Dr.Vander Leek is an allergist/immunologist currently in private practice in Calgary, AB.

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1 ASTHMA & ALLERGIES WHAT S THE CONNECTION? Question: Can allergies worsen asthma? Dr.Tim Vander Leek: Definitely! If you are continuously exposed to one of your allergic triggers, your asthma will be more severe and you will likely require more medications to control your symptoms. Many people who are exposed to a pet or other allergen continuously will not experience the immediate symptoms (for example, hay fever, wheezing), but this does not mean that they are not allergic. This is because constant exposure will contribute to inflammation in the airways of your lungs, and inflammation causes asthma symptoms. This constant exposure also makes it more likely for you to experience more severe symptoms when you are exposed to other triggers (an additive effect). Intermittent exposure to allergic triggers can cause immediate, and occasionally severe, asthma symptoms. All allergic triggers that have been identified should be avoided, so that your asthma is milder and easier to control on less medications. Dr.Vander Leek is an allergist/immunologist currently in private practice in Calgary, AB. Originally Published: ican Summer 2002 Newsletter ASTHMA & ANTIBIOTICS BY Dr. Sheldon Spier In 2007, there was a flurry of articles in the popular press about how the use of antibiotics before the first birthday may lead to an increased risk of developing asthma. The reference is a journal article that appeared in the June issue of CHEST, the Cardiopulmonary Journal that is the official publication of the American College of Chest Physicians. The study looked at healthcare and prescription databases in Manitoba, Canada, and assessed the association between antibiotic prescription use for non-respiratory tract infections during the first year of life of children born in 1995 and the prevalence of asthma when they reached the age of 7 years. What the study, in fact, concluded is that the development of asthma may be reduced by avoiding the use of broad spectrum antibiotics - quite a different conclusion than what some of the popular press is suggesting! This research in Manitoba supports the recently popularized hygiene hypothesis which basically says that the more our immune systems are protected from infections in the early years the more the immune system turns away from an infection fighting type of immune system to an asthma type immune system. The Manitoba study did not prove that there is an actual cause and effect i.e. that using antibiotics actually leads to more asthma, but they showed an association between the two. It does, however, make sense that when we use antibiotics to fight bacterial infections, that we use the most targeted approach possible and stay away from broad spectrum antibiotics if they are not needed. It is also important to know that there has been a huge increase in our ability to treat infections, especially in the very young and it is far more important to treat infections that have serious long term consequences than it is to worry about the potentially extra amount of asthma that might appear in the population because of it. ican Website Article Archive Page 2

2 For every action in life, there is a reaction. Clearly we should not stop using antibiotics to fight infections, but we should certainly use them carefully and appropriately. Sheldon Spier is a pediatric respirologist and past Medical Director of the Asthma Clinic, Alberta Children s Hospital. Dr. Spier was also Co-Leader (with Dr. Wendy Tink) of the Child Asthma Network Project , was funded by Alberta Health Innovation Fund. This project eventually led to the creation of the current Community Pediatric Asthma Service, sponsor of the ican website. Originally Published: ican Fall 2007 Newsletter ASTHMA & THE HYGIENE HYPOTHESIS BY SHELDON SPIER, MD The amount of asthma we see in developed countries has been increasing dramatically over the past several decades. People have speculated that pollution, or early exposure to things we may be allergic to, may be playing a large role in the increased in asthma. However, there is considerable evidence building up to say that a more likely culprit may be our clean living life style. When we are born, it seems that our immune system is set up in the allergic mode. During the first year of life when we come in contact with infections, our immune system is stimulated to move over to the infection-fighting mode. These two systems (allergic and infection fighting) seem to compete with each other. The ability of our immune system to move into infection-fighting mode may lower our tendency to have asthma. It has been documented, for example, that children in day cares have more infections at a young age, but less asthma later on in life. The fifth child of family will have less asthma than the first (because of infections brought home by the older children). Going into a barn with the animals on the farm on a regular basis in the first year of life dramatically lowers the amount of asthma we see, but only where there is little family history of asthma. Having cats and dogs in the first year of life may also lower the amount of asthma we see. This is probably not due to the exposure to the allergic part of the animal, but rather the exposure to more infections that we may get from animals that then leads to less asthma. Even breast feeding has been associated with more asthma (probably from the protection against infections), but the positive aspects of breast feeding are still greater than any negative aspects and everyone today still strongly recommends breastfeeding infants. It is VERY important to note that, once you are diagnosed with asthma, and are allergic to certain triggers such as cats, then you need try to avoid them as much as possible. While the hygiene hypothesis is not yet fully proven, is very interesting and there are many studies to support it. What we need now are more studies to show us what to do to help prevent asthma right from birth. Today, what we can best do when we have asthma is to control it by making the appropriate changes in our environment (avoiding our triggers) and regularly using the excellent preventative medications currently available. ican Website Article Archive Page 3

