Tagged Allergies

Si sufres de alergias, las mascarillas podrían ayudarte con los síntomas

Los estudios muestran que usar mascarillas en los espacios exteriores, además de ser efectivo contra la COVID-19, puede proteger a quienes sufren por las alergias estacionales.

Mientras llegamos a nuestra segunda primavera pandémica, muchos estamos desesperados por quitarnos los cubrebocas. Pero para 19,2 millones de estadounidenses adultos que sufren de alergias estacionales hay otra razón para seguir usando mascarillas.

Aunque los cubrebocas de tela y los quirúrgicos funcionan bien para protegernos de las partículas virales, los estudios muestran que las mascarillas también pueden ser efectivas para filtrar los alérgenos comunes, que normalmente flotan en tamaños mucho más grandes, lo que hace que sean más fáciles de bloquear. El polen de pino, por ejemplo, es aproximadamente 800 veces más grande que el coronavirus, dijo David Lang, alergólogo de la Clínica Cleveland. Incluso antes de la pandemia, les aconsejaba a sus pacientes con alergias graves que usaran mascarillas al aire libre, especialmente durante actividades prolongadas como la jardinería o la limpieza de los patios.

El uso de mascarillas para aliviar los síntomas de las alergias puede requerir un poco de “ensayo y error”, dijo Purvi Parikh, alergóloga e inmunóloga en el centro de salud NYU Langone. Pero “si hay menos polen entrando en la nariz y boca, es menos probable que sufras un ataque de alergia”, dijo.

Recientemente, un grupo de investigadores israelíes estudió cuánto cambiaban los síntomas de las personas con alergias leves, moderadas y graves al usar mascarillas. Con base en los datos recopilados por 215 miembros del personal de enfermería que usaron cubrebocas quirúrgicos o mascarillas N95 durante un período de dos semanas, encontraron que en el caso de 44 trabajadores sanitarios con síntomas de alergia severa, casi el 40 por ciento experimentó menos estornudos, secreción y congestión nasal cuando usaban una mascarilla quirúrgica o N95. Entre las 91 personas con síntomas moderados, el 30 por ciento mejoró cuando usaron una mascarilla quirúrgica; y esa cifra se elevó al 40 por ciento cuando usaban una N95. Entre las 80 personas que comenzaron el estudio con síntomas leves, 43 (alrededor del 54 por ciento), sintieron que sus síntomas mejoraron al utilizar una mascarilla quirúrgica o N95, dijo Amiel Dror, médico científico del Centro Médico Galilee y académico en la Facultad de Medicina Azrieli de la Universidad Bar-Ilan que es el autor principal del estudio.

El uso de mascarillas también fue más efectivo para los miembros del personal sanitario con alergias estacionales que para quienes presentan síntomas durante todo el año. Usar cubrebocas no resolvió el problema de la picazón en los ojos, según el reporte de septiembre, publicado en The Journal of Allergy and Clinical Immunology.

Aunque los hallazgos sugieren que usar una mascarilla puede reducir los síntomas de alergia en algunas personas, los investigadores advirtieron que se necesitan más estudios. Es posible que el personal sanitario experimente menos síntomas porque, cuando no estaban trabajando, se quedaban en casa y evitaban las multitudes durante los encierros, por lo tanto, tenían menos exposición a los alérgenos presentes en el medioambiente. Pero el hecho de que el uso de mascarillas, que cubren la nariz y la boca, se asociara con la mejoría de los síntomas nasales, pero no con la irritación de los ojos, sugiere que usar cubrebocas probablemente ayudó a reducir muchos síntomas de las alergias.

Además de filtrar los alérgenos, usar mascarillas también hace que el aire en nuestras cavidades nasales sea más cálido y húmedo, dijo Dror. “Sabemos que el aire seco y el aire frío a veces pueden provocar una reacción en la nariz”, dijo. “Este es un beneficio adicional de usar cubrebocas. Con todo lo malo, eso es algo bueno”.

La protección varía dependiendo de la mascarilla, el ajuste y, en el caso de las mascarillas de tela, según el tejido que se use en la fabricación. Y, a menos que usen cubrebocas en todo momento, las personas pueden verse afectadas por los alérgenos de interiores como los ácaros del polvo o el polen que se transportan a través de las ventanas abiertas con la brisa primaveral.

“Puede ayudar, pero no necesariamente eliminará todos los síntomas”, dijo Sandra Lin, profesora de Otorrinolaringología y cirugía de cabeza y cuello en la Escuela de Medicina Johns Hopkins. “Mucha gente usa mascarillas la mayor parte del tiempo y todavía tiene síntomas de alergia”.

Aquí hay otros consejos para reducir sus síntomas durante la temporada de alergias.

  • Protege tus ojos. Lang recomienda a las personas que sufren de alergias usar anteojos o gafas cuando estén al aire libre, lo que ayuda a evitar que los alérgenos como el polen de los árboles entren en contacto directo con los ojos.

  • Lava y cambia con frecuencia la mascarilla. “Lo último que quieres es que se quede algún alérgeno atrapado ahí”, dijo Parikh. Ella recomienda a los pacientes cambiarse de ropa al volver a casa y ducharse antes de dormir, para asegurarse de que el polen no se pegue a la piel y lavar las mascarillas reutilizables con frecuencia. Los Centros para el Control y la Prevención de Enfermedades recomiendan lavar los cubrebocas de tela después de cada uso.

