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Archive for the ‘Allergies/Cold’ Category

 

Can Exercising Every Day Keep Your Allergy Symptoms Away?

Friday, November 13th, 2015

By Nicholas Rudy, PharmD Student Cedarville University School of Pharmacy

Recently, many magazines and online publishers have written articles indicating the benefit of exercise in the alleviation of allergy symptoms. The website Total Gym Pulse reports that the American Academy for Allergy, Asthma and Immunology (AAAAI) indicates warm-up exercises can improve allergy symptoms.1 According to the site, a blood-pumping workout promotes the removal the allergen from the body.1 Additionally, Total Gym Pulse along with Fitness Magazine propose that exercise relieves allergy-related congestion by reducing swelling in the nose.1, 2 While the use of warm-up exercises are approved for the control of allergy symptoms by AAAAI, there is insufficient clinical evidence to conclude that moderate to intense exercise is directly linked to allergy symptom relief.

However, the adverse effects of exercising outside with airborne, outdoor allergies are clear. A 2010 study found that those with airborne allergies (i.e. pollen) had increased levels of IgE after exercising outside.3 IgE is a type of antibody that plays a key role in allergic reactions. Accordingly, increased levels of IgE are indicative of a heightened allergic response. Yet, the study stated that further evidence is needed to form a conclusive connection between airborne allergies and exercise.3 Similarly, the International Forum of Allergy and Rhinology published a study on the differences in nasal obstruction between seasonal allergy sufferers and healthy patients after exercise. Children who had an allergy to pollen were compared to children who did not during a time outside of pollen season. No child had obstructed nasal passages at the beginning of an exercise challenge. By the end of the challenge, children with a pollen allergy had greater nasal obstruction than children without the allergy.4 But again, further evidence is required to link airborne, outdoor allergies to exercise.

But don’t be discouraged, allergy sufferers! Exercising, regardless of the benefits, does not have to be an uncomfortable burden during allergy season. In fact, there are many credible suggestions for managing your symptoms in order to achieve a great workout. So don’t let that stuffy nose, sneezing or those itchy, watery eyes get in the way of staying fit during allergy season!

First, be sure to take your allergy medication as prescribed. It is hard to focus on exercising when allergy symptoms feel unbearable. Using your medication as prescribed can relieve the nasal congestion associated with allergies that makes exercising difficult.5  Breathe through the nose as much as possible. Your nasal passages are designed to function as humidifiers and filters. They warm and moisten air while stopping allergens and other irritants.5

Be strategic about where you workout! If exercising outdoors with an airborne allergy, choose a time and location to minimize exposure to allergens. The pollen count tends to be highest in the morning and early afternoon. Avoid areas with lots of trees and fields as these areas may exacerbate your symptoms.5

Set an intensity that feels right for you. You can best determine what your body can handle. Take into account the severity of your symptoms and the activeness of your lifestyle. Start your aerobic workout off slow and gradually build intensity to avoid exhaustion.6  

Don’t forget the warm-up! Like the AAAAI, the American College of Sports Medicine (ACSM) claims that a low-intensity warm-up may help relieve allergy symptoms. The ACSM suggests that a warm-up lets the lungs adjust to a new environment and reduces the chances of inflammation, thus making breathing easier and exercising in allergy season more bearable.6

Perhaps most importantly, talk to your doctor about your specific allergies, how they might affect your workout and what adjustments you can make.

There is no reason to fear, allergy sufferers! Your symptoms can be controlled. If you keep taking your allergy medications, working out at your own pace and minimizing your exposure to allergens, you’ll be more comfortable during your workout! Though no definitive connection between exercise and allergy relief is currently available, exercise is good for your health. There is no need to let allergy season crumble your determination to stay fit and be healthy!

References

  1. Salada L. Fighting allergies and asthma with exercise. Total Gym Pulse Web site. http://www.totalgymdirect.com/total-gym-blog/working-out-allergies/. Published March 20, 2014.
  1. Greenfield P. 5 seasonal allergy remedies. Fitness Magazine Web site. http://www.fitnessmagazine.com/health/conditions/allergies/seasonal-allergy-remedies/. Published May, 2011.
  1. Aldred S, Love JA, Tonks LA, Stephens E, Jones DS, Blannin AK. The effect of steady state exercise on circulating human IgE and IgG in young healthy volunteers with known allergy. Journal of Science and Medicine in Sport. 2010;13(1):16-19.
  1. Harmancı K, Urhan B, Anıl H, Kocak A. Nasal and bronchial response to exercise in children with seasonal allergic rhinitis out of the pollen season. International Forum of Allergy & Rhinology. 2015;5(2):143-148.
  1. Sorace P. Exercising with allergies and asthma. ACSM Fit Society Page. 2014;16(2):4-5.
  1. Briner W. Action plan for allergies. Champaign, IL: Human Kinetics; 2007.

Lather, Rinse, and Repeat

Tuesday, December 2nd, 2014

By Logan Conkey, PharmD Student

Students are in the swing of things now that fall has begun. Students are at a higher risk of spreading sickness to others because of the environment they are in.  October is here and this month initiates flu season as well as a time where more illness is being shared.1 To prevent the spread of illness, the CDC recommends cleaning hands frequently, including after using the restroom.2 Many people do not like to wash their hands and a survey reported by the American Society for Microbiology reported 1 in 5 teenagers and adults claimed they do not wash their hands after they use the restroom.3 With so many germs being passed around, students often become sick and have to miss school. Recently, a group of researchers in New Zealand wanted to see if there was a relationship between the amount of school days missed due to illness and hand hygiene that included hand sanitizer combined with normal and frequent hand washing.

