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Atopic Conditions and Introducing Solid Foods

As the incidence of atopic diseases such as asthma, atopic dermatitis, and food allergies continues to rise among children, the timing of solid food introduction has been the subject of several large studies. Introducing solid foods to infants less than 4 months old increases the risk of developing eczema and asthma, particularly in children with a family history of atopic disease. More recent studies, however, show that delaying solid food introduction too long may increase the incidence of food allergies. Like so many things in child development, the introduction of solid foods may have an optimal window.

Jill A. Poole and colleagues tested the hypothesis that late introduction of cereal grains would lessen the incidence of wheat allergy in children by following 1612 children from birth to a mean age of 4.7 years. Children whose parents reported the development of wheat allergy were tested for wheat-specific immunoglobulin E levels. Contrary to their hypothesis, the data indicated an increased risk of developing wheat allergy in children who received their first exposure to cereal grains after age 6 months. However, for children who are genetically susceptible to developing celiac disease, early exposure to gluten-containing cereals was more problematic than delaying exposure. Poole and colleagues report that celiac-susceptible children introduced to gluten-containing cereal before age 3 months had a "five-fold increased risk of celiac disease autoimmunity as compared with children exposed at 4 to 6 months of age. There was a marginal increased risk of celiac disease autoimmunity if first exposure was after 6 months."

Other large studies are also finding that the timing of solid food introduction is associated with the development of atopic conditions in children. A 2008 Dutch study involving 2558 infants in an ongoing prospective birth cohort study reported: "More delay in introduction of cow milk products was associated with a higher risk for eczema. In addition, a delayed introduction of other food products was associated with an increased risk for atopy development at the age of 2 years." A 2008 German study found that food sensitivities were more common in children who began eating solid foods after age 4 or 6 months (depending on the food). The German researchers also found that eczema "was significantly more frequent in children who received a more diverse diet within the first 4 months."

A 2010 Finnish study indicates that there may be an optimal window for introducing different foods: "After adjustment for potential confounders, late introduction of potatoes (> 4 months), oats (> 5 months), rye (> 7 months), wheat (> 6 months), meat (> 5.5 months), fish (> 8.2 months) and eggs (> 10.5 months) was significantly directly associated with sensitization to food allergens." In addition, inhalant allergy was "significantly associated" with late introduction of potatoes, rye, meat, and fish. Timing of solid food introduction appears to have a significant effect on the development of all types of atopic conditions.

Greer FR, Sicherer SH, Burks AW, American Academy of Pediatrics Committee on Nutrition and Section on Allergy and Immunology. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics. 2008;121:183-191. Available at: Accessed March 17,2010.

Nwaru Bl, Erkkola M, Ahonen S, Kaila M, et al. Age at the introduction of solid foods during the first year and allergic sensitization at age 5 years [abstract]. Pediatrics. January 2010; 125(1): 50-59. Available at: Accessed March 17, 2010.

Poole JA, Barriga K, Leung DYM, Hoffman M et al. Timing of initial exposure to cereal grains and the risk of wheat allergy. Pediatrics. 2006;117:2175-2182. Available at: Accessed March 17, 2010.

Snijders BEP, Thijs C, van Ree R, van den Brandt PA. Age at first introduction of cow milk products and other food products in relation to infant atopic manifestations in the first 2 years of life: The KOALA Birth Cohort Study [abstract]. Pediatrics. July 2008; 122(1); e1 15-e122. Available at: cgi/content/abstract/122/1/e115. Accessed March 17, 2010.

Zutavem A, Brockow I, Schaaf B, von Berg A, Diez U, et al. Timing of solid food introduction in relation to eczema, asthma, allergic rhinitis, and food and inhalant sensitization at the age of 6 years: results from the Prospective Birth Cohort Study LISA [abstract]. Pediatrics. January 2008;121 (1 );e44-e52. Available at: http://pediatrics.aappublication org/cgi/content/abstract/121/1/e44. Accessed March 17, 2010.

