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Self Care Pharmacy Blog

Sugar and Spice

October 28th, 2015

By: Micah Bernard800px-Ground_cinnamon

Cinnamon. What comes to mind when you hear that word? Cinnamon buns, cinnamon glazed apples, snickerdoodles? It’s no secret that cinnamon and sugar are a great pair! But is there more to the relationship between sugar and cinnamon than just the great taste?

People with pre­diabetes or type 2 diabetes must be very careful to manage blood sugar levels. This can be achieved by following a special diet, losing weight, exercising, and taking medications such as metformin. Now there is a common spice that is being investigated as a supplement to help control blood sugar. In 2013, NPR published an article stating that cinnamon can help lower blood sugar.1 But is this claim backed up by science? Researchers in the last few years have been studying the impact of cinnamon on the management of blood sugar and have had promising results.
In 2003, researchers sought to determine if cinnamon could improve blood glucose levels in people with type 2 diabetes.2 In this study of 60 people with type 2 diabetes ranging in age from 45 to 58, subjects took either a placebo or one of three amounts of cinnamon: 1, 3, or 6 grams each day. After 40 days, the results showed that cinnamon in any of the three doses helps lower blood glucose levels 18­-29%, while no significant changes were reported in the placebo groups.

Another study in 2006 of 79 diabetic patients looked at whether cinnamon extract helps improve glycemic control in patients with type 2 diabetes.3 Each person either received a capsule of 3 grams of cinnamon or a placebo three times a day for 4 months. The results showed that the reduction in fasting blood glucose levels in the patients receiving cinnamon (10.3%), was significantly greater than in the control group, who had a reduction of only 3.4%. However, no significant differences were seen in hemoglobin A1c, which is an indicator of average blood sugar levels over the past three months.

A recent study that ran statistical tests on data from ten randomized controlled trials studying cinnamon’s effect on blood glucose found that cinnamon decreased fasting blood glucose levels by 24.59 mg/dl.4 There was no significant difference in the patients’ hemoglobin A1c. The study was unable to determine what the optimal dose of cinnamon or duration of treatment; this is an area where further research is needed.

How does cinnamon do it? Researchers do not fully know how cinnamon works, but they believe it may increase the body’s levels of and sensitivity to insulin, the hormone that helps your cells take sugar out of the blood stream, thereby lowering blood sugar levels.5 In addition, cinnamon may slow the emptying of the stomach, so there is less of a spike of sugar in the bloodstream.6 There is debate among researchers about what dose of cinnamon should be used to manage blood sugar.

As with any supplement, it is important to check with your doctor before adding cinnamon to your diet. If, after talking to your doctor, you decide to see if cinnamon works for you, it is important to choose the right kind of cinnamon. Cinnamon comes in two varieties, Cassia and Ceylon. Cassia is the more common type found in many supermarkets, however in higher doses, such as those used to control blood sugar, coumarin isolates (not to be confused with the blood thinner Coumadin) found in cinnamon can cause liver damage.1 The Ceylon variety of cinnamon has only trace amounts coumarin isolates, making it safer for the liver.7 So, if you plan to supplement your blood sugar management with cinnamon, ask a pharmacist to help you correctly select the Ceylon variety.

While researchers still do not fully agree on the effectiveness of cinnamon as a supplement for controlling blood sugar in type 2 diabetics and pre­diabetics, many recent studies show promising results. The effects of cinnamon may not be enough to replace a drug intended to control blood sugar, but those with pre­diabetes or diabetes may find it a useful supplement to help manage their condition.

What are your thoughts on using a natural supplement to manage a health condition?

