Asthma in September

Asthma sufferers know that when it rains it spores - as fungi and mold get moving through the air. But many don't realize that the most dangerous month for children's asthma symptoms is dry September.

A study of hospital data in New York City found the spike in admissions in two to three weeks after the return to school. Additional New York studies indicated that cold and dry weather in autumn mostly increased admissions in the school-aged population (<18), while hot and dry weather in the summer caused spikes in asthma admissions across all ages. Doctor visits increase every September in many Northern Hemisphere countries. It happens in the United States, the United Kingdom, Mexico, Israel, Finland, Trinidad, and Canada, where 20% to 25% of all childhood asthma exacerbations requiring hospitalization have occurred in September.

Asthma hospitalizations in children 2-15 years in Canada

As students return to school, they are exposed to an increased number of indoor allergens, irritants and health risks. The "flu season" is approaching, weed pollen is not over yet, and indoor air is filled with pests, mold,
dust mites, animal dander, chalk
dust, cleaning agents, scented and unscented
personal care products and fumes.

So what can you do to manage asthma at school? Home environment is easier to control, but if you know your triggers, you can develop a plan - like asking teachers that pet animals with fur and feathers are not kept inside classrooms, dry-erase boards or " dustless" chalk are used instead of regular chalk and making sure that kids with asthma have reliable friends that can support them. 

REFERENCES

Sears MR, & Johnston NW (2007). Understanding the September asthma epidemic. The Journal of allergy and clinical immunology, 120 (3), 526-9 PMID: 17658590

Lin S, Jones R, Liu X, & Hwang SA (2011). Impact of the return to school on childhood asthma burden in New York State. International journal of occupational and environmental health, 17 (1), 9-16 PMID: 21344814

Lee CC, Sheridan SC, & Lin S (2012). Relating weather types to asthma-related hospital admissions in New York State. EcoHealth, 9 (4), 427-39 PMID: 23224756

Choi IS, Lee SS, Myeong E, Lee JW, Kim WJ, Jin J. (2013) Seasonal variation in skin sensitivity to aeroallergens. Allergy Asthma Immunol Res. 2013 Sep;5(5):301-8. doi: 10.4168/aair.2013.5.5.301.

Bates DV, Baker-Anderson M, Sizto R. (1990) Asthma attack periodicity: a  study of hospital emergency visits in Vancouver. Environ Res 1990; 51:51-70.

Weiss KB. Strachan D, Hansell A, Hollowell J, McNiece R, Nichols T, Anderson HR, et al. (1999) Collation and comparison of data on respiratory disease. Report to the Department of Health, August 1999.

Rosas I, McCartney HA, Payne RW, Calderon C, Lacey J, Chapela R, et al. Analysis of the relationships between environmental factors (aeroallergens, air pollution, and weather) and asthma emergency admis­sions to a hospital in Mexico City. Allergy 1998;53:394-401.

Garty BZ, Kosman E, Ganor E, Berger V, Garty L, Wietzen T, et al. Emergency room visits of asthmatic children, relation to air pollution, weather, and airborne allergens. Ann Allergy Asthma Immunol 1998; 81:563-70.

Harju T, Keistinen T, Tuuoponen T, Kivela S-L. Seasonal variation in childhood asthma hospitalizations in Finland, 1972-1992. Eur J Pediatr. 1997;156:436-9.

Monteil MA, Juman S, Hassanally R, Williams KP, Pierre L, Rahaman M, et al. Descriptive epidemiology of asthma in Trinidad, West Indies. J Asthma 2000;37:677-84.

The Hazards of Working Nights: for breasts and beyond

The jury is still out whether Angelina's choice is brave or fearful, but the fact remains: having or not having the "bad" genes is not enough to develop or avoid developing breast cancer. As a matter of fact, only 5% to 10% of breast cancer cases result directly from inherited gene defects. Check it yourself, by using this decision tool developed in Stanford.  Even though for members of some families with BRCA mutations the risk may be as high as 80%, this could be because of environmental exposures and behavioral habits "running in the family". What are they?

Among the controllable risk factors are hormone therapy, birth control pills, drugs (like DES discontinued in the 70s), the use of alcohol (if 2 or more drinks per day), heavy smoking since early age, gaining weight after menopause, exercising less than 1-2 hours per week,  certain cosmetics and personal care products, pesticides (such as DDE), PCBs (polychlorinated biphenyls) and other environmental exposures.