Sulfite Allergies

One in 100 people is sensitive to sulfites, according to Food and Drug Administration (FDA) estimates. While sulfites occur naturally in some fermented foods, such as wine and beer, most sulfite compounds are added as preservatives. Sodium sulfite, sodium bisulfite, sodium metabisulfite, potassium bisulfite, and potassium metabisulfite are among the common forms used in foods and medications. Eating and inhaling these compounds can cause allergic reactions, including hives, swelling, cough, and decreased lung function. Reactions can be mild or life-threatening. In addition, sulfites trigger asthma attacks, which is the primary reason that the FDA banned the use of sulfites on raw fruits and vegetables in 1986. Before that time, restaurants, salad bars, and grocery stores commonly used sulfites on lettuce and other raw produce to prevent browning. Since the ban, awareness of sulfite allergies and the compounds' ability to trigger asthma reactions has receded from public knowledge.

Sulfites' contribution to asthma is often unrecognized because most people with asthma do not react immediately after eating foods that contain the preservatives. Nonetheless, sulfites irritate airways in susceptible people, making a reaction to asthma triggers like cold air, exercise, or virus more likely. The Food Intolerance Network website ( contains several comments from readers who found that both coughs and asthma attacks resolved when their children stopped eating products with dried fruits. Dried fruits are frequently treated with sulfites to prevent discoloration.

As with other food allergies, the only way to prevent a reaction is to avoid foods that contain sulfites. Several websites list sulfite-containing foods. Dried fruits (excluding dark raisins and prunes), bottled lemon or lime juices, wine, molasses, sauerkraut, sauerkraut juice, and white and sparkling grape juices have the highest levels. People with asthma or sulfite allergy should also avoid dried potatoes, wine vinegar, gravies/sauces, and fruit toppings. At restaurants, the only potatoes that are likely to be sulfitefree are baked potatoes with the skin intact. Sulfites are also added to some medications. A list is available at

Allergies and sulfite sensitivity [Web page], WebMD. February 5, 2009. Accessed April 2, 2010.

Dengate S. Dangers of dried fruit [Web page], Food Intolerance Network. January2007 [update], Accessed April 2, 2010.

More D. Sulfite allergy [Web page). February 27, 2009. Accessed April 2, 1010.

Sinus Rinses

"Sinus Rinses May Do More Harm Than Good," announced a November 9, 2009, headline at This broad warning arises from a study presented at the American College of Allergy, Asthma & Immunology 2009 Annual Scientific Meeting that looked at sinus irrigation use in people with chronic infections. The study does not refer to the use of sinus rinses and neti pots during allergy season.

The study, led by Georgetown University clinical professor Tala M. Nsouli, MD, was designed to test the hypothesis that "'long-term use of [nasal sinus irrigation] may deplete the nose of its immune blanket of mucus, resulting in recurrent rhinosinusitis.'" Nsouli's team recruited 68 patients with recurrent rhinosinusitis (mean age, 29.3 years) who used nasal irrigation at least twice a day. Nasal irrigation consists of running a warm saline solution into one nostril (with the help of a squirt bottle or a neti pot) and letting the solution drain out of the other nostril. Participants in the Georgetown University study continued to perform nasal irrigation twice a day for one year. During that time, researchers kept track of acute rhinosinusitis events. During the second year, participants were asked to refrain from using nasal irrigation. During the nasal saline irrigation year, the patients had 544 episodes of acute rhinosinusitis (an average of 8 episodes per patient). During the year without nasal irrigation, the patients had 204 episodes of acute rhinosinusitis (an average of 3 episodes per patient): "a statistically significant decrease in frequency of 62.5% (P<.001)." As a control, a parallel group of 24 patients (mean age, 34.2 years) used nasal irrigation daily for 12 months. "[T]he control group's average frequency of RS was 50% higher than that found in the discontinuation group, which was also a statistically significant difference (P<.001)." Nsouli explains that frequent and long-term use of nasal irrigation may be depleting the "good mucus" that contains immune factors while rinsing away the bad.