Sources:

1. Aubrey A. Cinnamon Can Help Lower Blood Sugar, But One Variety May Be Best. NPR 2013. Accessed October 15, 2015.
2. Khan A, Safdar M, Ali khan MM, Khattak KN, Anderson RA. Cinnamon improves glucose and lipids of people with type 2 diabetes. Diabetes Care. 2003;26(12):3215­8.
3. Mang B, Wolters M, Schmitt B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36(5):340­4.
4. Allen RW, Schwartzman E, Baker WL, Coleman CI, Phung OJ. Cinnamon use in type 2 diabetes: an updated systematic review and meta­analysis. Ann Fam Med. 2013;11(5):452­9.
5. Kaiser C. Cinnamon’s Effect in Diabetes Uncertain. Cinnamon’s Ef ect in Diabetes Uncertain 2013. Accessed 2015.
6. Hlebowicz J, Darwiche G, Björgell O, Almér LO. Effect of cinnamon on postprandial blood glucose, gastric emptying, and satiety in healthy subjects. Am J Clin Nutr. 2007;85(6):1552­6.
7. Johannes L. Little Bit of Spice for Health, but Which One? WSJ 2013. Accessed 2015.

A Natural Approach to Preventing Gestational Diabetes

October 26th, 2015
image courtesy of freedigitalphotos.net

By Katie Woodward, PharmD Student

You are having a new baby! Congratulations! You’ve probably already had several opportunities to answer that age-old question, “What gender are you hoping for?” And it is likely you responded with something like, “I don’t care as long as my baby is healthy!” Thanks to new scientific research, your chances of delivering a healthy baby are constantly improving.

We are going to play a quick game of “Bad News/Good News.” The bad news: gestational diabetes may cause complications in your pregnancy. Several factors may put you at risk of developing gestational diabetes. If diabetes runs in your family, if you are overweight, not very active, or over the age of 40 you are at risk of developing gestational diabetes.1 Gestational diabetes can cause jaundice, high birth weight, trauma during birth, increase necessity for C-section, and increase likelihood of obesity or diabetes in the child.1,2 Gestational diabetes also puts a new mother at risk of developing Type 2 Diabetes, which can require insulin injections and other treatments to control.

Now, for the good news: new research has demonstrated that myo-inositol is a supplement you can take which significantly decreases your chances of developing gestational diabetes, even if you are at high-risk.3 For those already diagnosed with gestational diabetes, taking a myo-inositol supplement can help decrease your need for insulin, make you more likely to carry the baby to term, and decrease your infant’s chances of developing hypoglycemia.3 Standard treatment for gestational diabetes requires the patient to check blood sugar levels in the morning and after meals, which can require several needle sticks per day as well as the purchase of a glucometer, test strips, and lancets.4 Insulin injections are also used to help control the blood sugar in up to 20% of women with gestational diabetes.4

A research study published in the Journal of Maternal-Fetal and Neonatal Medicine was designed as a prospective, double-blind, randomized controlled clinical trial which compared a placebo group to a group of mothers who supplemented with myo-inositol twice daily.3 The myo-inositol group had significantly better outcomes including lower maternal BMI, longer gestation at the time of delivery, and decreased abnormal oral glucose tolerance test results. The oral glucose tolerance test is the standard screening measure for gestational diabetes.  One limitation was that the study was relatively small. Some of the data may have been statistically significant if there had been more women involved in the study; for instance, the myo-inositol group had a lower incidence of neonatal hypoglycemia, but the data was not quite strong enough to be statistically significant. Another interesting statistic is that 21% of women in the placebo group required insulin therapy, while only 3% of women in the myo-inositol group required insulin therapy. While larger studies may be needed to validate this data, this study demonstrated that at least 50% of women who take myo-inositol may benefit from the treatment.3 Since the current standard of care for prevention of gestation diabetes is diet change and monitoring blood sugar, myo-inositol may be an easy and beneficial way to minimize complications from gestational diabetes.  It also has a promising potential to minimize the requirement of insulin injections.