CNN Health published the article; Hand sanitizer doesn’t help in schools in August this year.4 The article was based on a study that took place in elementary classrooms in New Zealand and compared students who hand washed only and students using alcohol based hand sanitizer along with normal hand washing. All classrooms were taught proper washing techniques to ensure a standard practice and the alcohol sanitizer was provided to make certain it was the same strength throughout. The trial was conducted in 68 elementary schools, during the winter term, with children ages 5-11 The control group was instructed only to use regular hand washing with soap and water when cleaning their hands. The intervention group was instructed to wash their hands with soap and water and include the use of an alcohol-based sanitizer after they coughed, sneezed, and before meals. The outcome was to be determined by comparing the amount of total days students missed due to illness only. The results suggested there was not a significant difference between the groups regarding total days missed. The study did not look at specific illnesses such as flu when collecting data and the study may have been limited because there was a flu epidemic during this season. Another limitation included parental direction and whether the parents were instructing students to differ from the provided procedure. Some students also complained about the taste of the sanitizer on their hands when eating and this believed to have made the children less compliant when using it. The complaints came from a handful of schools and the sanitizer was replaced with an equivalent.5

The CDC says hand washing with soap should be the first option and hand sanitizer should be used if soap and water are not available. Alcohol-based sanitizers do not eliminate all forms of germs.6 It is confirmed that proper hand washing and/or the use of alcohol-based hand sanitizers has shown to reduce the risk of infection from certain viruses.7 Alcohol based sanitizers must be strong enough to be effective. Not all sanitizers are created the same and the recommended strength should be at least 60%.8 Other studies performed in the classroom regarding the used of alcohol based hand sanitizers has not persuaded researchers to consider them beneficial enough to place high priority on them and that hand hygiene education is the largest benefactor.9

The study performed in New Zealand provides proof we should not be putting a high priority on placing alcohol-based hand sanitizer in classrooms. Parents should encourage proper hand hygiene and instruct children when the most important times are to wash hands. If hand washing is not an option then hand sanitizer is a good second choice. While there does not seem to be a great benefit to sanitizer in the classroom, there have been no reported risks or problems with using it. The parent or teacher must decide if they want to incorporate sanitizer. There is no way of eliminating illness in children but parents and teachers can work together to improve the health of the classroom.

Are you and your students taking the proper precautions to prevent sickness?

 

References

  1. The Flu Season. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  2. Preventing Seasonal Flu Illness. CDC Website. Available at: http://www.cdc.gov/flu/about/qa/preventing.htm. Accessed October 3, 2014.
  3. Hand Sanitizer doesn’t help in schools. CNN Health Website. Available at: http://thechart.blogs.cnn.com/2014/08/12/hand-sanitizer-doesnt-help-in-schools/?iref=allsearch. Accessed October 3, 2014.
  4. Bratsis M. Flu Season: The Best Defense. Science Teacher [serial online]. October 2012;79(7):68. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  5. Priest P, McKenzie J, Audas R, Poore M, Brunton C, Reeves L. Hand Sanitiser Provision for Reducing Illness Absences in Primary School Children: A Cluster Randomised Trial. Plos Medicine [serial online]. August 2014;11(8):1-14. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.
  6. When & How to Wash Your Hands. CDC Website. Available at: http://www.cdc.gov/handwashing/when-how-handwashing.html. Accessed October 3, 2014.
  7. Prazuck T, Compte-nguyen G, Pelat C, Sunder S, Blanchon T. Reducing gastroenteritis occurrences and their consequences in elementary schools with alcohol-based hand sanitizers. Pediatr Infect Dis J. 2010;29(11):994-8.
  8. Roy K. Rethinking the use of hand sanitizers. Science Scope [serial online]. September 2009;33(1):74-76. Available from: Education Research Complete, Ipswich, MA. Accessed October 3, 2014.
  9. Meadows E, Le Saux N. A systematic review of the effectiveness of antimicrobial rinse-free hand sanitizers for prevention of illness-related absenteeism in elementary school children. BMC Public Health [serial online]. January 2004;4:50-11. Available from: Academic Search Complete, Ipswich, MA. Accessed October 3, 2014.

Flush Out Your Child’s Allergies!

Thursday, November 20th, 2014

By Kelly Huston, Pharm.D. Student.

Got allergies? Is your child sneezing and/or have a stuffy, itchy, or runny nose? Flushing the nose out with a saltwater solution may provide some relief. Allergies are the body’s response to a substance that causes these symptoms.1 Because germs can contribute to allergy symptoms, flushing the nose could help by removing germs and by increasing the nose lining’s ability to stop germs from entering the body.2,3 Parents are looking for a simple solution to relieve their children’s allergic symptoms. Rinsing the nose out with a saltwater solution may be the answer they are hoping for.

Currently, self-treating allergies in children less than twelve years old is only appropriate if they have been seen by the doctor. However, if the child is twelve years or older, self-care is appropriate without first seeing the doctor. The best way to treat allergy symptoms in children is to avoid the cause of the allergic reaction. If the child cannot avoid the cause of the reaction, a second option to try before using medications is to flush the nose out with a saltwater solution. If medication is necessary, remember that choosing the medicine focused on relieving your child’s main symptom(s) can greatly help.1

An article published in June 2014 entitled, The Effectiveness of Nasal Saline (seawater) Irrigation in Treatment of Allergic Rhinitis in Children, looked at how effective flushing out the nose with a saltwater solution is at reducing allergy symptoms. The study consisted of sixty-one children between the ages of two and fifteen who were diagnosed with allergies. The individuals were randomly placed in three groups to look at how well fluticasone propionate (a steroid-medication used in the nose), nasal rinsing, and a combination of both methods relieved the symptoms of allergies. The study looked at the ability of each of the three treatments to reduce the symptoms of itchy nose, runny nose, blocked nose, and sneezing. The researchers found that flushing the nose out twice a day had no side effects among any of the children, improved all of the children’s symptoms after three months, and was effective when combined with the nasal medication. They discovered that both flushing out the nose and using the nasal medication caused the children’s symptoms to improve more at four, eight, and twelve weeks, compared to each method done individually. Using both methods made it possible to reduce the amount of medication used to treat the allergies. Using a larger amount of the nasal medication can be costly, but flushing the nose out in combination with this medication may lead to a decrease in the cost of treating allergies. These findings reinforce the idea that flushing out the nose with saltwater can effectively relieve the symptoms of allergies. However, this study is limited. A good scientific study will include a group (called the control group) that does not receive any type of treatment in order to see if the treatment that the other group is receiving is really as good as the researchers think it will be. This study did not have a control group. Another limit of the study was that it only looked at one nasal medication and did not look at other medications used to treat allergies.3 Previous studies have looked at the effectiveness of flushing out the nose. In fact, two studies conducted in the years 2000 and 2012 concluded that flushing the nose is effective at reducing allergy symptoms.4,5

Currently, there are several different methods of rinsing out the nose such as a Neti Pot, battery powered pulse water device, bulb syringe, and squeeze bottle. The proper technique of flushing out the nose is important because, if done inappropriately an infection may result.6 This procedure can be done one to two times a day or as needed to relieve symptoms.7 Individuals should wash their hands and make sure the device is dry and clean before following the procedure below. Specific directions may vary between methods, but they generally include:

  • Over a sink, learn your head sideways and facedown to avoid getting the solution in your mouth.
  • Keep your mouth open, place the spout of the device that is filled with the saltwater solution in the top nostril, so that the liquid comes out the other nostril
  • Once finished, blow your nose. Lean your head to the other side and facedown. Then repeat this procedure for the other nostril.6

Mild side effects may include slight stinging. Stop using this treatment and see the doctor if a headache, fever or nosebleed occurs.6 Also, if this treatment does not improve allergy symptoms, the use of a medication may be an option.1 If concerns or questions come up, please speak with a pharmacist or doctor.