Despite the headline that seems to blame nasal sinus irrigation for causing sinus infections, Nsouli is more concerned about long-term use of the procedure for treating infections: "'Treating bad mucus with [nasal saline irrigation] for 1 week to 10 days is fine and patients can use it for 6 to 8 weeks after surgery. ... But if the bad mucus is present all the time, it means that that person has an infection and needs to be treated with other medication.'"

The online reports that I found describing this study do not say how rhinosinusitis episodes were determined or whether study participants had a history of infections (which might explain the long-term use). Also, the report on the Georgetown University study does not give any method for monitoring patient compliance during the no-irrigation year. If saline irrigations are helpful for relieving symptoms of chronic rhinosinusitis, as a 2007 Cochrane Database Systematic Review claims, participants may have continued to use saline irrigation periodically. In addition, the type of saline solution--hypotonic, isotonic, or hypertonic--was not defined. The type of solution as well as the frequency of irrigation may be important factors.

While frequent irrigation may reduce the immune defense provided by 'good' mucus, nasal irrigation also promotes clearance of airborne irritants--a definite plus during pollen season. The article "Saline Nasal Irrigation for Upper Respiratory Conditions," published in American Academy of Family Physicians' journal, says, "Saline nasal irrigation may improve nasal mucosa function through several physiologic effects including direct cleansing; removal of inflammatory mediators; and improved mucociliary function, as suggested by increased ciliary beat frequency." The AAFP article refers to two studies that evaluated the effect of daily nasal irrigation on woodworkers exposed to wood dust. The woodworkers "demonstrated significantly improved sinus symptoms, mucociliary clearance, and expiratory nasal flow."

An Italian study tested nasal irrigation with hypertonic solution (three times/day) in a randomized controlled study involving 20 children. The children were allergic to Parietaria, a plant that causes hay fever symptoms for about six weeks in Italy each year. Children using nasal irrigation exhibited significantly less nasal itching, rhinorrea, nasal obstruction, and sneezing during the 3rd, 4th, and 6th weeks of the study. The children also used fewer oral antihistamines.

The American Academy of Family Physicians says: "Contraindications for saline nasal irrigation include incompletely healed facial trauma, because of the potential to leak saline into unwanted tissue planes or spaces; and neurologic or musculoskeletal problems, such as significant intention tremor, that increase the risk of aspiration."

Brauser D. Daily nasal saline irrigation not recommended for long-term use [Web page], Medscape Medical News. November 11, 2009. Accessed March 16, 2010.

Garavello W, Romagnoli M, Sordo L, Gaini RM, et al. Hypersaline nasal irrigation in children with symptomatic seasonal allergic rhinitis: a randomized study. Pediatr Allergy Immunol. 2003;13:140-143. Available at: Accessed March 16, 2010.

Gardner A, Sinus rinses may do more harm than good [Web page]. HealthDay. November 9, 2009. Accessed November 11, 2009.

Harvey R, Hannan SA, Badia L, ScaddingG. Nasal saline irrigations for the symptoms of chronic rhinosinusitis [abstract]. Cochrane Database Syst Rev. July 1 8, 2007; (3):CD006394. Available at: Accessed March 16, 2010.

Kim C-H, Song M H, Ahn Y E, Lee J-G et al. Effect of hypo-, iso-and hypertonic saline irrigation on secretory mucins and morphology of cultured human nasal epithelial cells [abstract]. Acta Oto-laryngologica. 2005; 125(12):1296-1300. Available at: Accessed March 16, 2010.

Rabago D, Zgierska A. Saline nasal irrigation for upper respiratory conditions. Am Fam Physician. November 15, 2009; 80(10): 1117-1119. Available at: Accessed March 16, 2010.