Since it is a compound naturally found in both your body and your baby’s body, you can safely consume myo-inositol supplements.5 The product may be a little bit difficult to find in grocery stores, but it can be found in combination products or ordered online. According to research, the supplement is best if taken 2000 mg twice daily (make sure you separate the doses by at least six hours.)One product can be purchased from Fairhaven Health6 where you can get a 60-day supply for less than $20.* Myo-inositol is often combined with another compound called D-chiro inositol, which has also been demonstrated to assist with gestational diabetes.7 The combination product is called Ovasitol and it can be purchased online from Theralogix Nutritional Science Company, but it must be ordered online and can cost up to $1 per day ($90 for a 90 day supply.)8 Another product to consider is called Sensitol, and it contains D-chrio inositol, myo-inositol, and alpha lipoic acid. The product can be ordered online and a thirty day supply is $52.9

Gestational diabetes can have some scary consequences for you and your baby. Based on the evidence, I would recommend that any mother who has increased risk of gestational diabetes should discuss supplementation with myo-inositol with their medical provider.   It could help prevent or minimize problems associated with gestational diabetes. Myo-inositol may be expensive and may not be easily accessible to all; since it is commonly used as a preventative supplement, do you think that pregnant women at high risk for developing gestational diabetes should consider it as an option?

*The manufacturer suggests that the drug be taken four times daily, but in studies, the 2000 mg dose was only recommended twice daily.3 Also, this will help decrease the cost of the drug.

**Note: The Cochrane Collaboration is working on a new study to further describe the dosing and efficacy of myo-inositol as a treatment/ prevention method for gestational diabetes and it should be released soon.

References

  1. Available at: http://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2014. Accessed October 14, 2015.
  2. Brown J. Myo-inositol for preventing gestational diabetes. Cochrane Database Of Systematic Reviews [serial online]. February 2, 2015;(2)Available from: Cochrane Database of Systematic Reviews, Ipswich, MA. Accessed October 11, 2015.
  3. Matarrelli B, Vitacolonna E, Celentano C, et al. Effect of dietary myo-inositol supplementation in pregnancy on the incidence of maternal gestational diabetes mellitus and fetal outcomes: a randomized controlled trial. The Journal Of Maternal-Fetal & Neonatal Medicine: The Official Journal Of The European Association Of Perinatal Medicine, The Federation Of Asia And Oceania Perinatal Societies, The International Society Of Perinatal Obstetricians [serial online]. July 2013;26(10):967-972. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 11, 2015
  4. Available at: http://www.mayoclinic.org/diseases-conditions/gestational-diabetes/basics/treatment/con-20014854. Accessed October 21, 2015.
  5. D’Anna R, Scilipoti A, Di Benedetto A, et al. myo-Inositol supplementation and onset of gestational diabetes mellitus in pregnant women with a family history of type 2 diabetes: a prospective, randomized, placebo-controlled study. Diabetes Care [serial online]. April 2013;36(4):854-857. Available from: MEDLINE, Ipswich, MA. Accessed October 11, 2015.
  6. Available at: http://www.fairhavenhealth.com/myo-inositol.html?cmp=bing&kw=myo-inositol&utm_source=BingShopping&utm_medium=CSE&utm_campaign=myo-inositol. Accessed October 14, 2015.
  7. Costantino D, Guaraldi C. [Role of D-chiro-inositol in glucidic metabolism alterations during pregnancy]. Minerva Ginecol. 2014;66(3):281-91.
  8. Available at: http://www.theralogix.com/index.cfm?fa=products.ovasitol.default&dvsn=reprohealth. Accessed October 14, 2015.
  9. Available at: http://catalog.designsforhealth.com/Sensitol?quantity=1. Accessed October 21, 2015.

Could your phone be used for more than games?

October 16th, 2015

By: Abigail Savino

Nowadays, it seems as if everyone has a cell phone – from kids to our grandparents, they are commonplace.  So why not design an application for the phone that could help improve our health? There are fitness tracking apps and calorie counting apps that are designed to help develop healthy lifestyles, but some suggest using text messages as forms of encouragement.1 One research study tested out the power of a text message in helping people become healthier over a period of six months.256px-Texting_closeup

Researchers from Sydney, Australia studied the effectiveness of text messaging on health in patients with coronary heart disease, a cardiovascular disease where plaque builds up in the arteries slowing the flow of blood to the heart.2,3 One group of patients received a typical intervention such as modifying diet and exercise at the suggestion of their doctor.3 The other group received four text messages each week providing advice, encouragement, and support for lifestyle changes. Text messages that the participants received were selected from a bank catered to the participant’s chronic condition. Participants who were smokers received a message similar to: “Try identifying triggers that make you want a cigarette and plan to avoid them.” Those who were trying a modified dietary approach received messages such as: “Try avoiding adding salt
to your foods by using other spices or herbs.” Others told to increase physical activity received messages like: “Don’t forget physical activity is good for you! It reduces your risk of diabetes, heart attack, stroke, and their complications.” Investigators also sent texts containing information about the cardiovascular system, for example, “Studies show that stress…can increase the risk of heart disease. Please talk to a health professional if you need help.”