Given this information, will you flush out your nose, or a loved-one’s nose with saltwater solution to relieve symptoms in the future?

References:

  1. Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012.American Rhinologic Society. Nasal/Sinus Irrigation. http://care.american-rhinologic.org/irrigation Updated August 2012. Accessed October 29, 2014.
  2. Chen J, Jin L, Li X. The Effectiveness of Nasal Saline Irrigation (seawater) in Treatment of Allergic Rhinitis in Children. International Journal Of Pediatric Otorhinolaryngology [serial online]. July 2014;78(7):1115-1118. Available from: Academic Search Complete, Ipswich, MA. Accessed October 30, 2014.
  3. Tomooka LT, Murphy C, Davidson TM. Clinical Study and Literature Review of Nasal Irrigation. Laryngoscope, 2000, 110, 7, 1189-1193, John Wiley & Sons. http://onlinelibrary.wiley.com/doi/10.1097/00005537-200007000-00023/full
  4. Hermelingmeier K, Weber R, Hellmich M, Heubach C, Mösges R. Nasal irrigation as an adjunctive treatment in allergic rhinitis: a systematic review and meta-analysis. American Journal Of Rhinology & Allergy [serial online]. September 2012;26(5):e119-e125. Available from:
  5. MEDLINE with Full Text, Ipswich, MA. Accessed October 30, 2014.
  6. U.S. Food and Drug Administration. Is Rinsing Your Sinuses Safe? http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM316649.pdf Published August 2012. Accessed October 27, 2014.
  7. deShazo R and Kemp S. Patient information: Allergic Rhinitis. UpToDate. http://www.uptodate.com/contents/allergic-rhinitis-seasonal-allergies-beyond-the-basics Updated February 2014. Accessed October 30, 2014.

 

Proactive Use of Probiotics

Tuesday, October 28th, 2014

by Sarah Winey, PharmD candidate

According to the World Health Organization (WHO), two leading causes of death in young children, under the age of 5, are respiratory infections and diarrhea.1 Both respiratory tract infections (RTIs) and severe diarrhea are often caused by a bacterial infection, so an effective prevention therapy could reduce the incidence of these infections.  Currently, strategies are rarely employed for the prevention of these disease states, except avoidance of foods and conditions that may have an impact, such as fatty foods and environmental irritants. Avoidance of environment irritants can include avoidance of individuals who may carry infection and appropriate hygienic measures, such as hand washing. However, medical treatment frequently occurs only when the patient becomes symptomatic. The standard treatment for diarrhea involves fluid and electrolyte replacement or zinc supplementation, while the standard treatment for bacterial respiratory tract infections often involves antibiotic therapy.1 Probiotic therapy has been suggested as a potential preventative strategy for combating bacterial infections, including those associated with diarrhea and RTI’s.

Probiotics are live, healthy bacteria that are ingested in the form of a dietary supplement or cultured dairy products.2 The human body holds a significant amount of natural healthy bacteria in various locations, including the gastrointestinal (GI) tract.  When harmful bacteria enters the body, it competes for limited space with the healthy bacteria.  In the case of infection, the harmful bacteria overwhelms the system. The goal of probiotic supplementation is to overwhelm at risk areas, such as the GI tract, with healthy bacteria; in fact, the labeled dose is in terms of number of live cells or colonies, usually upward of one million.  In clinical testing, most patients do not experience side effects or experience only minor GI effects such as gas.3 According to current guidelines, probiotics have not been determined to replace standard treatment; nevertheless, the 2007 National Health Interview Survey found that probiotic-type products were the fifth most used natural product for children.3

In March 2014, the Pediatrics journal published a trial with the goal of determining whether a probiotic, Lactobacillus reuteri, had a significant impact on incidence of diarrhea in preschool children. The study was a forward-looking, random-sample, placebo-controlled trial (placebo- an identical substance to probiotic but has no effect) occurring from April 2011-June 2012 in four different day care centers in southeast Mexico City. The study population was comprised of healthy children aged six months to three years, born full term, and of similar socioeconomic status. The primary outcome, or goal, of the study was to determine if the number of days children experienced diarrhea was impacted by probiotic intervention. In addition, the number of days children experienced RTI’s, days of absence caused by diarrhea or RTI, days of antibiotic use, days of medical visits and cost impact due to intervention were studied. The study’s limitations included the possible lack of generalizability based on study location and choice of probiotic species.4

This study provided additional support to the theory that probiotic therapy can impact the prevention of bacterial infections, specifically diarrhea and RTI’s. The results showed that the intervention significantly reduced the incidence of both diarrhea and RTI.4 Additionally, the days of absence, number of medical visits, and antibiotic use were also significantly reduced as a result of probiotic intervention.4 Several other studies have found similar results. For instance, according to a Cochrane research review, probiotics were found to be a beneficial prevention strategy for infection; specifically, this study found that upper respiratory tract infection rate was reduced with probiotic use.5 Another research review of Randomized Control Trials (RCT’s) showed a decrease in duration and stool frequency as a result of probiotic intervention for diarrhea.6

In conclusion, probiotic therapy is a safe and seemingly effective for the prevention of respiratory infections and diarrhea.  This form of therapy may prove especially useful to parents of young children in daycare centers who are constantly in a crowded environment, which could lead to increased infection.  An additional option is the use of yogurt or other cultured dairy products, which also have the capability to reestablish normal, healthy bacteria in the GI tract. Currently probiotics are not an officially approved recommendation for children, should they be?