One of such exposures is working at night. And Kristan Aronson's team from Queen's University showed that the risk is not limited to nurses, as in most previous studies.


The study examined over 1000 breast cancer cases vs about the same number of healthy cases, matched by age in Vancouver, British Columbia and Kingston, Ontario.  It found that breast cancer risk was twice higher with 30-plus years of night-shift work versus people that did not have night-shift jobs. The risk is more than three times higher for those working at nights in the health care field. But people working at nights or having rotating schedules for shorter duration of time seem to be unaffected.

Why would staying awake after dark for many years be hazardous to health? Perhaps because of the lack of Melatonin. This hormone is produced naturally by our brains when lights go out, to make us less alert and prepare us for sleep. The more daylight exposure versus night time darkness, the better. Melatonin might help the body in many different ways - for example, by downregulating some of the hormones influencing tumor growth or by exhibiting anti-oxidant and immuno-enhancing properties.
Night shifts are also associated with increased stress and a plethora of health conditions as seen from the number of sick leaves people take, periodontal index (measure of oral health), glucose tolerance, number of heart attacks and strokes, cases of IBS and internal cancers. Actually, night time work was shown to increase the risk of cancers even more than exposure to exhaust fumes.

But this is all statistics. Individual cases can certainly break the mold. Yet, it's summer, so let's make the most of natural light.

REFERENCES

Grundy A, Richardson H, Burstyn I, Lohrisch C, Sengupta SK, Lai AS, Lee D, Spinelli JJ, & Aronson KJ (2013). Increased risk of breast cancer associated with long-term shift work in Canada. Occupational and environmental medicine PMID: 23817841

Hansen J, Lassen CF Nested case-control study of night shift work and breast cancer risk among women in the Danish military Occup Environ Med 2012; DOI: 10.1136/oemed-2011-100240.

M S Wolff and A Weston. Breast cancer risk and environmental exposures. Environ Health Perspect. 1997 June; 105(Suppl 4): 891–896. PMCID: PMC1470027

Madigan MP, Ziegler RG, Benichou J, Byrne C, Hoover RN. Proportion of breast cancer cases in the United States explained by well-established risk factors. J Natl Cancer Inst. 1995 Nov 15;87(22):1681–1685.

Blood and Taxes

Nothing is certain, but blood pressure does increase in the end of  winter and beginning of spring. According to Aurametrix users and google statistics. As a matter of fact, it highly correlates with tax fever - as found by Google Correlate algorithm comparing millions of web queries  - see the figure on the right with searches for property taxes shown in red. Or check it yourself!

But the reason for raising blood pressure is not always taxes. Seasonal variation in blood pressure was noticed and described more than 50 years ago and was connected to periods of decreasing outdoor temperature. It happens to healthy individuals and those who suffer from high blood pressure, especially in the elderly.

The figure shows fluctuations in blood pressure observed by French researchers in a large study of 9294 65+ old residents of Bordeaux, Dijon, and Montpellier. Both systolic and diastolic parts of blood pressure as well as heart rate measurements significantly differed across the seasons with a clear trend for increase in colder months. And decreases following warmer weather - the higher the temperature, the larger the blood pressure decreases. Changes in blood pressure relative to outdoor temperature were largest in the elderly (80+ years old).  On average, for a 15°C decrease in outdoor temperature, Systolic blood pressure (SBP) increased 0.8 mm Hg in those aged 65 to 74 years compared with 5.1 mm Hg in the oldest group (≥80 years). For a 15°C increase in temperature, SBP decreased 9.9 mm Hg in the youngest group vs 13.8 mm Hg in those 80 years or older. Winter increases in blood pressure did not seem to be caused by increased alcohol consumption and decreased activity. Neither were they dependent on the indoor temperatures - spending over 12 hours in warm rooms did not help.

The inverse correlation of blood pressure and outdoor temperature is even stronger for "apparent temperature"- aka the perceived coldness derived from the combination of temperature and wind. And it was observed all over the world - as documented in studies performed in US, Denmark, China, Japan... Possible explanations include direct thermoregulation-mediated vasoconstriction, hypothalamic-pituitary-adrenocortical axis (HPAA) and sympathetic nervous system (SNS) activation, sodium/volume retention and impaired endothelial-dependent vasodilatation.  Reduced sleep duration or quality could be also contributing.

Environmental hypertensionology is a very young science. Many things in our environment can cause high blood pressure. The exact mechanisms are not well understood, but systems like Aurametrix could utilize the wealth of empirical evidence and use it for prediction and prevention.