3 Suggested reading for parents: The Hygiene Hypothesis by Stanley Goldstein, Asthma Magazine, September/October 2002,Vol. 7, No. 5 Suggested reading for health care professionals: Let them eat dirt by Garry Hamilton, New Scientist, July 18, 1998 Vol 159, Number 2143, page 26 (6) Sheldon Spier is a pediatric respirologist and past Medical Director of the Asthma Clinic, Alberta Children s Hospital. Dr. Spier was also Co-Leader (with Dr. Wendy Tink) of the Child Asthma Network Project , was funded by Alberta Health Innovation Fund. This project eventually led to the creation of the current Community Pediatric Asthma Service, sponsor of the ican website. Originally Published: ican Winter 2003 Newsletter CAN T WAIT TIL SUMMER Cough, Wheeze, Tight Chest, Short of Breath Cough, wheeze, tight chest and short of breath are the most common symptoms of asthma that is not well controlled. Don t miss any fun this summer! Remember the keys to asthma self-management: 1. Avoid your triggers as much as you can 2. Take your medications according to your Asthma Action Plan controller (everyday) plus reliever (only if you have symptoms) make sure your medication is not empty or expired 3. Check your device and your technique 4. Asthma is in good control when you have: No daytime symptoms No night time symptoms No limits to normal physical activity No missed school or work No need for reliever medication except for exercise Did you know asthma emergency visits spike in September, a couple of weeks after school starts? That s when taking a vacation from asthma medication and sharing viruses catches up with kids. Don t be part of the September rush to emergency this year. If you stopped taking or forgot to take your asthma medications in the summer, start taking them before school starts and go back to school with asthma in control this year. Originally Published: ican Summer 2008 Newsletter ican Website Article Archive Page 4

4 DON T FORGET THE NOSE! BY Dr. Mary Noseworthy The nose should be considered as part of single airway therapy for asthma, but it is commonly forgotten in the diagnosis and treatment of asthma. When your environment triggers seasonal/allergic rhinitis ( hay fever ), daily oral antihistamines and nasal steroids are recommended. Rhinitis is defined as swelling in the nose which usually results in an itchy, runny nose. If your nose is involved, successful asthma treatment and management will include nasal therapy, usually a nasal steroid spray for your nose. Dramatic changes in barometric pressure, like those we experience in Calgary during a chinook, also cause inflammatory changes in the nose and lungs may mean some of you will benefit from nasal therapy all year! See our nasal steroid instruction sheet online at Video Central Device Demos Nasal Steroid or click here. Dr. Noseworth, MD, FRCPC. Is Medical Co-Leader, Community Pediatric Asthma Service & Medical and Director, Asthma Specialty Clinic, Alberta Children s Hospital. Originally Published: ican Fall 2012 Newsletter MEDICATION UPDATE: Alvesco by Dr. Sheldon Spier Until recently there were three excellent inhaled corticosteroids (ICS) in primary use for asthma in Canada budesonide (Pulmicort), beclomethasone (Qvar) and fluticasone (Flovent). The newest addition to the market is ciclesonide (Alvesco) which is presently available in a metered dose inhaler (MDI or puffer ). Some of the drug s most important properties are: it has extremely high protein binding in the serum so it is delivered to the liver to be metabolized almost entirely which means almost no other tissues of the body are exposed to the medication it only becomes activated in the lungs so it causes minimal thrush or voice hoarseness in well controlled asthma, it can be used as a once daily medication As with many medications, the product is presently approved by Health Canada for patients 18 years of age and older, but there are many clinical studies of children down to the age of 12 and some clinical studies in younger children. I personally would have little or no hesitancy prescribing this medication to children of any age once I have informed parents/patients. Sheldon Spier is a pediatric respirologist and past Medical Director of the Asthma Clinic, Alberta Children s Hospital. Dr. Spier was also Co-Leader (with Dr. Wendy Tink) of the Child Asthma Network Project , was funded by Alberta Health Innovation Fund. This project eventually led to the creation of the current Community Pediatric Asthma Service, sponsor of the ican website. Originally Published: ican Spring 2007 Newsletter ican Website Article Archive Page 5

5 NEW ASTHMA MEDICATION. ZENHALE Zenhale has been approved by Health Canada for use in children over 12. Zenhale is a combination of mometasone (Nasonex), a well known and effective inhaled corticosteroid, and formoterol (Oxeze), a rapid onset and long-acting bronchodilator that has not previously been available in a metered dose inhaler (MDI) in Canada. This new product is most comparable to Symbicort since they both use the same long-acting bronchodilator. It also has some similarities to Advair. The Zenhale MDI device is blue in colour and must not be confused with short-acting bronchodilators alone (reliever medication). Originally Published: ican Fall 2011 Newsletter NEW ASTHMA MEDICATION Asmanex (mometasone) Asmanex is a once daily inhaled corticosteroid (ICS) Asmanex (mometasone) for use in children 12+ years. Mometasone is a well known and effective nasal steroid (used in Nasonex ). Asmanex is most comparable to Alvesco, QVAR, Flovent and Pulmicort. This once-a-day ICS is available in 200 mcg (pink) and 400 mcg (purple). The new device is a Twisthaler loaded by twisting off the cap, has a counter and will not open when it is empty. The lock when it s empty feature is a valuable and unique first in Canada. If you have any difficulty filling this prescription at your pharmacy, have any difficulty filling this prescription at your pharmacy, contact Merck Customer Service at Originally Published: ican Fall 2012 Newsletter OZONE FRIENDLY Asthma medications are ozone friendly. Metered dose inhalers now use Hydrofluoralkane (HFA) instead of the more damaging Chorofluorocarbon (CFC). Devices such as the Diskus and Turbuhaler are ozone friendly by their design they contain only the medication in a dry powder form, without any carrier agents. Originally Published: ican Summer 2012 Newsletter STRATEGIES FOR ALLERGY SEASON Try and decrease your allergy symptoms (repeated sneezing, congestion, runny nose, itchiness in the nose, roof of mouth, throat, eyes and ears) during allergy season with some of the following strategies: take/increase your asthma medication as prescribed by your physician or detailed on your asthma management plan I f your asthma symptoms worsen during allergy season postpone outdoor activities until later in the morning. Pollens are usually emitted between the hours from 5 10 am keep your home and car windows closed. Use air conditioning if you have it, but remember to clean air filters regularly stay indoors on hot, dry, windy days if you are suffering from hay fever ican Website Article Archive Page 6