References:

  1. World Health Organization.Children: Reducing mortality. Media centre: Fact Sheets Web site. http://www.who.int/mediacentre/factsheets/fs178/en/. Updated 2014. Accessed September 20, 2014.
  2. EBSCO CAM Review B. Probiotics. Salem Press Encyclopedia Of Health [serial online]. January 2014;Available from: Research Starters, Ipswich, MA. Accessed August 31, 2014.
  3. National Center for Complementary and Alternative Medicine. Oral probiotics: An introduction. 2012.
  4. Gutierrez-Castrellon P, Lopez-Velazquez G, Parra M, et al. Diarrhea in Preschool Children and Lactobacillus reuteri: A Randomized Controlled Trial. Pediatrics [serial online]. n.d.;133(4):E904-E909. Available from: Science Citation Index, Ipswich, MA. Accessed September 24, 2014.
  5. Hao Q. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Of Systematic Reviews [serial online]. July 26, 2011;(9)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed September 20, 2014.
  6. Applegate J, Fischer Walker C, Ambikapathi R, Black R. Systematic review of probiotics for the treatment of community-acquired acute diarrhea in children. BMC Public Health [serial online]. October 2, 2013;13(Suppl 3):1-8. Available from: Academic Search Complete, Ipswich, MA. Accessed September 1, 2014.

Seeking relief when your child is coughing?

Wednesday, October 22nd, 2014

by Laura Farleman, PharmD candidate

Is your child’s nagging cough keeping you up at night? The honey in your kitchen may be the alternative to drug-laced syrups parents are searching for to calm their children’s coughs. The thick syrup nature of honey helps to soothe the throat and increase saliva, which can help reduce the urge to cough. Although not always severe, cough causes anxiety and disrupts sleep for parents and children. This drives many parents to seek immediate relief for their children. In recent years popular opinion has drifted toward the use of honey, but has research proven this golden nectar effective?

The current standard of care for cough in children under the age of 6 recommends talking to a doctor. In 2008, manufacturers voluntarily updated cough and cold product labels to state “do not use” in children under 4 years of age. There are few options available when treating cough in children under 4 years old without talking to a doctor. Main treatment options for children over the age of 4 have focused on cough syrups, such as Delsym or Benadryl containing dextromethorphan (DM) or diphenhydramine (DPH), respectively.1

Honey for acute cough in children, a Cochrane review published in June 2014 looked at the effectiveness of honey for cough in children compared to two commonly used cough medications. A Cochrane review is an organized review of primary research in human health care and health policy. It is recognized worldwide as the highest standard in evidence-based health care. In other words, Cochrane reviews provide the most reliable source for health care information. However, this Cochrane review is limited by only including two small studies each with high risk of bias. This review included two random-control trials involving 265 children (aged 2 to 18 years old) comparing the effect of honey to DM, DPH and ‘no treatment’ on cough relief.2 According to Honey for acute cough in children, researchers determined honey to be a better option than ‘no treatment’ and diphenhydramine (Benadryl) options. Honey was found to be equal to dextromethorphan (Delsym) for reducing frequency, severity, and impact of cough on sleep quality.2

The first study used for this review was published by Paul et al. in 2007, included 105 children (aged 2-18 years) and found honey to be a better option for treating cough than no treatment. Comparison of honey and DM did not show differences in the 2007 Paul study. 3 Compared to DM and no treatment, parents favored honey for relief of their child’s nighttime cough and sleep difficulty.3 The second study used for this review, Shadkam 2010, included 139 children (aged 2-5 years) with a cough and revealed that a 2.5-mL honey dose before sleep provided greater relief of cough compared to DM and DPH.1

A journal review by Dr. Ron Feise from 2008 about the Paul 2007 study stated that honey was better than no treatment for cough frequency, but DM was not a better treatment than ‘no treatment’.4 According to this journal review, DM used to treat childhood cough is not supported by the American Academy of Pediatrics (AAP)5 or the American College of Chest Physicians (ACCP)6. DM is associated with several adverse side effects in children, such as nausea, vomiting, constipation, and/or dizziness.7 In contrast, honey is generally recognized as safe with the exception of a severe form of food poisoning in children under the age of 1.8 Honey is not appropriate in this age group, because the bacteria in the stomach of infants (less than one year of age) has not fully developed.8 Honey provides a safe and effective option for children (1 year and older) over OTC cough and cold medications, which aren’t recommended for children younger than 6 years old.

Practically, what does this mean? The next time your child develops a cough you might consider grabbing some honey from the kitchen or local grocery store. When your child begins to develop a cough, start by giving your child (12 months or older) ½ teaspoon of honey (2.5 mL), or (if 2 years old or older) two teaspoons (10 mL) of honey. Honey may be taken/given as often as is needed to relieve coughing. The thick syrup of honey coats and soothes the back of the throat, while the sweet taste results in salivation, which thins mucus and reduces the urge to cough. Honey may also help the body fend off colds by alleviating cold symptoms and reducing the length of a cough or cold. In addition to honey, ensure your child drinks enough fluid and consider increasing your child’s intake of vitamin C.9

It is important though, to remember that coughing isn’t completely terrible. It’s the body’s way to clear mucus from the airway. If your child is otherwise healthy and sleeping relatively well, typically there is no reason to suppress a cough. If your child has a fever, prolonged or worsening cough, wheezing, or cold symptoms lasting longer than two weeks please talk to a doctor.10

Have you tried using honey for cough in the past? Did you find it effective? In the future, will you use honey to relieve coughing?

References

 

  1. Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A comparison of the effect of honey, dextromethorphan, and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010;16(7):787-793.
  2. Oduwole O, Meremikwu MM, Oyo-Ita A, Udoh EE. Honey for acute cough in children. Evidence-Based Child Health: A Cochrane Review Journal. 2014;9(2):401-444.
  3. Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM,Jr. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.
  4. Feise R. Journal review II. [commentary on] paul IM, beiler J, McMonagle A, shaffer ML, duda L, berlin CM jr. effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. arch pediatr adolesc med 2007. Journal of the American Chiropractic Association. 2008;45(8):20-1.
  5. Committee on Drugs. Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99(6):918-920.
  6. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006;129(1 Suppl):260S-283S.
  7. Kelly LF. Pediatric cough and cold preparations. Pediatrics in Review. 2004;25(4):115-123.
  8. Grant KA, McLauchlin J, Amar C. Infant botulism: Advice on avoiding feeding honey to babies and other possible risk factors. Community Practitioner. 2013;86(7):44-6.
  9. SCHARDT D. Cold front. Nutrition Action Health Letter. 2014;41(2):11-13.
  10. Teitze, JK. Cough. In: Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: an interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012:205-215

 

Can Probiotics Help Prevent the Common Cold?