Mayo Clinic Article on Alternative Asthma Treatments has a surprisingly positive article about the use of complementary asthma treatments, including herbs. The article lists several beneficial complementary and alternative medicine treatments, and others that need more research. In its list of "Asthma alternative therapies that may work," Mayo staff includes basic diet and exercise advice, breathing exercises, herbs, and supplements. Three different types of breathing exercises are recommended for people with asthma: Buteyko breathing technique, the Papworth method, and yoga breathing (pranayama). Both Buteyko breathing and the Papworth method use relaxation and breathing exercises to reduce overbreathing, or hyperventilation. The Buteyko approach also includes advice about medication use, nutrition, and general health. Yoga breathing focuses on taking deep, slow and steady breaths. The exhale is usually longer than the inhale.

"Herbal remedies and dietary supplements have been used for thousands for years to treat lung disorders, and are still considered a primary asthma treatment in many countries," say Mayo Clinic staff. Herbs that have shown some promise in treating asthma symptoms include butterbur, dried ivy, ginkgo extract, Tylophora indica, French maritime pine bark extract (Pycnogenol), and Indian frankincense (Boswellia serrata). Traditional Chinese, Indian, and Japanese medicine tend to use herbs in combinations rather than singly. "There's some evidence that certain combinations of herbs are more effective than taking one herb on its own," the Mayo Clinic article explains. Instead of bewailing the lack of herb and supplement regulation, the article points out that concerns about product quality should lessen. The FDA requires that all supplement and herb manufacturers meet good manufacturing practices by June 26, 2010. These measures should improve overall product quality and purity.

Concerns about herbal side effects and possible drug interactions are not a reason to avoid herbs, according to this article. "These concerns don't necessarily mean trying an herbal treatment's a bad idea--you just need to be careful. Talk to your doctor before taking an herbal remedy to make sure it's safe for you." Unfortunately, most doctors have little knowledge about herbs. A 2010 survey of Drug and Therapeutic Bulletin subscribers (primarily physicians) shows that doctors are poorly informed about the use of herbs and most do not know where to get reliable information. Consequently, many conventional doctors simply tell patients not to use herbs.

The asthma therapies "that need more research," according to the Mayo article, are acupuncture, homeopathy, massage, chiropractic, relaxation therapy, and inspiratory muscle training. Inspiratory muscle training uses breathing exercises to strengthen lung muscles. "[L]ack of solid evidence doesn't necessarily mean these treatments don't work," say Mayo staff. "Although they haven't been rigorously tested in a way that proves they're effective, many haven't been proved ineffective either--they simply haven't been investigated thoroughly enough to make a judgment." CAM practitioners have been saying the same thing about nonconventional therapies for years. Bravo, Mayo!

American Botanical Council. Impact of current Good Manufacturing Practices for dietary supplements on small manufacturers. HerbalGram. 2009;84:66-68. Available at: html?lssue-84. Accessed March 23, 2010.

Brunner S. Are doctors knowledgeable about herbal medicines? [Web article] Medical News Today. April 8, 2010. Accessed April 9, 2010

Mayo Clinic. Asthma treatment: Do complementary and alternative approaches work? [Web article] October 2, 2009. Accessed Marcy 16, 2010.

Laughter and Allergies

Impressed by Norman Cousins's use of laughter to reduce his pain stemming from ankylosing spondylitis in the 1970s and by studies showing laughter's ability to reduce cortisol levels (linked to stress) and increase natural killer cell activity, Dr. Madan Kataria decided to start a "Laughter Club" in 1995, at a public park near his home in Mumbai, India. For two weeks, participants told jokes or funny stories during their early-morning meetings. Then, running out of good jokes, participants began sharing hurtful and offensive jokes. The good-feel humor was turning sour. Reviewing the research, Kataria realized: "Our body cannot differentiate between pretend and genuine laughter." Just as our biochemistry responds when we smile--whether or not we have a "reason" to smile--biochemistry responds when we laugh. At the next meeting, Kataria asked participants "to act out laughter" with him for one minute. "Pretend laughter quickly turned into real laughter." The laughter was contagious. The experience showed him that humor is not the only stimulus for laughter. Kataria developed laughter exercises that draw on childlike playfulness and an impulse to laugh that comes straight from the body instead of waiting for the mind to say that something is funny and worth a laugh. Laughter Yoga was born. Information about Laughter Yoga is available at as well as on YouTube.