The primary outcome of the study was to determine the text messaging effect on cholesterol levels. After six months, the participants who partook in the text messaging intervention had an average LDL cholesterol level of 79 mg/dL which was lower than the typical intervention group who had an average of 84 mg/dL.3 The study also monitored blood pressure, body mass index (BMI), active smokers, and physical activity levels.4 These were all positively affected by the intervention – average blood pressure for the text message intervention group was 128/81 vs 136/84 for control, BMI was lower at 29 vs 30.3, and more physical activity was completed at 936.1 minutes per week compared to 642.7 minutes per week. The study also started off with 184 smokers in the text message intervention group and ended with only 88 people still smoking. Since cardiovascular disease can be managed by lifestyle changes (diet, smoking, physical activity), it is significant that the text messages focused on those areas and help explain why these results were observed.2 One limitation to the study is the small scale, which may not allow representation of the full effect of clinical outcomes. This study was conducted through a hospital facility so it is not known how generalizable this will be to the overall population. Additionally, the messages were only sent in English excluding non-English speakers, the final results were recorded through self-reporting, cost-effectiveness of the intervention was not studied, and the study was not completely blinded.

Similar ideas have been popping up in other places in healthcare. Medicaid uses this system to give more individualized attention to their patients.5 They do this by sending appointment reminders, medication reminders, and also educational material that relates to them specifically.5 Also a study has been done with patients that have had a stroke in which the text messages were sent to remind them to take their medications, dietary and lifestyle changes, and to be in contact with a health care provider.6 This study increased appointment and medication adherence by 40%.5

Data from the research study above shows that text messaging could help to improve your health, and almost everyone has a phone so your motivation comes straight to your fingertips. If your doctor recommends you to be a part of a program like this then I suggest you strongly consider becoming a participant. If you don’t think a typical intervention approach is going to benefit your health, using this text message system could help to improve your health on your own time. It is great that they send little reminders to help motivate and remind you why it is important to follow through. Participating in something similar to this would be beneficial to improve your health as a whole. With today’s technology, this will likely become a bigger thing in the near future. Would you be willing to try using text messages as encouragement or as reminders? I know I would, everyone needs a little bit of motivation to get the ball rolling with whatever you are battling.

 

References

  1. Macfarlane S. Can A Simple Text Lower Your Cholesterol?. Diabetes Insider. 2015. Available at: http://diabetesinsider.com/can-a-simple-text-lower-your-cholesterol/39648. Accessed September 29, 2015.
  2. Heart.org. What is Cardiovascular Disease? 2015. Available at: http://www.heart.org/HEARTORG/Caregiver/Resources/WhatisCardiovascularDisease/What-is-Cardiovascular-Disease_UCM_301852_Article.jsp. Accessed October 1, 2015.
  3. Chow CK, Redfern J, Hillis GS, et al. Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: A randomized clinical trial. JAMA. 2015;314(12):1255-1263.
  4. University Herald. Texting Patients Could Lower Cholesterol, Blood Pressure. 2015. Available at: http://www.universityherald.com/articles/23954/20150923/texting-patients-could-lower-cholesterol-blood-pressure.htm. Accessed September 30, 2015.
  5. Comstock J. RCT: Text message-based program boosts adherence to appointments, medication | MobiHealthNews. Mobihealthnewscom. 2014. Available at: http://mobihealthnews.com/34749/rct-text-message-based-program-boosts-adherence-to-appointments-medication/. Accessed September 29, 2015.
  6. 6. Kamal A, Shaikh Q, Pasha O et al. Improving medication adherence in stroke patients through Short Text Messages (SMS4Stroke)-study protocol for a randomized, controlled trial. BMC Neurology. 2015;15(1). doi:10.1186/s12883-015-0413-2.