  • Encuentra una mascarilla que no te irrite el rostro. Elegir la mascarilla correcta para un usuario con alergias puede ser importante. La gente con piel sensible puede reaccionar a algunos tintes textiles y deben usar detergentes sin aroma, o elegir mascarillas quirúrgicas o de grado médico, que es menos probable que irriten la piel. “Mis pacientes con alergias tienen piel muy sensible porque los mismos bichos que los hacen estornudar o toser también pueden irritarles la piel”, dijo Parikh.

  • Consulta con un médico si los síntomas de alergia son severos. “Si las personas continúan presentando síntomas que interfieren con sus actividades normales, si faltan al trabajo o la escuela, si su sueño se interrumpe por las noches, deben consultar a su médico”, dijo Lang. “Podemos ayudar de otras maneras. No deberían sufrir innecesariamente”.

Dani Blum es asistente de noticias en la sección Well de The New York Times.


How Wearing a Mask Can Reduce Allergy Symptoms

Research shows that wearing masks outdoors can protect against more than Covid-19 for people who suffer from seasonal allergies.

As we head into our second pandemic spring, many of us may be itching to give up our masks. But for the 19.2 million American adults suffering from seasonal allergies, there’s another reason to keep wearing your mask.

While cloth and medical masks do a good job of protecting us from viral particles, studies show masks also can be effective at filtering common allergens, which typically float around in much larger sizes, making them easier to block. Pine tree pollen, for example, is about 800 times larger than the coronavirus, said Dr. David Lang, an allergist at Cleveland Clinic. Even before the pandemic, he advised patients with severe allergies to wear a mask outside, especially for prolonged activities like gardening or yardwork.

Using masks to alleviate allergy symptoms can require a bit of “trial and error,” said Dr. Purvi Parikh, an allergist and immunologist at N.Y.U. Langone Health. But over all, “if there’s less pollen going into your nose and mouth, you’re less likely to have an allergy attack,” she said.

Israeli researchers recently studied how much difference wearing a mask could make for allergy sufferers with mild, moderate and severe symptoms. Using data collected from 215 nurses who used surgical masks or N95 masks during a two-week period, they found that among the 44 nurses with severe allergy symptoms, nearly 40 percent experienced less sneezing, runny nose and stuffy nose when they wore either a surgical or N95 mask. Among the 91 nurses with moderate symptoms, 30 percent improved when they wore a surgical mask; that rose to 40 percent when they wore an N95. Among the 80 nurses who started the study with mild symptoms, 43 nurses, or about 54 percent, felt their symptoms improved while wearing a surgical or N95 mask, said Dr. Amiel Dror, a physician-scientist at Galilee Medical Center and Bar-Ilan University Azrieli Faculty of Medicine and the lead author on the study.

Mask use was also more effective for the nurses with seasonal allergies than those with year-round symptoms. Wearing a mask did not solve the problem of itchy eyes, according to the September report, published in The Journal of Allergy and Clinical Immunology.

Although the findings suggest that wearing a mask can reduce allergy symptoms for some people, the researchers noted that more study is needed. It could be that the nurses experienced fewer symptoms because, when they weren’t working, they were staying home and avoiding crowds during lockdowns, and thus had less exposure to allergens in the environment. But the fact that mask wearing, which covers the nose and mouth, was associated with improvements in nasal symptoms, but not eye irritation, suggests that masking probably did help reduce many allergy symptoms.

In addition to filtering out allergens, wearing a mask also makes the air in our nasal cavities warmer and more humid, said Dr. Dror. “We know that dry air and cold air sometimes has the ability to elicit a reaction in the nose,” he said. “This is an extra benefit of wearing a mask. With all the bad, you can find some good.”

Protection varies mask to mask, depending on the fit and, for cloth masks, the weave of the fabric. And unless you wear a mask at all times, you may still be affected by indoor allergens such as dust mites or pollen carried through open windows on spring breezes.

“It can help, but it’s not necessarily going to take away all your symptoms,” said Dr. Sandra Lin, a professor of Otolaryngology — Head and Neck Surgery at Johns Hopkins School of Medicine. “Pretty much everyone’s wearing masks most of the time now, and people are still getting allergy symptoms.”

Here are some more tips to reduce your symptoms during allergy season.

  • Protect your eyes. Dr. Lang recommends people who suffer from allergies wear glasses or sunglasses when they’re outside, which helps block allergens like tree pollen from making direct contact with eyes.

  • Wash and change your mask frequently. “The last thing you want is allergen getting trapped in it,” Dr. Parikh said. She recommends patients change their clothes when they get home and shower before sleep, to ensure that pollen doesn’t stick to their skin, and wash reusable masks frequently. The Centers for Disease Control and Prevention recommends washing a cloth mask after each use.

  • Find a mask that doesn’t irritate your skin. Choosing the right mask for an allergy-prone wearer can also be important. People with sensitive skin may react to dyes in some fabric masks and should use perfume-free detergents. Or choose a surgical or medical grade mask, which are less likely to irritate skin. “My allergy sufferers have very sensitive skin because the same critters that make them sneeze or cough also can irritate their skin,” Dr. Parikh said.