I am not aware of any clinical studies that show Laughter Yoga's long-term effects; but Japanese studies, performed by Hajime Kimata, MD, PhD, show that feel-good humor can reduce the allergic response. In a 2001 clinical letter to JAMA, Kimata reported that watching an 87-minute Charlie Chaplin comedy reduced allergic patients' response to skin-prick tests with commercial allergen extracts. All 26 patients had atopic dermatitis. In addition, all 26 were allergic to house dust mites; 23 were also allergic to cedar pollen and 21 to cat dander. Wheal responses to dust-mite skin-prick tests significantly reduced in size and incidence after viewing the Chaplin film. Five produced no wheal, according to the graph. Mean wheal diameter before viewing the humorous film was about 11 mm and dropped to 5 mm after the film. The decrease in allergen responsiveness was still present two hours--but not four hours--after the film. Wheal responses to cedar pollen also decreased, from a mean of 8 mm before the film to a mean of 2 mm after. The mean wheals caused by cat dander fell from 7 mm to 2 mm. As a control, Kimata repeated the experiment using dust mite allergen and an 87-minute video featuring weather information. Mean wheal responses taken after viewing this video did not differ much from baseline

In a 2004 crossover study, Kimata exposed 20 people with dust mite-allergic bronchial asthma and 20 healthy participants to methacholine in a baseline bronchial challenge test. Two weeks later, each participant was randomly assigned to watch a humorous film or a nonhumorous one. Immediately after the viewing, all participants were given another bronchial challenge test to methacholine. After another two-week interlude, participants watched the alternate film, followed by another challenge test. Kimata repeated the experiment with 15 epigallocatechin gallate (EGCg)-allergic people and 15 healthy people. (For this experiment, he used EGCg in the bronchial challenge tests.) Bronchial responsiveness significantly decreased in allergic patients after watching the humorous film but not after the nonhumorous film. Neither film produced an effect on bronchial responsiveness in the healthy participants.

Laughter can trigger a cough or other symptoms in children with asthma, according to a 2003 Australian study with 21 children. The study authors view "mirth-triggered asthma" as a sign of "suboptimal asthma control." The researchers are not suggesting that asthma sufferers stop laughing.

Allergy and asthma. Laughter Yoga International. Accessed March 17, 2010.

Concept and philosophy of Laughter Yoga. Laughter Yoga International, Accessed March 17, 2010.

History of Laughter Yoga, Laughter Yoga International. Accessed March 17, 2010.

Kimata H. Effect of humor on allergen-induced wheal reactions [letter]. JAMA. February 14, 2001;285(6):738. Available at; Accessed April 8, 2010

____. Effect of viewing a humorous vs. nonhumorous film on bronchial responsiveness in patients with bronchial asthma [abstract]. Physiol Behav. June 2004:81(4):681-684. Available at: Accessed March 17, 2010.

Liangas G, Morton JR, Henry RL, Mirth-triggered asthma: is laughter really the best medicine? [abstract] Pediatr Pulmonol. August 2003; 36(21:107-112. Available at: Accessed March 17, 2010.

Hypothyroidism and Asthma

Is low thyroid function a significant factor in the rising incidence of asthma and other respiratory disorders? Retired Canadian family physician David Derry accidentally noticed a connection between hypothyroidism and asthma in the mid-1980s. One of his chronic asthma patients reported "considerable" improvement in his asthma after an endocrinologist prescribed Eltroxine (T4) to address thyroid inflammation. Learning of this patient's response, Derry's receptionist, who had asthma since age 12, asked if she could try thyroid too. Keeping her asthma under control required multiple medications and frequent hospital visits. At first, Derry prescribed 180 mg of desiccated thyroid for her, then raised the dose to 250 mg. Her hospital visits due to asthma ended, and medication became an occasional rather than constant need. Gradually, Derry tried the same protocol on his other patients with severe asthma -22 people in all. While not all were totally cured, all of them "improved tremendously," he writes. "By 1990 all asthma patients were on thyroid and thus from 1990 to 2002, I did not see another acute asthma attack in my office and none of these 22 patients came in for their asthma."