Skipping Breakfast: Do the Benefits “Outweigh” the Risks?

October 16th, 2015

By Vineeta Rao, PharmD Student Cedarville University

You have heard the concept all over the news and social media: Skipping breakfast leads to weight gain. Nutritionists and researchers have long speculated that when one skips breakfast, his hunger and lack of energy will cause a rebound-effect in which he will consume more calories by snacking than he would have if he had eaten breakfast.2 But a recent study published by the American Journal of Clinical Nutrition has found that when men and women skip breakfast, they actually consume far fewer calories compared to the days when they do eat breakfast.1

Breakfastpic

In this traditional crossover study, participants were allowed to eat as they pleased and report their own eating habits to the study investigators. Investigators consulted the same patients on various occasions to obtain a report of how many meals they had eaten, what they had eaten for each meal, and what time of day they had eaten. Then, investigators examined each person’s data individually; they compared the participant’s calorie intake on the days when he or she ate breakfast to a day when he or she did not eat breakfast. Researchers also included any snacking between meals in the total calorie count. On average, men in the study consumed 247 kcal more on a breakfast day than a non-breakfast day, and women consumed 187 kcal more on a breakfast day than on a non-breakfast day.1 Apparently, snacking was not enough to make up the calories lost from skipping breakfast! If participants regularly ate a few hundred fewer calories a day, then over time, breakfast skipping actually led to weight loss rather than weight gain.

Overall, the participant’s choices in food were similar between breakfast days and non-breakfast days, with breakfast days containing more whole grains, fruits, and dairy.1 One limitation of this study is that participants reported their own diet choices.1 Thus, if a patient forgot to report a snack item, the calorie deficit calculated above would not be correct. Additionally, participants tend to change their food choices when they know that they are being monitored.

Researchers all over the world cannot seem to agree on this matter. Skipping breakfast goes against the current standard of care, but it shows compelling evidence that it may actually assist in weight loss. Although many researchers have suspected that skipping breakfast will cause people to snack more frequently and to choose unhealthy snacks that lead to weight gain, very few research studies have shown this to be true. For example, one study that expected this to be true examined the effects of skipping breakfast in children in Taiwan and did not find any connections between skipping breakfast and obesity.2

So, does this mean that we should encourage breakfast skipping as a weight-loss strategy? An editorial response to this research study says yes! Because obesity and weight gain is associated with risks for chronic diseases such as heart disease, high blood pressure, diabetes, and stroke, getting rid of this small but significant calorie intake could help to prevent such diseases.3

However, other researchers are not convinced. The study in Taiwanese children found that breakfast-skipping may not be suitable for all people. For example, this study found that children who ate breakfast regularly had better cognitive ability and academic performance than children who did not eat breakfast regularly.2

Additionally, some research studies have shown that skipping breakfast can actually increase the risk of developing Type II diabetes by decreasing insulin tolerance and raising blood sugar. When three universities in China examined the risk factors that lead to Type II diabetic patients’ condition, they found skipping breakfast was associated with an increased risk for the disease.4

So what can we learn from all these findings? In short, skipping breakfast does not appear to lead to weight gain, but the current research on other health risks and benefits of skipping breakfast is controversial. You most likely won’t have to worry about gaining weight from missing breakfast now and then due to a busy schedule, but the research is too gray to conclude that skipping breakfast is safe and healthy for everyone. One fact that remains true across all these studies is that the quality of the food you eat matters. Whether you eat breakfast or not, it is important to eat a balanced diet with whole foods, good sources of protein, and a focus on non-starchy vegetables. Nutrient-rich diets are important in healthy weight management and prevention of disease states.5

What do you think? Does the benefit of weight loss “outweigh” the possibility of potentially contributing to the development of chronic diseases?

