mother,  Ah Yes, my Mom did leave a legacy didn’t she?  Oh, none of us are hypochonriacs! )

– Don Elton Columbia, SC http://www.midcarolina.org

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Anyone else have the same croup to asthma theory?  My son and daughters were all croupers, now one daughter and my son have mild asthma.  Other daughter does the hives and exema thing.  Now I am the severely asthmatic Mother,  Ah Yes, my Mom did leave a legacy didn’t she?  Oh, none of us are hypochonriacs! )

Actually my son Patrick was hospitalized once for croup.  He had a few episodes when he was a toddler, but not too many.  However, he did develop asthma when he was 15 and is highly allergic to just about everything.  I developed asthma at age 44. Interesting thought. Patrice

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I remember when my daughter was very small, she had repeated episodes of croup.  To this day, I feel that croup is a forerunner of asthma.  She had her first croup episode when she was four months old.  We had a wonderful Dr. who not only had respect for what can happen when a child has croup, but also had respect for me, and my experience as the oldest of nine children, all of whom were croupers.  And being the only daughter of a severely asthmatic mother, I pretty much have been there, done that.  When my daughter was two we moved to a new town, a new state, a new Dr.  The first time she had an episode, I called for an appointment with the Dr.  I was given an appointment several days later.  So I took her to emergency, where the Dr. had to meet me.  He informed me that "there is no such thing as croup" and that I was going to turn my daughter into a hypochondriac by running to emergency with her all of the time.  Of course he did prescribe amoxicillin, I took her home and put together a croup tent.  Anyone else have the same croup to asthma theory?  My son and daughters were all croupers, now one daughter and my son have mild asthma.  Other daughter does the hives and exema thing.  Now I am the severely asthmatic Mother,  Ah Yes, my Mom did leave a legacy didn’t she?  Oh, none of us are hypochonriacs! )

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I did not give my children solids until at least 6 months for my daughter and 7 mos for my son and to the best of my "then" knowledge did not give them anything with nuts, egg or milk until their first birthday. Unfortunately with my son, trace amounts seemed to bother him before he got the actual foods… ie bread that had milk powder/butter in it or was made "golden" with egg glaze, the baby foods that had milk deriviatives as a filler,  french fries with coating on them,  and other things you wouldn’t notice if you didn’t know your child was allergic. While breastfeeding, he was "stuffed up", gassy and had excema constantly, when he tried to stop nursing, the doctors suggested my breastmilk was drying up and I should drink more milk and water to increase it… of course he couldn’t breathe when we tried that!  His chest rattled to the point we could feel it when we held him, and 4 doctors told me that it was just "echoing from the sinus cavities"  "BS!" I said,  the kid has asthma symptoms.  no one believed me until he went into anaphalaxis with 1 Tbsp of macaroni and cheese on his first birthday. Since I now know how to eliminate milk and egg and corn from the child’s direct diet,  I am most concerned with what will get into my breastmilk or to the baby in these last months of pregnancy. Kellie http://freeweb.pdq.net/berg…@pdq.net/kellie.htm#allergy

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Kellie Berger wrote: > This group was a godsend with my 2nd child’s allergies and I am hoping you > might help me try to avoid/reduce any in my 3rd child.  I am 7 months > pregnant. > I have read somewhere that avoiding known family allergens during the last > months of pregnancy and during breastfeeding, you can eliminate such > allergies in children.  I have also read that limiting them is better – less > risk of nutrition problems, and that the little bit that passes through to > the milk (when you are limiting your diet) will condition the child to > tolerance of the substance. > Is there any basis in ANY of this? > Kellie

Hi Kellie,     I can only tell you what I have seen, but I have a friend who’s two boys had severe allergies.  she nursed her last boy for a year and he didn’t have the allergies the others had.     I would tend to go with eliminating known allergens if I were you, since the object of breast feeding to avoid allergies is to give the baby’s immune system a chance to mature before introducing allergens.   it is known that a child under the age of one shouldn’t have ANY egg white for instance, since it increases the chance of them becoming allergic to it.  Therefore, I would think avoiding known allergens would produce a less allergic child than giving them a little, at least til they get a little older.  they you could introduce them slowly and not to often to prevent overexposure, which would probably tend to increase the chances of allergy as well. Just my two cents worth.   Kitty — Kitty in Somerset, PA mail to:basyefel…@floodcity.net http://eboard.com/sewingstuff

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Hi – My understanding is that you should eliminate all substances that the baby’s immediated relatives are allergic to during the last trimester of pregnancy and during the first 12 months of life, including through breastmilk.  (A nutritionist will help you maintain a balanced diet.) Also delay the introduction of solids until 7 months, and don’t introduce the common allergens (wheat, egg, shellfish, nuts, peanuts, berries, dairy) until after 12 months of age.  Stay alert for signs of allergy, including eczema amd colic. You can do a Medline search at www.nih.gov for "allergies" and "breastfeeding", where there is a fair bit of research.  There’s little available on allergies and pregnancy. Good luck! –Beth Kevles   kev…@mit.edu   http://web.mit.edu/kevles/www/nomilk.html — a page for the milk-allergic   Disclaimer:  Nothing in this message should be construed as medical   advice.  Please consult with your own medical practicioner.