Monday, December 2nd, 2013

by Andrea Bashore, PharmD student

There are many types of illnesses caused by respiratory tract infections. One that we are all familiar with is the common cold. About 22 million school days are lost in America due to this sickness, and it is the leading cause of doctor’s visits and missed days of work.1 It is common for adults to contract three to four colds each year, while the elderly and young have a higher risk of catching four to six colds annually.1 An article on Natural Standard has proposed that probiotics, or “good” bacteria, can help reduce the risk for upper respiratory tract infections.2 Common ways to prevent a cold may be washing one’s hands frequently, getting plenty of rest, or dressing appropriately for cold weather. In addition to these things, it has now been found that probiotics can be an added measure against catching a cold. Most of us have probably seen probiotics advertised on yogurt such as Activia. There have been several health benefit claims about these good bacteria, and one of the most common uses is for gastric and intestinal illnesses.3 Other benefits are alleviation of lactose intolerance and food allergies, blood pressure control, and control of inflammation in arthritis.3 Along with these benefits, research has found a new use for probiotics.

The article “Probiotics May Reduce the Risk of Respiratory Tract Infections” discusses a study with new findings. Researchers recruited 465 people to participate in the study.3 They separated the participants into three different groups with the first receiving a probiotic, the second receiving a different probiotic, and the third receiving a placebo.3 The group who took probiotic BI-04 showed a significantly lower risk for an upper respiratory illness compared to the placebo group.3 Because of this comparison the researches concluded that it was an effective supplement for preventing colds.

Along with this research, there has been more evidence that supports this idea of cold prevention with probiotics. Bacteria in the nasal cavity cause upper respiratory infections, and a study in Switzerland took this into account when testing probiotics.4 They concluded that probiotics decrease the amount of this potentially illness causing bacteria.4 Another study focused on children in day care centers. They tested the same probiotics as the Switzerland study, and their results showed that use of the probiotics substantially reduced the number of respiratory tract infections in the study’s population.1

Though the conclusions from each of these articles support the claim of probiotics preventing respiratory tract infections, they cannot make the claim that probiotics directly cause this prevention. This is what the evidence shows, but we cannot say that this is a cause and effect since the articles do not give a full explanation of how this kind of good bacteria is working to prevent infection. The probiotics do not make any direct contact with the nasal cavity, though the results showed prevention of bacteria in this area.1 Even with this limitation, I would agree that probiotics are helpful and would suggest this to others. A meta-analysis done on probiotic therapy for diarrhea reported that out of four different studies no serious adverse effects were reported.5 While I believe that more studies need to be done on the safety and adverse effects of probiotics, they have not been reported to be harmful. If simply eating yogurt everyday or taking a probiotic supplement can help someone’s health through the cold season, I would gladly suggest this. I don’t think it is necessary for every person to do this, but it is something that I would recommend. There are many other ways to help prevent colds, and this is simply and additional preventative measure. Encouraging patients to take probiotics to prevent colds also opens the door to inform them of other health benefits that they may not have known.

The common cold puts a damper on our everyday lives, and using probiotics to prevent respiratory tract infections is a step towards a healthier population. This is such a simple way that we can help our communities fight the cold season.3 As pharmacists, we can easily encourage our patients to take probiotics to help prevent a cold. Can we confidently tell patients that this will be effective? How as pharmacist can we properly inform patients on probiotics and the benefits they provide? Through research and educating ourselves on this topic we can hope to better the health of our community.

 

References

  1. Snovak N, Abdović S, Szajewska H, Mišak Z, Kolaček S. Lactobacillus GG in the prevention of gastrointestinal and respiratory tract infections in children who attend day care centers: A randomized, double-blind, placebo-controlled trial. Clinical Nutrition. 2010; 29: 312-316. Available at: http://www.clinicalnutritionjournal.com/article/S0261-5614(09)00203-9/fulltext. Accessed November 2, 2013.
  2. Probiotics May Reduce the Risk of Respiratory Tract Infections. Natural Standard. 2013. Available at: http://www.naturalstandard.com/news/news201310010.asp. Accessed November 2, 2013.
  3. Parvez S, Malik KA, Kang A, Kim Y. Probiotics and their fermented food products are beneficial for health. Journal of Applied Microbiology. 2006; 100: 1171-1185. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2672.2006.02963.x/full. Accessed November 2, 2013.
  4. Glück U, Gebbers J. Ingested probiotics reduce nasal colonization with pathogenic bacteria (Staphylococcus aureus, Streptococcus pneumoniae, and hemolytic streptococci). The American Journal of Clinical Nutrition. 2003;77: 517-520. Available at: http://ajcn.nutrition.org/content/77/2/517.short. Accessed November 2, 2013.
  5. Nandini D, Costa V, MacGregor M, Brophy J. Probiotic therapy for the prevention and treatment of Clostridium difficile-associated diarrhea: a systematic review. Canadian Medical Assiciation Journa. 2005; 173: 167-179. Available at: http://www.cmaj.ca/content/173/2/167.full. Accessed November 25, 2013.