References:

  1. Kant AK, Graubard BI. Within-person comparison of eating behaviors, time of eating, and dietary intake on days with and without breakfast: NHANES 2005-2010. Am J Clin Nutr. 2015;102(3):661-70.
  2. Ho C, Huang Y, Lo YC, Wahlqvist ML, Lee M. Breakfast is associated with the metabolic syndrome and school performance among taiwanese children. Res Dev Disabil. 2015;43–44:179-188.
  3. Levitsky DA. Breaking the feast. Am J Clin Nutr. 2015;102(3):531-2.
  4. Bi H, Gan Y, Yang C, Chen Y, Tong X, Lu Z. Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies. Public Health Nutr. 2015:1-7.
  5. United States Department of Agriculture. Scientific Report of Dietary Guidelines 2015 Advisory Committee. <http://health.gov/dietaryguidelines/2015-scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf>

Weighing in on Liquid Measurement Error

December 5th, 2014

By Bryan Feldmann, PharmD student

If someone were to ask you what the difference was between a teaspoon and a tablespoon, would you know what to say? You might have prescriptions from your doctor or medications you bought over-the-counter that tell you to take a number of tablespoons or teaspoons of the medication. A teaspoon will usually be abbreviated as “tsp” and tablespoon as “tbsp.” Because the two abbreviations look very similar, it can be easy to mix them up at a first glance. This can be a big problem, because it is so important that meds are taken exactly as directed.

You may already know what teaspoons and tablespoons are, but many people do not. Tablespoons and teaspoons are two different units of measurement. Similarly to gallons and liters, teaspoons and tablespoons are both used for determining how much volume something has (in other words, how much space it takes up). You will usually see units of volume used when your medication is a liquid.
So, how do these two similar units of measure differ? To begin, a teaspoon is smaller than a tablespoon. You can remember this by thinking of how big a table is compared to a cup of tea. In fact, tablespoons are three times larger than teaspoons. Now, just think about how dangerous it might be if someone accidentally took three times the amount of drug they were supposed to by mistake. According to a new study published by the American Academy of Pediatrics (medical care of children and teens) there are more than 10,000 calls to the poison control center every year because of errors patients made in how much of a liquid medicine they took.1 Just imagine the horror of the parents and caretakers being forced to call the emergency number because of an adverse reaction to a medication error. Since liquid medications are usually given to children, the study also specifically measured how many times parents made a mistake when pouring medicine for their kids. When they were supposed to measure with either teaspoons or tablespoons, they accidentally measured incorrectly 40% of the time, or 2 out of every 5 times!1 What can be done to fix this?

Teaspoon (tsp) and tablespoon (tbsp.) look so alike it is no wonder people can mix them up, but there is another common way to measure volume— the milliliter, or “mL.” A milliliter looks and sounds nothing like a teaspoon or a tablespoon, so it would stand to reason that people would not confuse it with anything else. There are 5 milliliters (mL) in a teaspoon, meaning there are 15 mL in a tablespoon.2 So milliliters are also useful for being more precise, since not everything must be in multiples of 5 milliliters. In another study, parents who had to measure medications in teaspoons or tablespoons were compared to those who measured in milliliters.3 The parents who were asked to use teaspoons and tablespoons were about twice as likely to make a mistake.3 287 single parents or pairs of parents were studied to get these results.3 This is a very small sample when compared to how many parents there are giving medications to children in the country, so more research should still be done.