6 don t hang your laundry or sheets out to dry. Allergens will collect on them have someone else mow your lawn or rake your leaves since these activities stir up pollens. Keep your lawn cut to discourage grass from pollinating i.e. going to seed take a shower at the end of the day when pollen counts are high to keep the pollen off your pillows and sheets consult your doctor about prescription nasal corticosteroid sprays and over the counter allergy medications (antihistamines) that may improve your allergy symptoms during peak periods Originally Published: ican Spring 2007 Newsletter TIPS FOR DEALING WITH OUTDOOR ALLERGENS BY CINDY BRONCONIER, CRE Why do allergies act up in the summertime? Many people suffer from airborne pollen and mold spore allergens. These allergens can cause symptoms which include multiple sneezing, congestion, runny nose and itchiness in the nose, roof of the mouth, throat, eyes and ears, also known as seasonal allergic rhinitis or hay fever. If you think you suffer from seasonal allergy symptoms, talk to your doctor about allergy testing. The results of allergy testing will help you decide which recommendations to follow: Wind pollinated plants emit small pollens which trigger allergic responses. Insect pollinated plants from flower producers do not usually cause a problem. Molds are microscopic fungi which float in the air and are affected by wind, rain, snow and temperature changes. Pollens and mold spores are released at different times throughout the year. It may be useful to check when your triggers peak in the high season and make changes in your outdoor activities to decrease these symptoms. Pollen sources are broken down into different trees, grass, weeds and prevalent mold spores: Tree pollens are high at the beginning of the season from mid March until the beginning of June. Grass pollens peak from June to the beginning of August. Weeds are high in the fall period Mold spores are high at the beginning of spring when the ground is nearly bare and also in the late summer and fall (harvest time). There are many variables when considering pollen counts in your area. Your own sensitivity level to a specific trigger, as well as the intensity of the exposure and the number of allergens you are exposed to, will affect the magnitude of your symptoms. The weather in your area can greatly influence pollen and mold counts. Windy, hot and dry days increase both of these counts. Rainy and cloudy days cause decreased counts by washing the pollen out of the air. Peak pollen and spore counts vary from year to year depending on many factors including the weather of the current and previous year. ican Website Article Archive Page 7

7 Recommendations during allergy season to improve your symptoms include: Postpone outdoor activities until later in the morning. Pollens are usually emitted between the hours from 5-10am Keep windows closed at night to avoid pollens or molds from entering your home. If possible use air conditioning instead. Remember to clean your air conditioning filter regularly. This strategy also applies when traveling in a car Stay indoors on hot, dry and windy days, if you are suffering from hay fever Don t hang your laundry or sheets out to dry. Allergens will collect on them Have someone mow your lawns and rake your leaves since these activities stir up pollens and molds. A tight fitting mask may filter out some pollens. Keep the lawn cut to discourage grass from pollinating, that is going to seed Have a shower at the end of the day, when the pollen counts are high to keep the pollen off your sheets and pillows Consult with your doctor about nasal corticosteroid sprays by prescription and over the counter allergy medications (antihistamines) that may improve your allergy symptoms during peak periods For more information about allergens and other related topics log on to the American Academy of Allergy, Asthma and Immunology website at Originally Published: ican Spring 2004 Newsletter USING YOUR EPI-PEN OR TWINJECT Take a few minutes this summer to remind your family members how to help someone in an anaphylactic emergency: Helpful Tools Act quickly! It is easier to stop an anaphylaxis reaction in it s first stage. Practice increases your confidence to use an auto injector in any emergency: Next time your auto injector expires, practice injecting it into an orange. Remember to throw away the orange! Be careful NOT to inject your thumb or finger. Get medical help if you do. Take a few minutes to remind your family and friends how to help someone in an anaphylactic emergency. Watch the videos and learn how to use an EpiPen, Twinject or Allerject device. Originally Published: ican Summer 2008 Newsletter ican Website Article Archive Page 8