Effectiveness of Acupuncture on Allergy Treatment

Sunday, November 24th, 2013

By Yeseul Kim, PharmD student

Many people in the world are suffering from allergies and they want some relief from the symptoms whether they are mild or serious. Some are using OTC allergy medications, such as Allegra, Benadryl, and Claritin, for treatment. However, these OTC allergy medications can cause some side effects, such as drowsiness, dizziness, constipation, or dry mouth.1 Therefore, people often try another treatment like acupuncture which may have fewer side effects than OTC medications. According to National Center for Complementary and Alternative Medicine (NCCAM), this therapy originally came from Asian countries and has been studied for over a thousand years for a wide range of conditions.2

The article, “Acupuncture may be antidote for allergies”, from CNN Health, deals with treating allergy patients with the therapy of acupuncture.3 Since some patients have already adopted the acupuncture method for relieving pain, one study tried to evaluate the effect of acupuncture on patient’s allergies. The researchers divided allergy patients into three groups.4 The first group received acupuncture treatments with antihistamines as needed, the second group received fake acupuncture treatments with antihistamines as needed, and the third group did not receive any acupuncture, and only took antihistamines for treatment.4

The study results showed some effectiveness of acupuncture for allergy treatment. The first group took less antihistamines and showed improvement in symptoms.4 There is a placebo effect also as shown in second group, in which some patients improved with fake acupuncture.4 Based on improvement seen in this study, I agree with and support the use of acupuncture in addition to antihistamines for allergy treatment. Another study found similar results and helps increase the validity of this study. The 2008 Berlin allergic rhinitis acupuncture study concluded that “the result of this trial suggests that treating patients with allergic rhinitis in routine care with additional acupuncture leads to clinically relevant and persistent benefits.”5

Although the study reported a higher quality of life for allergy patients after acupuncture treatment, there are some limitations to the study. The researchers noted, “We found that acupuncture led to statistically significant improvements in disease-specific quality of life and antihistamine use after eight weeks of treatment compared with sham acupuncture and with antihistamine alone, but the clinical significance of the findings remains uncertain.”6 Also, acupuncture was less effective on severe allergy symptoms. If patients with severe allergies do not get relief from OTC medication or acupuncture, they may want to try prescription products for their allergies.

Another study, Effect of Acupuncture in the Treatment of Seasonal Allergic Rhinitis: A Randomized Controlled Clinical Trial, found a significant improvement in nasal and non-nasal symptoms between the two types of acupuncture treatments.7 The study concluded at the end that “no side effects were observed for both groups. The results indicate that acupuncture is an effective and safe alternative treatment for the management of Seasonal Allergic Rhinitis.”7

I want to recommend acupuncture therapy with use of antihistamines for allergy patients, even though this is different from the standard of care. The current standard of care is taking antihistamines only for treatment. Several studies have found a positive result in treating allergies and acupuncture is a safe treatment as reported side effects are rare. Acupuncture treatment also contains some placebo effect which I believe is another important mechanism in patient treatment. A positive state of mind largely influences the improvement of symptoms  

Through various research, the efficacy of acupuncture on allergies is proven, but some are still questioning the exact scientific mechanism of how the acupuncture works. Some patients will get better with acupuncture but others will not.  We should think about “What are the factors that can lead to less effectiveness?” and “Should we recommend an acupuncture treatment for a patient before recommending OTC medications to a patient?”

References

 

1. Berardi RR, Kroon LA, McDermott JH et al. Handbook of nonprescription drugs, an interactive approach to self-care. APhA Publications; 2006.

2. Acupuncture: An Introduction. National Center for Complementary and Alternative Medicine Web Site. http://nccam.nih.gov/health/acupuncture/introduction.htm. Updated 2012. Accessed October 30, 2013.

3. Sifferlin A. Acupuncture may be antidote for allergies. CNN.com Web Site. http://www.cnn.com/2013/02/19/health/acpuncture-allergies/. Updated 2013. Accessed October 29, 2013.

4. Benno Brinkhaus, Miriam Ortiz, Claudia M. Witt, Stephanie Roll, Klaus Linde, Florian Pfab, Bodo Niggemann, Josef Hummelsberger, András Treszl, Johannes Ring, Torsten Zuberbier, Karl Wegscheider, Stefan N. Willich; Acupuncture in Patients With Seasonal Allergic RhinitisA Randomized Trial. Annals of Internal Medicine. 2013 Feb;158(4):225-234.

5. Louis PF. Banish allergies with acupuncture: Here’s how. Naturalnews.com Web Site. http://www.naturalnews.com/040305_allergies_acupuncture_studies.html. Updated May 13, 2013. Accessed October 30, 2013.

6. Radford B. Acupuncture for Allergies? Jury’s Still Out. Discovery.com Web Site. http://news.discovery.com/human/health/acupuncture-for-allergies-jurys-still-out-130222.htm. Updated 2013. Accessed October 30, 2013.

7. Xue C, English R, Zhang J, da Costa C, Li C. Effect of Acupuncture in the Treatment of Seasonal Allergic Rhinitis: A Randomized Controlled Clinical Trial. American Journal Of Chinese Medicine [serial online]. January 2002;30(1):1. Available from: Academic Search Complete, Ipswich, MA. Accessed October 31, 2013.

Hand Sanitizer: Effective or Toxic?

Saturday, November 23rd, 2013

by Joseph Newman, PharmD student

Hand sanitizer is often used as a quick and convenient alternative to washing your hands. Whether it is a quick squirt after leaving the gym or the super market, or pulling it out after shaking lots of hands or coughing, it has become one of the most common ways to clean hands and get rid of germs. But is using all of this hand sanitizer actually preventing you from getting the flu or a cold? Is it any more or less effective when compared to washing with soap and water?

In his recent article1 on CNN, Bob Barnett evaluates the use of hand sanitizer and suggests that there are safety and efficacy concerns for hand sanitizers containing triclosan. Barnett states that according to Allison Aiello, an associate professor of epidemiology at the University of Michigan, there is no evidence that products containing triclosan have any benefit and that hospitals won’t use them. He goes on to cite other sources saying that there is little benefit of triclosan-containing products over washing with soap and water. Barnett claims that triclosan can disrupt the endocrine system and reduce muscle strength, as shown in animal studies. He also claims that triclosan does not protect against viruses and fungi. Barnett makes the distinction that alcohol-based hand sanitizers are good at killing bacteria and some viruses and can be used as an alternative to hand washing, but concludes by emphasizes the fact that washing with soap and water is the most effective way to eliminate germs.

I agree with most of this article. According to the World Health Organization, hand washing is “the most important hygiene measure in preventing the spread of infection.”2 I also agree that alcohol-based hand sanitizer is a good idea if you can’t wash your hands. Barnett’s recommendation for hand washing and alcohol-based hand sanitizer is one that is consistent with the standard for self-care in regards to hand hygiene. However, there are some limitations to his article, especially in his evaluation of triclosan-containing products. For one, he only cites a couple different sources. His claims of potentially harmful effects of triclosan and its limited effectiveness cannot be backed up without further research. Furthermore, Barnett says that studies support his claims, but then fails to provide information about or references to those studies.

