April 29th, 2019

 

LAST THOUGHTS


Now that we have thoroughly explored nutrition and asthma in humans, what other adjunctive therapies can be leveraged for better outcomes?

Simply put, think of asthma or allergies symptoms as a glass of water overflowing. If the cup overflows, then you have disease symptoms like sneeze, congestion, itchy eyes, wheeze, shortness of breath, cough and so on. Therefore, it would make sense that we reduce the volume of water in the cup to reduce the disease burden. This helps to rebalance the immune response.

Other than the previously discussed nutritional and micronutrient changes, what can we do?

First - Avoid known triggers of disease. If you are allergic to dust, cat or dog hair, pollen, etc, learn how to mitigate these antigenic triggers in your local environment. Visit websites like www.aaaai.org or my good friends at allergy choices. Here are some basics from Dr. Cipriani's article in Frontiers of Pediatrics:

House Dust Mite
• Use bed-encasing for mattress and duvet/pillows
• Wash bedding weekly in hot water and dry in a heated drier
• Remove dust mite reservoirs (i.e., toys and stuffed animals, carpets)
• Reduce indoor humidity (less than 50%)
• Vacuum with a HEPA filter bag
• Remind that chemicals to kill mites or denature proteins have a modest effect
Pets
• Remove pet from bedrooms and everywhere the child spends a lot of time
• Clean accurately upholstered furniture, walls, and carpet
• Remove upholstered furniture and carpet if possible
• Encase the mattress and pillows with bed encasing
• Keep the pet clean with frequent washes
• Use a HEPA air filter
Insects
• Inspect to detect hiding places debris (grease, kitchen) and identify food sources
• Store food in sealed containers
• Exterminate with pesticides or bait traps
• Remove clutter and seal holes or cracks in the home
Mold
• Reduce indoor humidity (less than 50%)
• Remove contaminated carpets, wallpaper, and woodwork
• Treat washable surfaces with detergent and water and then dry completely
• Repair water leaks
Pollen
• Keep windows closed
• Bath to remove allergens from hair and body
• Consider to use HEPA air filtration
• Consider same principles for outdoor mold avoidance (Cipriani et. al. 2017)

Second - Consider subcutaneous immune therapy allergy shots (SCIT) or sublingual immune therapy (SLIT) to retrain the immune system to recognize these triggers as benign actors and not trouble makers. I prefer to go the SLIT route as it is much cheaper, requires less family time driving to the office weekly for shots as all doses are administered at home and works equally well. The only hiccup remains that SLIT is not covered by most insurances (cannot understand why)! The cost is very reasonable for the benefit outcome. We have offered this desensitization route for years with excellent results. Find a provider link

Third - always take your medicines as directed until the prevention interventions kick in and your provider team agrees to wean the meds. Asthma flairs can and will kill some patients every year. Please take this very seriously. I have seen this happen. Compliance in medicine is a major key to positive outcomes.

The story finishes today,

Thank you DM for being an awesome kid!

Dr. M

Cipriani Frontiers in Pediatrics Article