  • Talk to a doctor if your allergy symptoms are severe. “If people are continuing to have symptoms that interfere with normal activity — if they’re missing work, missing school, their sleep is disrupted at night — see a physician,” Dr. Lang said. “There are other ways we can help. You shouldn’t be suffering needlessly.”

There’s No ‘One Size Fits All’ Treatment for Asthma

Personal Health

There’s No ‘One Size Fits All’ Treatment for Asthma

A new set of guidelines recognizes the complexity in the interaction between a patient’s genetics and the environment.

Credit…Gracia Lam
Jane E. Brody

  • Feb. 15, 2021, 5:00 a.m. ET

Asthma may be a disease with one name. But experts say that unbeknown to most people who have it, it is not just one disease, nor is there a “one-size-fits-all” treatment for it.

Rather, as detailed in a new 54-page set of guidelines developed by an expert panel, in the 13 years since the last guidelines were issued, tremendous progress has been made in understanding the causes and physiological effects of various kinds of asthma and the different approaches needed to treat them and minimize flare-ups in children and adults. The guidelines were published in December in the Journal of Allergy and Clinical Immunology.

“In recent years, we’ve recognized that everyone’s asthma is a little different, with different underlying mechanisms, and the paradigm for treating it has changed completely,” said Dr. Michael Wechsler, an asthma specialist at National Jewish Health in Denver.

Asthma is now recognized as a far more complex condition than experts realized in 1991 when the first comprehensive guidelines were issued. It is now considered a syndrome with many different characteristics, or phenotypes, that result from the interaction between a person’s genetics and environment.

Also, though not discussed in detail in the updated guidelines, the newest treatment with what are known as biologics is heralding new forms of personalized therapy for patients with severe asthma that is not well-controlled by other, albeit cheaper, remedies. Biologics are drugs made from modified molecules from the cells of live organisms designed to target specific disease pathways that culminate in asthma symptoms.

“The last 13 years have seen an explosion of new strategies, new concepts, new understanding of mechanism, new drugs and new treatments,” Dr. Wechsler said in an interview. “In just the last five years, five new drugs have been approved for treating asthma.”

The new guidelines can be especially helpful for people being treated for asthma, mild or severe, that is now not adequately controlled. More than half of asthma patients are treated by primary care doctors, with referrals to specialists like pulmonologists or allergists when their condition is severe or doesn’t respond well to treatment, said Dr. Michelle M. Cloutier, professor emerita at the University of Connecticut School of Medicine who chaired the expert panel.

Asthma afflicts about 25 million people in the United States, including 5.5 million children. It is not an infection, although the body reacts as if an enemy had attacked it. Rather, asthma is a chronic respiratory disease in people whose airways become inflamed in response to various triggering substances or behaviors. The inflamed airways swell and narrow and the muscles surrounding them tighten, causing a bronchospasm. Unless the bronchospasm is quickly reversed, it can become very difficult to breathe and result in hospitalization or death.

Although people with asthma always have some degree of airway inflammation, they are particularly sensitive to certain factors that can make the inflammation much worse and result in labored breathing. Thus, some people with asthma have environmental allergies, for example, to pollen, animal dander, dust mites, rodents or cockroaches, that when encountered can trigger an asthmatic attack. Others are sensitive to irritants in the air, like tobacco smoke, air pollutants, or substances with strong odors.

For example, Dr. Wechsler said, “Even what is used to clean can be irritating to a person with asthma.”

For some people with asthma, a viral infection, like the flu or common cold, or use of a medication like aspirin, an Nsaid or beta-blocker, can enhance inflammation in the airways and result in labored breathing. Still others experience constricted airways when they exercise, especially in cold weather.

Even strong emotions, like fear, anger, excitement or laughter, and sudden changes in the weather are problems for some people with asthma.

Although several people I know with asthma feared they would be especially susceptible to contracting Covid-19 and becoming severely ill, the evidence has not shown an increased risk either in contracting the coronavirus or developing a worse infection if they did, Dr. Wechsler said. In fact, he added, “treating asthma may even protect against Covid.”

Researchers now recognize that the triggering event of an asthma attack can have different manifestations within the airways and therefore respond better to different treatments. As Dr. Cloutier explained, in allergic asthma, inflammatory cells called eosinophils collect in the airways, but when a viral infection triggers the inflammation, cells called neutrophils are released, warranting a different treatment.

The new guidelines highlight the value of a measurement called FENO that stands for fractional exhaled nitric oxide, a biomarker described as useful in correctly diagnosing and adequately treating asthma in different patients. For children aged 5 and older, a nitric oxide measurement can help confirm the diagnosis of asthma and evaluate the effectiveness of treatment.

Although the guidelines do not provide hard-and-fast rules, they offer valuable treatment suggestions when currently used remedies do not result in the best relief possible. For example, the panel stated unequivocally that encasing mattresses and pillows in allergy-protective covers is not in itself an adequate remedy for someone allergic to dust mites.