Upon further research, I found that alcohol-based hand sanitizers are an “appropriate alternative to hand washing for hand cleansing”3 and that they improve hand hygiene practices within the home setting.4 Another study showed that alcohol-based hand sanitizers are safe. In this study, volunteers applied hand-rubs with varying amounts of ethanol onto their hands before being tested for blood concentrations of ethanol and acetaldehyde. According to the study, any alcohol absorbed through the skin was below toxic levels in humans.5 This supports Barnett’s claim that alcohol-based hand sanitizers can be safe and effective. As far as triclosan containing hand sanitizers, the FDA states that triclosan is not known to be hazardous to humans6 and according to one study, is “well tolerated by a variety of species, including human beings.”7 According to this research, it appears as though triclosan is not toxic, contrary to the research that Barnett refers to in his article.

Hand sanitizers that are alcohol-based appear to be safe to use as well as effective at promoting hand hygiene and preventing some illnesses, and while triclosan appears to be non-toxic, there was not very much research available on the effectiveness of hand sanitizers containing that ingredient. So what does this mean for me and you in terms of using these products to prevent colds, the flu and other common diseases? As a pharmacist, these types of questions come up often when discussing over-the-counter treatment of colds. Alcohol-based hand sanitizer can be a very useful tool in self-care of colds to prevent the transmission of germs while on-the-go. However, washing your hands is still the most important measure in preventing the spread of infection.2

So what do you think? Should we continue to use hand sanitizer? Should we switch to only soap and water? Or do you think there should be more research done on this issue?

 

References:

  1. Barnett, B. Is hand sanitizer toxic? CNN. October 16, 2013. Available at http://www.cnn.com/2013/10/16/health/hand-sanitizer-toxic-upwave/index.html?hpt=he_bn3. Accessed November 13, 2013
  2. Hospital Infection Control Guidance. World Health Organization Web site. 2003 Available at: http://www.who.int/csr/surveillance/infectioncontrol/en/print.html. Accessed November 13, 2013
  3. Vessey J, Sherwod J, Warner D, Clark D. Comparing Hand Washing to Hand Sanitizers in Reducing Elementary School Student’s Absenteeism. Pediatric Nursing [serial online]. July 2007;33(4):368-372. Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed November 14, 2013
  4. Sandora TJ, Taveras EM, Shih MC, et al. A randomized, controlled trial of a multifaceted intervention including alcohol-based hand sanitizer and hand-hygiene education to reduce illness transmission in the home. Pediatrics. 2005;116(3):587-94. Available at http://pediatrics.aappublications.org/content/116/3/587.long. Accessed November 14, 2013
  5. Kramer A, Below H, Bieber N, et al. Quantity of ethanol absorption after excessive hand disinfection using three commercially available hand rubs is minimal and below toxic levels for humans. BMC Infect Dis. 2007;7(1):117. Available at http://www.biomedcentral.com/1471-2334/7/117/. Accessed November 14, 2013
  6. Consumer Updates > Triclosan: What Consumers Should Know. Federal Drug Administration Website. August 29, 2012. Available at http://www.fda.gov/forconsumers/consumerupdates/ucm205999.htm. Accessed November 14, 2013
  7. Bhargava H, Leonard P. Triclosan: Applications and safety, American Journal of Infection Control, Volume 24, Issue 3, June 1996, Pages 209-218, ISSN 0196-6553, Available at http://www.sciencedirect.com/science/article/pii/S0196655396900176. Accessed November 14, 2013

Can Zinc Really Stop a Cold in its Tracks?

Sunday, November 10th, 2013

By Laura Cummings, PharmD Student Cedarville University

‘Tis the season for the spread of the common cold. While not always severe, the congestion, cough, and other cold symptoms are often irritating and can detract from focus and productivity, which drives many cold sufferers to seek a quick solution at the first sign of symptoms. One option that has gained popularity in recent years is zinc lozenges, but have they been scientifically proven effective?

In her article “Do some foods or supplements actually help treat a cold?” Leslie Beck explores several non-drug options commonly used in an attempt to reduce the duration and/or severity of the common cold.1 One treatment that she discusses is zinc lozenges. I agree that some zinc lozenges are scientifically supported as effective, however I disagree with her recommendation of zinc gluconate and zinc citrate lozenges specifically. Furthermore, the article does not include citations to facilitate further research by interested readers.

Although the exact mechanism of action of zinc is still under investigation, researchers have determined that it exerts its effects on the body’s cells rather than directly on the viral cells themselves. This is because the irritating symptoms associated with the common cold are due to an overreaction of the body’s immune cells. Therefore, inhibition of these cells by zinc allows the effective elimination of the virus from the body to occur, while simultaneously reducing the excessive immune effects that cause symptoms such as a runny nose, sneezing, cough, and congestion.2

Science et. al. analyzed 17 randomized controlled clinical trials testing for the treatment effects of various types and dosage forms of zinc on the common cold, when compared with placebo.3 The most commonly supported conclusion was that high-dose zinc acetate treatment was capable of shortening a cold by about two and a half days in adults. It is important to note that zinc gluconate and zinc sulfate did not show similar effectiveness, nor did any zinc treatment used in the treatment of colds in children. Although Science et. al. did not suggest the reasoning behind this, Prasad et. al. have proposed that this is due to increased bioavailability of the acetate form.4 Another suggested conclusion was that zinc was capable of reducing the severity of cold symptoms as rated by patients on graded scales. However, the studies also revealed that side effects of oral zinc can include bad taste and nausea. Another systematic review conducted by Singh helped solidify the specific recommendations for therapy.5 Through the analysis of 18 randomized controlled clinical trials, the authors were able to conclude that in order to be most effective, zinc therapy should begin within 24 hours of the onset of symptoms and should consist of lozenges containing ≥ 75mg of zinc.

So what does this mean practically? When you begin experiencing cold symptoms, stop by the OTC aisle to pick up some 75mg zinc acetate lozenges. Start taking them within 24 hours of the first symptoms and continue as directed on the box (typically every 2-3 hours while awake) until symptoms are gone. You may experience side effects of bad taste and nausea, in which case you can choose to discontinue therapy if you determine that the side effects of zinc outweigh its ability to shorten your cold. This treatment should shorten the duration of your cold by at least 2 days and may decrease the severity of the cold while it lasts.