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Hi, Kelly – Congratulations! And kudos to you for your perseverance and advocacy on behalf of your children. Not sure whether any if this will help, but here’s our story: I have two children, both breastfed. And both with food allergies. I did not remove foods from my diet while pregnant. Each child turned out to be allergic to the foods which most often cause allergic reactions: eggs, dairy, soy, peanut, chocolate, nuts and berries. Coincidentally, several of the foods were those I tended to binge on during my pregnancies. Both children had the following symptoms, from about day 3 or 4 after birth: severe stomach cramping accompanied by inconsolable screaming/shrieking (not just crying), excessive gassiness, reflux (spitting up in quantities larger than typical, but still less than vomiting), spinach green (and odorous) diarrhea, and eczema. We treated the symptoms with mylicon drops for comfort and diphenhydramine for the allergic reactions. Neither of my children ever had anaphylactic symptoms; our allergies have always been the ’slow’ type. After identifying all the allergens (through trying them and seeing whether there was a reaction, which usually occurred within an hour or so) and eliminating them, even a small taste of an offending food produced symptoms. My older child outgrew her allergies at 6 months. My younger child has outgrown most but not all of his allergies and he is 3. What I have read in magazines, on the net, and heard from an allergist at a La Leche League conference is, completely eliminating foods known to cause allergies within your family (ones you, baby’s father, or baby’s sibs have had) is currently being advised, but with no studies to show the efficacy of doing so. It’s kind of a, "better safe than sorry, we are giving this advice based upon suspicions," kind of thing. The nutritional consequences were minimized by the allergist, who said consulting with your doctor and a nutritionist will help to avoid deficiencies. My experience was that eliminating the foods my daughter was allergic to was pretty easy (dairy, eggs, tomato, peanuts and chocolate) and she outgrew her allergies quickly. With my son, I was less successful at eliminating foods (because of my lack of discipline and his longer list of allergies), and he reacted every time I ’slipped.’ He weaned on his own at 15 months (considerably earlier than my daughter), which turned out to be the only way to remove all known allergens from his diet. His symptoms finally were controllable after weaning, so I think he knew that my milk kept making him sick. I personally think there is a link between foods consumed during pregnancy and a child’s allergies after birth because that proved to be the case with both my pregnancies/children. As they say, "Your mileage may vary." Adelle Stavis "Kellie Berger" <berg…@pdq.net> wrote in message

news:1424F0A438BFE8D9.EDFA8E471325E6C8.0B0F7A4AA847C4D9@lp.airnews.net… – Hide quoted text — Show quoted text -> This group was a godsend with my 2nd child’s allergies and I am hoping you > might help me try to avoid/reduce any in my 3rd child.  I am 7 months > pregnant. > My daughter is lactose intollerant and allergic to corn, my son was severely > allergic to any trace of egg or milk.  Through a bit more than two years of > strict avoidance we are now able to give him both and she can tolerate some. > Both children were breast fed.  We went through 5 doctors and anaphalaxis at > age 1 with my son before anyone believed me that it was more than just > cronic sinus infections he was suffering with. > I have read somewhere that avoiding known family allergens during the last > months of pregnancy and during breastfeeding, you can eliminate such > allergies in children.  I have also read that limiting them is better – less > risk of nutrition problems, and that the little bit that passes through to > the milk (when you are limiting your diet) will condition the child to > tolerance of the substance. > Is there any basis in ANY of this? > We recently moved and don’t have an allergist here to ask… My OB is > researching this too, but I would like as much info as possible! > Kellie

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This group was a godsend with my 2nd child’s allergies and I am hoping you might help me try to avoid/reduce any in my 3rd child.  I am 7 months pregnant. My daughter is lactose intollerant and allergic to corn, my son was severely allergic to any trace of egg or milk.  Through a bit more than two years of strict avoidance we are now able to give him both and she can tolerate some. Both children were breast fed.  We went through 5 doctors and anaphalaxis at age 1 with my son before anyone believed me that it was more than just cronic sinus infections he was suffering with. I have read somewhere that avoiding known family allergens during the last months of pregnancy and during breastfeeding, you can eliminate such allergies in children.  I have also read that limiting them is better – less risk of nutrition problems, and that the little bit that passes through to the milk (when you are limiting your diet) will condition the child to tolerance of the substance. Is there any basis in ANY of this? We recently moved and don’t have an allergist here to ask… My OB is researching this too, but I would like as much info as possible! Kellie

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