“Single-component interventions often do not work” in efforts to control indoor allergens, the panel wrote. Among the combined approaches suggested were using pesticides against house-dust mites on carpets, mattresses and furniture; air-filtration systems and air purifiers, including those with HEPA filters; removal of wall-to-wall carpets and area rugs, at least in the allergic person’s bedroom; and mold mitigation.

The report also cautioned against relying on a negative result from an allergy test if the person reports worsening symptoms when exposed to the allergen tested. On the other hand, some patients who test positive on an allergy test may not react to that substance in real life. Some may have developed a tolerance to the allergen that could be undone by attempts to reduce the patient’s exposure to it.

In sync with current trends in medicine toward shared decision-making, the panel emphasized the value of doctors and patients collaborating to come up with the most practical and effective approach to treat asthma in different individuals. For example, the panel wrote, “allergen mitigation interventions may be expensive or difficult for patients to use or maintain.” Doctors were urged to take into account the severity of the patient’s symptoms and life circumstances before recommending remedies that could be too challenging for the patient.

Patients should be engaged in treatment decisions, Dr. Cloutier said. Those with mild disease, for example, might prefer to take a single medication every day and use a “rescue” medication occasionally if they develop symptoms, while others would rather use the same two medications but only when needed.

What People With Allergies Should Know About Covid Vaccines

Here’s What People With Allergies Should Know About Covid Vaccines

Four people so far have had allergic reactions after getting the Pfizer-BioNTech vaccine. Experts say that shouldn’t deter most people from getting a jab.

Vaccinations underway in Orange, Calif., on Wednesday.
Vaccinations underway in Orange, Calif., on Wednesday.Credit…Jenna Schoenefeld for The New York Times
Katherine J. Wu

  • Dec. 18, 2020, 12:27 p.m. ET

Allergic reactions reported in two health workers who received a dose of Pfizer’s vaccine in Alaska this week have reignited concerns that people with a history of extreme immune flare-ups might not be good candidates for the newly cleared shots.

The two incidents follow another pair of cases in Britain. Three of the four were severe enough to qualify as anaphylaxis, a severe and potentially life-threatening reaction. But all four people appear to have recovered.

Health officials on both sides of the pond are vigilantly monitoring vaccinated people to see if more cases emerge. Last week, British drug regulators recommended against the use of Pfizer’s vaccine in people who have previously had anaphylactic reactions to food, medicines or vaccines.

And on Thursday, Dr. Doran Fink, deputy director of the Food and Drug Administration’s clinical division of vaccines and related products applications, addressed the issue during a meeting about the vaccine made by Moderna that contains similar ingredients and is expected to soon receive emergency use authorization, or E.U.A., from the agency.

“We anticipate that there may be additional reports, which we will rapidly investigate,” Dr. Fink said, adding that robust surveillance systems were in place to detect these rare events.

Still, Dr. Fink said that “the totality of data at this time continue to support vaccinations under the Pfizer E.U.A., without new restrictions.”

The F.D.A., he added, would work with Pfizer to revise fact sheets and prescribing information for the vaccine so that the public would understand the risk of allergic reactions and know how to report them.

What do we know about the people who had bad reactions?

The first two confirmed cases of allergic reactions came from two health care workers in Britain. Both had a medical history of serious allergic reactions, but had not previously been known to have trouble with any of the vaccine’s ingredients. After an injection of epinephrine — the typical treatment for anaphylaxis — both recovered.

(A third British incident described as a “possible allergic reaction” was also reported and appears to have been minor.)

On Wednesday, two health workers in Alaska experienced reactions as well. One was too mild to be deemed anaphylaxis. But the other, which occurred in a middle-aged woman with no history of allergies, was serious enough to warrant hospitalization, even after she got a shot of epinephrine.

“What is happening does seem really unusual to me,” said Dr. Kimberly Blumenthal, an allergist, immunologist and drug allergy researcher at Massachusetts General Hospital. Vaccine-related allergic reactions are typically rare, occurring at a rate of about one in a million.

Dr. Blumenthal also pointed out that it was a bit bizarre to see allergic reactions clustering in just two locations: Britain and Alaska. Zeroing in on the commonalities between the two hot spots, she said, might help researchers puzzle out the source of the problem.

Do we know for sure that their reactions were caused by the vaccine?

British and U.S. agencies are investigating the causes, but no official has declared a direct link.

But Dr. Blumenthal suspects they were connected to the shots, because the reactions were immediate, occurring within minutes of injection.

“We have to think it was related because of the timing,” she said.

Nor is it known if a particular ingredient might have been the cause. Pfizer’s vaccine contains just 10 ingredients. The most important is a molecule called messenger RNA, or mRNA — genetic material that can instruct human cells to make a coronavirus protein called spike. Once manufactured, spike teaches the immune system to recognize the coronavirus so it can be fought off in the future. Messenger RNA, which is naturally found in human cells, is unlikely to pose a threat, and degrades within about a day of being injected.

The other nine ingredients are a mix of salts, fatty substances and sugars that stabilize the vaccine. None are common allergens. The only chemical with a history of causing allergic reactions is polyethylene glycol, or PEG, which helps package the mRNA into an oily sheath, protecting it as it goes into human cells.