Derry, who has a PhD in biochemistry, researched medical literature for reports about asthma and thyroid hormone. He found a 1911 study in which patients at a large French asthma clinic were effectively treated with thyroid hormone. He also found a 1968 study in which asthmatic children improved when given growth hormone and thyroid. Growth hormone got the credit for the improvement. Yet, when radioactive thyroid hormone has been injected in animals, the hormone concentrates in the lungs' air sacs.

Instead of starting with asthma patients, Dr. John C. Lowe, author of The Metabolic Treatment of Fibromyalgia, first worked with hypothyroid patients who had breathing problems. He says that medical literature has many reports of people with hypothyroidism or thyroid hormone resistance who have labored breathing, also known as "air hunger" or dyspnea. Too little thyroid activity causes respiratory muscle and diaphragm weakness, a condition called hypothyroid myopathy. Thyroid hormones also affect the phrenic nerve that regulates diaphragm contractions and the brain centers that regulate breathing. Sleep apnea is a common respiratory disorder in people with hypothyroidism.

On his website, Lowe refers to several studies of thyroid treatment in people with asthma. In a 1991 Egyptian study, 23 asthmatic children were given T3 even though they were not hypothyroid. At the end of 30 treatment days, the researchers reported: "'... an obvious subjective improvement of their asthmatic conditions with a decrease in the number of exacerbations. Seven patients stopped their usual anti-asthmatic medicines, being maintained on T3 only and 3 have decreased the amount of bronchodilators needed. A significant improvement of pulmonary function tests was noted in all patients.'" [Abdel Khalek K et al. J Asthma. 1991;28(6):425-431]. Another study involved hypothyroid children without asthma. In this study, the children were taken off thyroid hormone for a month. "By the end of the month, the children's bronchial tubes became more reactive to antigens," Lowe writes. It took over two and a half months of thyroid treatment before the children's bronchial tubes returned to their normal nonreactive state.

Because of the large number of people who display hypothyroid symptoms yet test negative on conventional tests, alternative and integrative physicians have resorted to trial courses of thyroid supplementation to see how individual patients respond. Lowe suggests using a T4/T3 combination or T3 alone. Other doctors, such as Derry, use desiccated thyroid. Hypothyroidism can occur because the thyroid does not produce enough hormone (T4), the pituitary does not produce enough TSH (the hormone that turns on thyroid production), T4 does not get converted in T3 (a more active form), and cells do not absorb and/or do not utilize T3.

Derry D. Topic; asthma and thyroid hormones [Web article]. Accessed March 16, 2010)

Lowe JC. Air hunger to death: breathing problems of hypothyroid patients [Web article]. February 25, 2005 (updated January 30, 2006). Accessed August 11, 2009.

Wilson L. Causes for thyroid imbalances. In: Nutritional Balancing and Hair Mineral Analysis. 4th ed. Prescott, AZ: Center For Development Inc.; 2010:330-331.

Academy Statement Against Genetically Modified Foods

Could the prevalence of genetically modified (GM) crops in the food supply be a factor in the rise of asthma, allergies, and inflammation? In genetic modification, bioengineers take DNA from one organism and insert it into the DNA of another (usually a different species) to give the recipient new qualities. In the case of GM corn and cotton, bioengineers have inserted pesticide genes from the soil bacterium Bacillus thuringiensis, the source of Bt spray used by organic farmers, into the plants' genomes. GM soy has been engineered to withstand the Monsanto pesticide Roundup. US food manufacturers have used GM soy, corn, and cottonseed oil for over 10 years. Unlike pharmaceutical manufacturers, biotech companies do not have to show that their products are relatively safe. No safety studies were performed before GM entered the US food supply.