The high blood pressure season is almost over. Fortunately, many critically ill people made it through and, hopefully, learned more. Let's gear up to make the next time easier.

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REFERENCES

Alpérovitch, A. (2009). Relationship Between Blood Pressure and Outdoor Temperature in a Large Sample of Elderly IndividualsThe Three-City Study Archives of Internal Medicine, 169 (1) DOI: 10.1001/archinternmed.2008.512

Halonen, J., Zanobetti, A., Sparrow, D., Vokonas, P., & Schwartz, J. (2010). Relationship between outdoor temperature and blood pressure Occupational and Environmental Medicine, 68 (4), 296-301 DOI: 10.1136/oem.2010.056507

Brook RD, Weder AB, & Rajagopalan S (2011). "Environmental hypertensionology" the effects of environmental factors on blood pressure in clinical practice and research. Journal of clinical hypertension (Greenwich, Conn.), 13 (11), 836-42 PMID: 22051429

Will you get the flu this season?

Worst of flu season may be over. But you can still catch a chill. If you shake hands with lots of sick people, for example. Or don't keep sufficiently warm. Yes, your mother has told you, and you thought it was just an old wives' tale, but it wasn't. Scientists (Johnson and Eccles, 2005) provide evidence that cold exposure may induce cold symptoms without any contact to sick individuals. As we all carry dormant (sub-clinical) infections in our nose, genitals and other parts of the body, and these viruses may get reactivated. Ever noticed the need to blow nose after spending some time in cold air? Your body might be trying to expel the waking-up microbes.

Emerging health analysis software tools like Aurametrix aim at keeping us healthy by warning about symptoms and diseases. Prolonged exposure to cold means that 4-5 days after the exposure there is 10% probability of developing nasal stuffiness, sneezing, throat irritation of mild fever. 10% if Aurametrix knows nothing else about you. Higher if you are in the most vulnerable age & health conditions group, have a history of more frequent cold infections in prior years or were recently exposed to other stressors. Aurametrix can draw additional conclusions from looking at ingredients in your diet and chemicals in your environment.  Medical records could add another thousand variables. Medical codes given to every documented complaint, prior medications, procedures, information about attending doctors and payments were shown to help predict C.difficile infections in hospitals using machine learning (Wiens, Guttag, Horvitz, 2012).

Social media (in addition to notifications by official sources) keeps us more aware and more afraid of the flu. But what if we are not able to keep away from exposure to a virus, forgot to clean our hands and could not avoid a non-ventilated area with sneezing sick people? The good news is that if we did everything else right we have a fighting chance. As it was shown in a scientific study (Huang et al., 2011), only 9 out of 17 healthy human volunteers exposed to H3N2 virus developed mild to severe symptoms.

So be happy to be healthy, in addition to doing your best to stay flu-free.

Image Credits: Allison Morris, OnlineEducation.net  

REFERENCES

Johnson C, & Eccles R (2005). Acute cooling of the feet and the onset of common cold symptoms. Family practice, 22 (6), 608-13 PMID: 16286463

Jankowski R, Philip G, Togias A, Naclerio R. Demonstration of bilateral cholinergic secretory response after unilateral nasal cold, dry air challenge. Rhinology 1993; 31: 97-100

J. Wiens, J. Guttag, E. Horvitz. Learning Evolving Patient Risk Processes for C. Diff Colonization, Machine Learning for Clinical Data Analysis, ICML 2012, Edinburgh, Scotland, June 2012.

Huang Y, Zaas AK, Rao A, Dobigeon N, Woolf PJ, Veldman T, Øien NC, McClain MT, Varkey JB, Nicholson B, Carin L, Kingsmore S, Woods CW, Ginsburg GS, & Hero AO 3rd (2011). Temporal dynamics of host molecular responses differentiate symptomatic and asymptomatic influenza a infection. PLoS genetics, 7 (8) PMID: 21901105

On Apples and Trees

An apple doesn't fall far from the tree. So if you don't like apples, trees won't like you either. And the other way around.

If your mother ate apples during pregnancy, she might have protected you from asthma. And if you like apple juice, this might help you avoid chronic wheezing issues.

 

Research has already proven these and many similar connections. Now a new study suggests that eating apples could also help you cope with seasonal allergies - particularly with allergies to birch pollen. And vice versa - a birch pollen therapy can help you tolerate apples.