But PEG is, generally speaking, inert and widespread. It’s found in ultrasound gel, laxatives like Miralax and injectable steroids, among other drugs and products, Dr. Blumenthal said. Despite the chemical’s ubiquity, she said, “I’ve only seen one case of a PEG allergy — it’s really, really uncommon.”

It’s still possible that something else could be causing the reactions — perhaps a factor related to how the vaccines are transported, thawed or administered, Dr. Blumenthal said.

Did the volunteers in Pfizer’s clinical trials have any bad reactions?

A small number of volunteers in Pfizer’s clinical trials experienced allergic reactions. Just one of the 18,801 participants who received the vaccine in a late-stage trial had anaphylaxis, and the incident was deemed unrelated to the vaccine, said Steven Danehy, a spokesman for Pfizer. No severe reactions were found in people who got a placebo shot.

Pfizer excluded people with a history of anaphylaxis to vaccines from its clinical trials.

What does the F.D.A. say about these reactions?

Several experts raised concerns about the allergic reactions in meetings convened to discuss both Pfizer’s and Moderna’s vaccines. The agency has advised caution, noting that health care providers should not administer the vaccine to anyone with a “known history of a severe allergic reaction” to any component of the vaccine — a standard warning for vaccines.

Should people with mild allergies wait to get vaccinated?

There’s no evidence that people with mild allergies, which are quite common, need to avoid the vaccine. Allergies are, simply put, the product of an inappropriate immune response against something harmless — pollen, peanuts, cat dander and the like. In many cases, the results of this overreaction are mild symptoms such as a runny nose, coughing or sneezing.

But allergies are specific: A reaction to one substance does not guarantee a reaction to another. On Monday, the American College of Allergy, Asthma and Immunology released guidance stating that people with common allergies “are no more likely than the general public to have an allergic reaction to the Pfizer-BioNTech Covid-19 vaccine.”

William Amarquaye, a clinical pharmacist at Brandon Regional Hospital, said he wouldn’t let his asthma or allergies stop him from taking the vaccine when it is offered to him in the next few weeks. He’s also never had trouble with other vaccines he has taken in the past.

“It should still be OK to take the vaccine,” Dr. Amarquaye said. “I’m actually excited about it.”

What about people with a history of severe allergies?

Most people in this category should be good to go, too, said Dr. Eun-Hyung Lee, an expert in allergy and immunology at Emory University.

Guidelines released by the Centers for Disease Control and Prevention identify only one group of people who might not want to get Pfizer’s vaccine: those with a known history of severe allergic reactions to an ingredient in the injection.

People with a history of anaphylaxis to any other substance, including other vaccines or injectable drugs, can still get the vaccine, but should consult their health care providers and be monitored for 30 minutes after getting their shots. Everyone else, like people with mild or no allergies, need to wait only 15 minutes before leaving the vaccination site.

“In general, the immediate reactions that require epinephrine are those that happen within the first 30 minutes,” said Dr. Merin Kuruvilla, an allergist and immunologist at Emory University.

Some people will understandably be concerned. Dr. Taison Bell, a critical care physician at UVA Health in Charlottesville, Va., said he worried about his 7-year-old son, Alain, who is severely allergic to several foods, including wheat, peanuts and cow’s milk. Alain has about two bouts of anaphylaxis each year.

It’s a bit of a relief that Alain is “later in the prioritization schema,” Dr. Bell said. By the time a vaccine is ready for him, he said, “we’ll get a better sense for how serious this is.” The family plans to discuss their situation with Alain’s doctor.

Ultimately, it’s unlikely that any of the ingredients in a coronavirus vaccine would cause Alain any issues. Alain has tolerated other vaccines, including the flu shot, in previous years, and is looking forward to his own shot at immunization to the coronavirus, said Dr. Bell, who received his first dose of Pfizer’s vaccine on Tuesday.

What about Moderna’s vaccine?

Two volunteers in Moderna’s late-stage clinical trial developed anaphylactic reactions, the company reported at the F.D.A. committee meeting on Thursday. Neither was deemed to be linked to the company’s vaccine, which also contains mRNA, because they occurred weeks or months after the participants received their shots. One of these volunteers also had a history of asthma and a shellfish allergy.

Moderna, unlike Pfizer, did not exclude people with a history of anaphylaxis from its trials.

Dr. Tal Zaks, the company’s chief medical officer, said that while Moderna’s vaccine recipe was similar to Pfizer’s, key molecular differences existed that could set the two products on different paths. He said that bad reactions to Pfizer’s vaccine did not guarantee that similar events would happen in relation to the Moderna shots.

Both vaccines do, however, include a version of PEG.

Dr. Blumenthal and others said that anyone concerned about having an allergic reaction to a vaccine should seek the advice of a health care provider.

For anyone getting the vaccine, it’s all about “balancing out the risks,” Dr. Lee, of Emory, said. Allergic reactions can be dangerous. But they are rare and treatable, and the tools to combat them should be available at all vaccination sites. The coronavirus, on the other hand, can have far graver consequences.

“When it’s my turn in line, I think weighing these odds is what I would do,” Dr. Lee said.

Weekly Health Quiz: Covid Vaccines, Winter Sports and a Cancer Breakthrough

1 of 7

Which statement about the new coronavirus vaccines is not true?