"... GM foods pose a serious health risk in the areas of toxicology, allergy and immune function, reproductive health, and metabolic, physiologic and genetic health," says the American Academy of Environmental Medicine (AAEM) in a May 2009 position statement that cites several studies and a report from the Union of Concerned Scientists. Animal studies show that GM crops cause immune dysregulation, including upregulation of cytokines associated with asthma, allergy, and inflammation. GM soy has seven times more trypsin inhibitor, a known allergen, than regular soy; and more people have a positive skin-prick test to GM soy than to regular soy, according to expert Jeffrey M. Smith. Bt cotton farmers in India report severe itching. Sheep and buffalo that graze on the Bt plants after cotton harvests have died. The dead animals had signs of severe irritation and black patches in their intestines and livers, indicative of toxin exposure. Laboratory studies of animals fed GM foods show intestinal damage and disruption of the intestinal immune system. Other documented effects of GM crops on animals include altered lipid and carbohydrate metabolism; infertility; and changes in the liver, kidney, pancreas, and spleen and in genetic expression. Genetic expression of over 400 genes changed in mice eating Bt corn, according to a 2008 long-term study cited by the AAEM: "These are genes known to control protein synthesis and modification, cell signaling, cholesterol synthesis, and insulin regulation."

Because GM foods have produced so many negative effects in animal studies, the AAEM urges physicians to be open to the possibility that GM food may be a contributing factor in their patients' ill health. The AAEM asks that doctors begin to document changes in patients' condition (if any) that occur when they stop eating GM food. The organization wants to compile case studies as a first step toward large-scale epidemiological research.

The AAEM also asks its members to educate patients, colleagues, and the public about how to avoid GM food. Buying organic is the first tactic, since certified organic products cannot use GM ingredients. Avoiding processed foods that contain nonorganic corn, soy, canola, and cottonseed is the second tactic. Unless they are certified organic, these crops are now primarily GM strains. Genetically modified beet sugar and Hawaiian papaya are also on the market. A shopping guide is available at

American Academy of Environmental Medicine. Genetically modified foods [Web article]. May 8, 2009. Accessed January 3, 2010.

How to avoid brands made with genetically modified organisms (GMOs) [Web article]. Non-GMO Shopping Guide. Accessed March 16, 2010.

Smith JM. Doctors warn: avoid genetically modified food [Web press release]. May 20, 2009. Institute for Responsible Technology. Accessed June 12, 2009.

New FDA Safety Controls for Long-Acting Beta Agonists

The US Food and Drug Administration issued new safety controls for long-acting beta agonists (LABA) on February 18, 2010, in an attempt to reduce their use. These drugs relax bronchial smooth muscles and are used to treat asthma and COPD (chronic obstructive pulmonary disease). Asthma patients who take LABAs have an increased risk of severe, even life-threatening, asthma symptoms, according to FDA analyses of clinical trials. As a result, the agency says: "LABAs should be used for the shortest duration of time required to achieve control of asthma symptoms and discontinued if possible, once asthma control is achieved. Patients should then be maintained on an asthma controller medication."

Single-agent LABAs, such as Serevent and Foradil, should never be used in asthma patients of any age without concurrent use of an asthma controller medication such as an inhaled corticosteroid. To assure compliance, adolescents and children should take combination drugs like Advair and Symbicort that contain long-acting beta agonists and corticosteroids. Whether an asthma controller medication truly lessens the risk posed by long-acting beta agonists is uncertain. Drug manufacturers will now be required to study the effect of combination LABA use, according to the FDA News Release.

More information is available at

Associated Press. Warning issued on 4 widely used asthma drugs. 18, 2010. Available at: Accessed February 18, 2010.

US Food and Drug Administration. FDA announces new safety controls for long-acting beta agonists, medications used to treat asthma [press release]. February 18, 2010. Available at; Accessed March 7, 2010.


briefed by Jule Klotter
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Title Annotation:allergies
Author:Klotter, Jule
Publication:Townsend Letter
Geographic Code:1USA
Date:Jun 1, 2010
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