Allergies affect many people in westernized countries. 10-15% of the population in North America and Europe suffer from immediate allergic reactions (type I), and birch pollen is a considerable cause of seasonal allergies. Its major allergen Betv 1  (responsible for more than 95% of allergies to birch pollen) can cross-react with Mal d 1 - the main allergen in apple. Thus during the pollination season, people sensitive to birch also might be sensitive to apples. But as Swiss and Slovenian scientists showed this year, just a piece of apple - 1-128 grams per day can help Birch-sensitive individuals to prepare for the allergy season. And it can increase their tolerance to apples - to the extent they can eat an entire apple per day after the treatment. Unfortunately, subsequently cutting apple intake means that birch allergies will return. 


Another recent study by Japanese allergists showed that injections of birch, ragweed and cedar pollen helped a highly allergic person tolerate apples. She could increase her intake from 3 grams (which is a tiny piece the size of half of a grape) to 50 grams, which is almost a half of an apple!  Allergy symptoms to most other fruits and vegetables also improved or disappeared. 

What is your relationship with apples and trees? Aurametrix can help you track your food sensitivities along with seasonal allergies, finding what combinations and amounts are right for you.


REFERENCES

Kopac P, Rudin M, Gentinetta T, Gerber R, Pichler Ch, Hausmann O, Schnyder B, & Pichler WJ (2012). Continuous apple consumption induces oral tolerance in birch-pollen-associated apple allergy. Allergy, 67 (2), 280-5 PMID: 22070352


Okamoto Y, & Kurihara K (2012). [A case of oral allergy syndrome whose symptoms were dramatically improved after rush subcutaneous injection immunotherapy with pollen extracts of birch]. Arerugi = [Allergy], 61 (5), 652-8 PMID: 22705787

Okoko BJ, Burney PG, Newson RB, Potts JF, Shaheen SO. Childhood asthma and fruit consumption. Eur Respir J. 2007 Jun;29(6):1161-8. Epub 2007 Feb 14.   


Miyake Y, Sasaki S, Tanaka K, Hirota Y. SAllergy. 2010 Jun 1;65(6):758-65. Epub 2010 Jan 22. Consumption of vegetables, fruit, and antioxidants during pregnancy and wheeze and eczema in infants.  

Hokkaido Igaku Zasshi. 1994 Nov;69(6):1409-26. [Clinical and immunological analysis of Birch pollenosis]. [Article in Japanese] Takagi S. Source Department of Otorhinolaryngology, Hokkaido University School of Medicine, Sapporo, Japan.

Seasonal Allergies in Japan

Japan belongs to the temperate zone with four distinct seasons, and has six principal climatic zones: Hokkaidō (北海道) with long, cold winters and cool summers; Central Highland (中央高地) with typical inland climate and large temperature differences between summers and winters and between days and nights; Seto Inland Sea (瀬戸内海): with mild climate; Pacific Ocean (太平洋): with cold rainy winters and hot humid summers;  Ryukyu Islands (南西諸) with warm rainy winters and hot humid summers. Heat and high humidity can lead to possible food poisoning, fatigue and heat stroke.

More than 5,000 species of plants find home in these diverse climatic conditions and more than 60 types produce pollen that can cause allergic reactions. In Tokyo, common allergy-causing plants and their pollen seasons are as follows:

Japanese cedar sugi (February - April)

Japanese cypress hinoki (mid March - early May)

Rice plant ine (May - mid July / mid August - mid October)

Ragweed butakusa (mid August - October)

Artemisia yomogi (mid August - October)

Japanese Cedar is one of the major causes of seasonal allergic rhinitis and seasonal allergic conjunctivitis (itchy eyes). Its pollen is one of the most potent known and may cause severe symptoms. In Tokyo, about one in 3.5 people is believed to suffer from sugi allergy. The Japanese cedar pollen is present from approximately the end of January until the beginning of April on the north island and mid-April until early May on the south island. The cypress tree flowers a little later than that of the cedar tree and could also contribute to allergies. The pollination of Ragweed begins in late summer, around August, but its impact is less significant than in North America. 

January

February

March

April

May

June

July

August

September

October

November

December

Trees

Grasses

Weeds

See this site by Allergy Research Group, Department of Otorhinolaryngolgy, Jikei Medical School, for more information. Or sign up for Aurametrix and start analyzing your allergies - to control them wherever you go.

More apps, less flu?