About 20 million Americans, including health care workers and residents of nursing homes, will be the first to get vaccinated

Vaccination requires two shots, three to four weeks apart

The vaccine can help protect you from getting infected with coronavirus, though it’s uncertain whether it will prevent you from spreading it to others

If you’ve already had natural Covid, it’s not safe to get vaccinated

2 of 7

In rare cases, the coronavirus vaccine has caused a severe allergic reaction, with symptoms such as a rash and shortness of breath developing about how long after getting the shot?

10 minutes

1 day

3 days

10 days

3 of 7

Mycobacterium marinum, a tuberculosis-like infection that can cause painful joint swelling, is spread through cuts in the skin from handling raw:

Pork

Fish

Poultry

Beef

4 of 7

Which of the following Winter Olympic Sports has the lowest rate of injuries?

Snowboard cross

Freestyle skiing aerials

Bobsled

Ski jumping

5 of 7

Paul Farmer, a medical anthropologist, received the $1 million Berggruen Prize for his work on:

Raising awareness of environmental cancers

Providing health care to underserved communities

Discovering the hepatitis C virus

Developing new methods of birth control

6 of 7

In recent decades, the mortality rate from falls in this age group more than doubled:

People aged 25 to 44

People aged 45 to 64

People aged 65 to 75

People over 75

7 of 7

A new scan that detects malignant cells anywhere in the body may lead to improved treatments for this cancer that kills 33,000 American men each year:

Testicular cancer

Penile cancer

Prostate cancer

Male breast cancer

Thumb Suckers and Nail Biters May Develop Fewer Allergies

Photo

Credit Getty Images

Babies have been seen sucking on their fingers in utero weeks before birth. But the sight of an older child with his fingers constantly in his mouth, sucking her thumb, biting his nails, can drive parents crazy, bringing up fears about everything from social stigma to germs.

A new study suggests that those habits in children ages 5 to 11 may indeed increase exposure to microbes, but that that may not be all bad.

When a pediatrician discusses thumb-sucking, it’s usually because a parent is worried. The thumb is in the mouth so constantly that there’s a worry about speech or about whether the teeth may be affected. It’s gone on too long, and an older child is being teased about it. And in those situations, especially when a child is over 4, we work with parents and children on how to break the habit.

Nail biting worries parents for similar reasons, and we often end up giving similar advice: Don’t make negative comments; look for the situations that bring on the behavior and find alternate strategies; praise and reward the child for not doing it; put a glove or a bandage on the hand to remind the child.

In a study published Monday in the journal Pediatrics, researchers drew evidence from an ongoing study of New Zealand children to show those whose parents described them as thumb-suckers and nail-biters were less likely to have positive allergic skin tests later in life.

The children were in the Dunedin Multidisciplinary Health and Development Study, in which 1,037 children born in 1972-73 in Dunedin, a coastal city in New Zealand, were assessed and tested as they grew up, with the most recent assessment done at age 38. Stephanie Lynch, a student at Dunedin School of Medicine and the first author of the paper, had the idea of using the data to look at a possible relationship between children who tend to have their fingers in their mouths and allergic sensitization.

The question of such a connection arose because of the so-called hygiene hypothesis, an idea originally formulated in 1989, that there may be a link between atopic disease — the revved-up action of the immune system responsible for eczema, asthma and allergy — and a lack of exposure to various microbes early in life. Some exposure to germs, the argument goes, may help program a child’s immune system to fight disease, rather than develop allergies.

In the study, parents were asked about their children’s nail-biting and thumb-sucking habits when the children were 5, 7, 9 and 11 years old. Skin testing for allergic sensitization to a range of common allergens including dust mites, grass, cats, dogs, horses and common molds was done when the children were 13 years old, and then later when they were 32. Thirty-one percent of the children were described as “frequent” nail biters or thumb suckers (or both) at one or more of those ages.

The study found that children who frequently sucked a thumb or bit their nails were significantly less likely to have positive allergic skin tests both at 13 and again at 32. Children with both habits were even less likely to have a positive skin test than those with only one of the habits.

These differences could not be explained by other factors that are associated with allergic risk. The researchers controlled for pets, parents with allergies, breast-feeding, socioeconomic status and more. But though the former thumb-suckers and nail-biters were less likely to show allergic sensitization, there was no significant difference in their likelihood of having asthma or hay fever.

Robert J. Hancox, one of the authors of the study, is an associate professor in the Department of Preventive and Social Medicine at Dunedin School of Medicine, a department that is particularly oriented toward the study of diseases’ causes and risk factors. He said in an email, “The hygiene hypothesis is interesting because it suggests that lifestyle factors may be responsible for the rise in allergic diseases in recent decades. Obviously hygiene has very many benefits, but perhaps this is a downside. The hygiene hypothesis is still unproven and controversial, but this is another piece of evidence that it could be true.”

Malcolm Sears, one of the authors of the paper, a professor of medicine at McMaster University in Hamilton, Ontario, who was the original leader for the asthma allergy component of the New Zealand study, said, “Early exposure in many areas is looking as if it’s more protective than hazardous, and I think we’ve just added one more interesting piece to that information.”

Dr. Hancox pointed out that the study does not show any mechanism to account for the association. “Even if we assume that the protective effect is due to exposure to microbial organisms, we don’t know which organisms are beneficial or how they actually influence immune function in this way.”