Have you tried zinc for colds in the past? Did you find it effective?

References

  1. Beck, Leslie. Do some food or supplements actually help treat a cold? The Globe and Mail. Oct. 14, 2013. Available from http://www.theglobeandmail.com/life/health-and-fitness/ask-a-health-expert/do-some-foods-or-supplements-actually-help-treat-a-cold/article14842492/. Accessed November 2, 2013.
  2. Hendley J. The host response, not the virus, causes the symptoms of the common cold. Clinical Infectious Diseases: An Offiial Publication Of the Infections Diseases Society Of America [serial online]. April 1998;26(4):847-848. Available from MEDLINE with Full Text, Ipswich, MA. Accessed November 6, 2013.
  3. Science M, Johnstone J, Roth D, Guyatt G, Loeb M. Zinc for the treatment of the common cold: a systematic review and meta-analysis of randomized controlled trials. CMAJ: Canadian Medical Association Journal=Journal De L’association Medicale Canadienne [serial online]. July 10, 2012;184(10):E551-E561. Available from MEDLINE with Full Text, Ipswich, MA. Accessed November 2, 2013.
  4. Prasad A, Fitzgerald J, Bao B, Beck F, Chandrasekar P. Duration of symptoms and plasma cytokine levels in patients with the common cold treated with zinc acetate. A randomized, double-blind, placebo-controlled trial. Annals of Internal Medicine [serial online]. August 15, 2000;133(4):245-252. Available from MEDLINE with Full Text, Ipswich, MA. Accessed November 6, 2013.
  5. Singh M, Das R. Zinc for the common cold. Cochrane Database Of Systematic Reviews. [serial online]. June 2013;(6) Available from CINAHL Plus with Full Text, Ipswich, MA. Accessed October 19, 2013.

Are cold medicines safe in young children?

Thursday, October 17th, 2013

By Maria Miller PharmD Student Cedarville University School of Pharmacy

Cold season is now upon us and that means doctor offices and pharmacies will be swarmed with people who are picking up prescriptions for their colds and buying over the counter medicine to help symptoms. Most people skip the doctor and head straight for over the counter medicines, including parents of young children.  Too often, parents are giving their children, 4 years and younger, cold medicine when they should not be. According to the Official Journal of the American Academy of Pediatrics, in the years 2004-2005, 5.7% of all emergency room visits were for children under the age of 12 who were experiencing adverse effects of cold medicine.1  Out of these children, 64% of them were between the ages of 2-5.1 Cold medicine products typically include pseudoephedrine, diphenhydramine, dextromethorphan, and guaifenesin.2  Labeling on these medicine bottles in 2008 stated it should not be used in children under 2 years of age. 3

An article posted in U.S. News during April 2013 discussed a survey that was given out to patients that asked if they administered cold medicines to their young children. The survey included 498 parents of children under the age of 3.3 The results showed that many parents gave their children cold medicines to help with their symptoms under the age of 4.3 According to the article, in 2008, labels on these over the counter cold medicines warned that they should not be given to children under 4.3 These medicines can cause allergic reactions, increased or uneven heart rate, slow and shallow breathing, confusion or hallucinations, drowsiness or sleeplessness, convulsion, nausea and constipation. 3 Parents giving their young children these medicines are generally confused by the labeling of ‘children’s’ medicine and they do not look at the back of the box that gives greater detail of what age the medicine should and should not be used in. The survey director Dr. Matthew Davis said, “Products like these may work for adults, and parents think it could help their children as well. But what’s good for adults is not always good for children.”3 This article urges parents to carefully read labels on children’s cold medicines before giving them to their young child.

Scientific studies have not found evidence that children’s cold medicine is effective. According to the New England Journal of Medicine, since 1985 all the controlled studies for cold medicine in children under the age of 12 have shown that there is no meaningful difference between the active drug of a cold preparation and placebo. 4 Even with this scientific evidence, some manufacturing companies refuse to change their labels to say that patients under the age of 6 should not use.4 Instead they market that their products are “safe, effective, and pediatrician recommended.” 4 Parents often take this as truth and give the medicine to their young children.

I fully agree with this article that parents need to look more carefully at the labels on medicines, especially when administering it to children younger than 6. Health care provider recommendations have age limits on cold products for the safety of children. When these recommendations are ignored either by accident or on purpose, the child is being put at risk for serious adverse effects. The easiest and quickest way to get a recommendation is from a local pharmacist. Pharmacists will be able to interpret directions if the parents are confused and will be able to determine if the child will need to be seen by a physician.

There are limitations to the article in the fact that it is a brief statement on how parents give cold medicines to young children when they shouldn’t. It mentions how they received these results through a survey but the article did not say what the name of the survey was nor did it say much more about the survey other than it was given to 498 parents with children under the age of 3. It would be beneficial to see the questions on the survey in order to evaluate if the questions matched what the results were. Another limitation is that the article could have gone deeper into what medicines are misused the most, how often parents ask pharmacists for help, and other studies that have been completed on the use of cold medicines in young children. It could also mention what would be the next step for parents to take. Pointing out the misuse is a great first start, but giving another option of what parents could do would be helpful.

How many of you know parents who give their young child cold medicine because they think it’s safe?

What do you use or recommend for colds in kids under 4 with cough or cold?

 

References:

 

1. Schaefer M, et al. Adverse Events From Cough and Cold Medications in Children. Official Journal of the American Academy of Pediatrics. 2008; 121: 783-787

 

2. Vernacchio L, et al. Cough and Cold Medication Use by US Children, 1999-2006: Results from the Slone Survey. Official Journal of the American Academy of Pediatrics. 2008; 122:323-329

 

3. HealthDay. Many Parents Give Kids Cold Medicines When They Shouldn’t, Survey Finds. U.S. News. April 23, 2013.  http://health.usnews.com/health-news/news/articles/2013/04/23/many-parents-give-kids-cold-medicines-when-they-shouldnt-survey-finds. Accessed October 2013.

 

4. Sharfstein, J. Over the Counter but No Longer under the Radar-Pediatric Cough and Cold Medications. The New England Journal of Medicine. 2007; 357:2321-224.