Fewer people caught the flu this season compared with  past years. And many more apps tracking the flu have been developed.  Any relationship between these two trends?

Of course, less flu could be just the result of fewer mutations in bugs, warmer weather and more vaccinations. Yet the power of good software - such as google flu trends, twitter-based trackers and numerous apps can not be underestimated. Thanks to these tools, we are now more aware (and more afraid).

The flu is inherently social. "Nip the flu in the bud by spreading information, not germs, through the social network", says Flu Alert app. and lets you sort your friends by their flu exposures. Virtual flu in Fluville is promoting healthy habits by showing how flu can spread. Fluspotter let's you exchange warnings with your facebook friends, Flutracking reads your e-mails, while Influ takes your voice messages and shares it with users around the world. Biodisapora is tracking disease outbreaks by monitoring air travel. Sickweather scans Twitter and Facebook posts, and Germtrax lets you also sync with Foursquare and Google+  to geo-locate your wereabouts while being sick - with one of 6067 sicknesses available in their database.

According to multiple research studies, flu-related Internet searches, use of certain phrases on Twitter and Facebook posts peak 1-2 weeks earlier than the epidemic curve and align reasonably well with CDC data.

Social media is a noisy but powerful adjunct to surveillance systems based on official sources. It gives us an opportunity of contributing to the community's common good. It raises our awareness, but is not sufficient on its own. Many other factors increase our individual risks. Air travel. Or stress (haven't you noticed flu season in Greece was the worst in the world this year?) Age and food, too.

Aurametrix is a personal health analysis system that tackles this problem with an integrative approach. It aligns your medical history and historical CDC information with your food, mood and amount of sleep. It  looks at all environmental predictions for today telling you if pollen, mold spores or air quality are more likely to be the reason for your symptoms, or if it is the rise in infectious diseases in your area. Aurametrix relies on a range of official sources and social media predictions. The data are constantly updated and refined, and causes linked with effects.

REFERENCES

Dugas, A., Hsieh, Y., Levin, S., Pines, J., Mareiniss, D., Mohareb, A., Gaydos, C., Perl, T., & Rothman, R. (2012). Google Flu Trends: Correlation With Emergency Department Influenza Rates and Crowding Metrics Clinical Infectious Diseases, 54 (4), 463-469 DOI: 10.1093/cid/cir883

Manago, Adriana M., Taylor, T., Greenfield, P.M. Me and my 400 friends: The anatomy of college students' Facebook networks, their communication patterns, and well-being. (2012) Developmental Psychology, Jan 30. doi: 10.1037/a0026338

Signorini A, Segre AM, Polgreen PM. The use of Twitter to track levels of disease activity and public concern in the U.S. during the influenza A H1N1 pandemic. PLoS One. 2011 May 4;6(5):e19467. PMID: 21573238

Ginsberg J, et al. Detecting influenza epidemics using search engine query data. (2009) Nature 457, 1012–1014.

Ortiz JR, et al. Monitoring influenza activity in the United States: A comparison of traditional surveillance systems with Google Flu Trends. PLoS ONE 6(4):e18687. 2011.

Christakis NA, et al. Social network sensors for early detection of contagious outbreaks. PLoS ONE 5(9):e12948. 2010.

Malik MT, Gumel A, Thompson LH, Strome T, Mahmud SM. "Google flu trends" and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba. Can J Public Health. 2011 Jul-Aug;102(4):294-7. PMID: 21913587

Collier N, Son NT, Nguyen NM. OMG U got flu? Analysis of shared health messages for bio-surveillance. J Biomed Semantics. 2011 Oct 6;2 Suppl 5:S9. PMID: 22166368

Basak P. Development of an online tool for public health: the European Public Health Law Network.
Public Health. 2011 Sep;125(9):600-3. Epub 2011 Aug 23. PMID: 21864871

Chew C, Eysenbach G. Pandemics in the age of Twitter: content analysis of Tweets during the 2009 H1N1 outbreak. PLoS One. 2010 Nov 29;5(11):e14118. PMID: 21124761

Scanfeld D, Scanfeld V, Larson EL. Dissemination of health information through social networks: twitter and antibiotics. Am J Infect Control. 2010 Apr;38(3):182-8. PMID: 20347636

Eysenbach G. Infodemiology and infoveillance: framework for an emerging set of public health informatics methods to analyze search, communication and publication behavior on the Internet. J Med Internet Res. 2009 Mar 27;11(1):e11. PMID: 19329408