Thumb sucking, especially in an older child, can still be a problem if it interferes with the teeth, or causes infections on the fingers, or gets a child teased. Lynn Davidson, a developmental pediatrician who is an attending physician at the Children’s Hospital at Montefiore in the Bronx, and the author of a review article on thumb sucking, said she tends to be “very low-key” about thumb sucking, since children often stop on their own as they grow.

With older children, Dr. Davidson suggests that parents, if they are worried, should try to analyze when and why the child resorts to thumb sucking or nail biting, and then try behavioral techniques, like offering a child a foam ball to hold and squeeze at those moments. “In an older child you can use their input, ask, what would you do with your hands instead of putting them in your mouth,” she said.

Dr. Sears said, “My excitement is not so much that sucking your thumb is good as that it shows the power of a longitudinal study.” (A longitudinal study is one that gathers data from the same subjects repeatedly over a period of time.) And in fact, as researchers tease out the complex ramifications of childhood exposures, it’s intriguing to look at long-term associations between childhood behavior and adult immune function, by watching what happens over decades.

So perhaps the results of this study help us look at these habits with slightly different eyes, as pieces of a complicated lifelong relationship between children and the environments they sample as they grow, which shape their health and their physiology in lasting ways.

Learning to Live With a Child’s Allergies

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Credit Andrew Scrivani for The New York Times

When your older daughter is a toddler and you are pregnant with your younger daughter, your husband says, “Every Friday, we should have family pizza night.” Four months later, you give birth to a daughter who is allergic to milk (meaning also to cheese), as well as to eggs, tree nuts, peanuts and maybe buckwheat and flaxseed. Very early on, certain foods leave rashes around her mouth or make her vomit, so you stop giving them to her. When she is 8 months old, her sister spills ice cream on her arm. Red bumps immediately rise in the places the ice cream touched.

Your daughter’s allergies are officially diagnosed just before she turns 1, and for her first birthday, you make her a “cake” out of puréed sweet potatoes topped with coconut yogurt (you are now well-versed in the debate about whether coconut is a tree nut and think it’s not). She feels about this cake the way most anyone would, which is that it’s gross.

You scour the Internet for recommendations on how to handle multiple food allergies. You find horror stories about children dying of anaphylaxis brought on by a single bite of the wrong thing.

You read every ingredient in everything you buy at the grocery store, even when you buy more than one package of the same thing, even when you buy the same product week after week. You come to know certain products so well that when they get a new ingredient, it’s like a friend getting a haircut.

You talk to a fellow “food allergy mom,” the friend of a friend, who explains that your family shouldn’t go out for ice cream because even if your daughter gets sorbet, the employee will use the same spoon to scoop it that he used for someone else’s cone of pistachio; and your daughter shouldn’t eat jelly at another family’s house because that family dips their peanut buttery knives in the jelly when making sandwiches. You have always been such a good worrier, but these are things you never thought to worry about.

You stop going to restaurants as a family; you stop bringing home carryout, except occasionally and furtively, when you and your husband take turns eating it standing up in a corner of the kitchen (his preference) or sitting on the upstairs bathroom floor with the door closed (your preference).

You never leave the house without Epi-Pens.

Your husband, who barely cooked before you had children, matter-of-factly learns to make vegan doughnuts and vegan waffles and vegan whipped cream.

Because it’s medically recommended that you keep exposing your older daughter to the foods your younger daughter is allergic to, you go once or twice a week with your older daughter to diners or bakeries or Vietnamese restaurants. These are delightful outings — your older daughter is excellent company and loves trying new things — at the conclusion of which you scrub your hands and hers, at the restaurant and again at home, with a vigor appropriate for performing surgery.

When your daughter starts preschool, you burst into tears at the meeting with her teachers where you discuss how to handle snack time.

On Halloween, your daughter goes trick-or-treating but you carry along a bag of candy for her to choose from. Your daughter takes her own cupcakes to birthday parties and her own snack on play dates.

You rarely travel as a family; when you do, you pack loaves of bread and jars of sun butter in your suitcase. You FedEx soy milk to Idaho.

You wonder if it’s all because you ate too many peanut M&Ms when you were pregnant. At the same time, you decide that if you had it to do over again, the minute your daughter emerged from the birth canal, you’d have chewed up a peanut and spit it from your mouth into hers, because you’ve heard that pediatricians now endorse early exposure to nuts.

Other things you’d have done to prevent her allergies, if only time-travel were possible and if only you’d known: gotten a dog; renounced your dishwasher; become Amish.

You lie awake at night fretting about what will happen when your daughter is old enough for sleepovers, or for kissing people, or for college.

Those parents who complain about not being able to send their kids to school with the PB&J they love? Those airplane passengers who groan audibly when the flight attendant announces they won’t be serving peanuts today? Those codgers who say allergies didn’t exist when they were young and it’s just a bunch of helicopter parenting? You detest them.

But you feel enormous gratitude towards the parents who write “sun butter” on the plastic bags they send sandwiches to school in, or who go over the exact menu for their kid’s birthday party and show no irritation when they say, “Bagged carrots,” and you ask, “Bagged carrots that you’ll buy bagged or bag yourself?”

You start going as a family to an ice cream parlor where your older daughter and your husband get ice cream and you and your younger daughter bring coconut bars from home. You frantically wipe down the table and chairs before you sit. You know this excursion would probably seem depressing from the outside; secretly, from the inside, you consider it slightly depressing. But mostly you consider it festive and triumphant. Now your daughter knows what an ice cream parlor looks like!

You understand that into every life a little rain must fall but just wish the rain had fallen on you rather than your child. Obviously, to some extent, it is falling on you. But you wish it had fallen on you completely.

As much trouble as her allergies are, you never wish your daughter was anyone other than her hilarious, stubborn, singing, dancing, mermaid-obsessed, food allergic self.

And even if you cannot master allergies, it turns out that you can make cookies that are both safe for your daughter and delicious.

Allergy-Friendly Cookies

For a family with a child with allergies to milk, eggs and nuts, this is a go-to recipe.


Curtis Sittenfeld is the author, most recently, of the novel “Eligible: A Modern Retelling of Pride and Prejudice.” This is adapted from an essay in “The Artists’ and Writers’ Cookbook: A Collection of Stories With Recipes,” edited by Natalie Eve Garrett, to be published this fall.

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More Support for Early Exposure to Peanuts to Prevent Allergies

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Research found that feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies

Research found that feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergiesCredit DeAgostini/Getty Images

LOS ANGELES — Evidence is accumulating that food allergies in children might be prevented by feeding infants peanuts and other allergenic food in their first year of life, researchers reported here Friday.

That finding would challenge the recommendation of the World Health Organization that babies be fed exclusively breast milk for the first six months of life.

“At least as far as peanut is concerned, I would recommend parting from that,” Dr. Gideon Lack, professor of pediatric allergy at King’s College London, said in an interview.

Dr. Lack was the senior author of a study last year that found feeding peanuts to young children starting when they are 4 to 11 months old sharply reduced the risk of their developing peanut allergies. That upended the conventional wisdom that it is best to avoid introducing peanuts until children are older.

Those results are already starting to affect feeding practices, but they left several unanswered questions. Now, some of those questions were answered by two additional studies that are being published in The New England Journal of Medicine and presented here at the annual meeting of the American Academy of Allergy, Asthma & Immunology on Friday.

One question was whether children who consume peanuts from an early age will still remain free of allergies if they stop consuming them. The researchers followed the children from the original study for another year, from the time they turned 5 until they turned 6. For that year, they were not supposed to eat peanuts at all.

The results were reassuring. There was no big increase in allergies.

“It tells you the protective effect is stable,” Dr. Lack said.

Another question was whether the early feeding technique could be applied to other types of foods and to children at normal risk of allergies. (The original study involved children deemed to have a high risk of peanut allergy.)

The researchers conducted a second study at King’s College London involving 1,300 infants who were 3 months old and being fed only breast milk. Half were randomly assigned to continue on only breast milk until 6 months of age, which is the recommended practice in Britain. The other half were to be regularly fed peanut butter and five other allergenic foods: eggs, yogurt, sesame, white fish and wheat. The children were assessed for allergies when they turned three.

Overall, 5.6 percent of the babies who were fed the allergenic foods early developed an allergy to at least one of the six foods, a modest improvement from the 7.1 percent in the breast-milk-only group. However, the difference was not statistically significant, meaning it could have occurred by chance.

One problem was that fewer than half the parents in the early-introduction group actually fed their children the required six foods on a regular basis. But when researchers looked only at those children whose parents adhered to the feeding regimen, there was a statistically significant reduction in allergies. Only 2.4 percent of those children developed a food allergy, compared with 7.3 percent of those whose parents faithfully stuck to breast milk only for six months. There were also significant reductions in peanut allergies alone and egg allergies alone.

One conclusion could be that feeding allergenic foods to infants early really does work to prevent allergies, providing that parents consistently do it.

But researchers cautioned there could be another explanation. One reason parents stopped feeding the foods is they perceived their children were having a possible allergic reaction to them. In that case, looking only at the children actually fed the food would overstate the effectiveness of the technique.

Dr. Lack said he did not think that was an explanation because the children in the early-introduction group whose parents did not adhere to the protocol did not have an unusually high rate of allergies at age 3.

In a commentary in The New England Journal of Medicine, Dr. Gary W.K. Wong, a pediatrician at Chinese University of Hong Kong, cautioned about jumping to conclusions. He said that in any case, the fact that so many parents did not stick to the regimen suggested it was too demanding to be practical, and that less burdensome ways must be found to introduce allergenic foods early.

“In the meantime,” he said, “evidence is building that early consumption rather than delayed introduction of foods is likely to be more beneficial as a strategy for the primary prevention of food allergy.”

The results of last year’s study on peanut allergy are already having an influence. The American Academy of Pediatrics and some other medical societies from the United States, Europe and several other countries issued a consensus statement calling attention to the findings that feeding peanuts starting early in life may prevent allergies. More formal guidelines are expected shortly.

A market might even be developing for baby peanut food. Dr. David Erstein, a New York allergist, started a company that sells a product called Hello, Peanut! — packets of peanut flour in measured doses that can be mixed into baby food to introduce infants to peanuts.

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