Just mixing up the units is not the only reason these forms of measurement are so problematic, however. Many homes have kitchen teaspoons and tablespoons spoons just for measuring in teaspoons and tablespoons, but a study in the International Journal of Clinical Practice showed that the spoons that people have differ drastically from one another and are not accurate.4 Another study, published in the Archives of Pediatric and Adolescent Medicine, which is itself published by the American Medical Association, found that oral syringes and droppers are the best tools to use to measure volume and avoid error.5 300 parents were asked to measure out one teaspoon of acetaminophen with dosing cups, dosing spoons, oral syringes, and droppers. 70% of the parents made an error when it came to using the dosing cups with printed markings, and 50% made an error when using dosing cups with etched markings. More than a third of just these mistakes alone would have been highly dangerous overdoses if this study were not conducted in a controlled environment. According to the Institute for Safe Medical Practices’ reporting on this study, “Parents who make mistakes when using dosing cups are often confused about the differences between teaspoons and tablespoons.”6 Mistakes were only made 6% of the time when using a dropper, 10% of the time when using an oral syringe, and 14% of the time when using a dosing spoon. Keep in mind that a dosing spoon is different than a kitchen teaspoon or tablespoon, in that it is accurately calibrated to hold the amount it purports to, unlike the others, which have been shown to vary from spoon to spoon. So we can rest assured that it would be much safer to measure a number of milliliters in a liquid measuring device such as a dropper instead of simply trusting in one of these spoons. Additionally, it is not very easy to measure the exact amount of medication such that it is lying flat at the brim of the spoon without making a mess. This could be much easier if a dropper or oral syringe was used.

It would be great if milliliters replaced teaspoons and tablespoons on all drug labels over time, but at the moment we will likely continue to encounter all three units of measure. Armed with the knowledge of how much each unit represents and being careful when you’re reading instructions will decrease your chances of committing a liquid medication measurement error. As a future pharmacist, I would recommend always using a measuring cup or another device such an oral syringe over a spoon to measure tablespoons and teaspoons, even if the spoons say they are designed specifically for that purpose. Share these important tips with friends and family and always be careful in order to guarantee positive outcomes for yourself and your loved ones. And if you are a health care provider follow the link here to see ISMP’s recommendations for preventing liquid medication errors.

Have you ever mixed up tablespoons and teaspoons? Have you seen someone else mix them up? What steps will you take to avoid liquid medication mistakes?

References

  1. Schmidt C. Child medication measurements confuse parents. cnn.com  http://thechart.blogs.cnn.com/2014/07/14/child-medication-measurements-confuse-parents/. Published July 14th, 2014. Accessed November 6, 2014.
  1. Teaspoon v. tablespoon: What’s the difference? Ismp.org https://www.ismp/org/consumers/teaspoon.asp Updated 2014 Accessed November 6, 2014
  1. Yin H, Dreyer B, Ugboaja D, et al. Unit of measurement used and parent medication dosing errors. American Academy of Pediatrics. 2014;134(2).
  1. Falagas ME, Vouloumanou EK, Plessa E, Peppas G, Rafailidis PI. Inaccuracies in dosing drugs with teaspoons and tablespoons. Int J Clin Pract. 2010;64(9):1185.
  1. Shonna Yin H, Mendelsohn AL, Wolf MS, et al. Parents’ medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med. 2010;164(2):181-186.
  1. Use an oral syringe or dropper to measure children’s medicines, not a cup.ismp.orghttps://www.ismp.org/newsletters/consumer/Issues/20100105.asp. Published June 2010. Accessed 12/02, 2014.

Lather, Rinse, and Repeat

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.

Electronic cigarettes: effective, or just the new “cool” sensation?

December 1st, 2014

By Samuel Tesfaye, Pharm.D. Student.

Electronic cigarettes (e-cigarettes) are becoming increasingly popular in the U.S. despite lack of evidence regarding their safety.1 According to the National Tobacco Survey, e-cigarette use in both the youth and adult population has nearly doubled from 2011-2012.2 Many smokers of conventional cigarettes are using e-cigarettes as an aid to help them quit smoking. Unlike conventional cigarettes that release smoke, e-cigarettes are battery-powered devices that deliver nicotine through emission of a vapor.3 The vapor within the e-cigarettes is generated by heating a solution made up mostly of propylene glycol or glycerol.1

Several reasons support this increased popularity of e-cigarettes, especially among the youth. E-cigarettes can easily be carried around in the pocket and come in a variety of different flavors, which makes them appealing to the user.3 There is also a “coolness” associated with e-cigarette use likely arising from aggressive advertisement of e-cigarettes on national TV and other social media.3 The lack of the appealing qualities in other treatment methods, such as nicotine patches, offers little incentive for youths to use anything other than e-cigarettes.

Because e-cigarettes are relatively new products, research on the long-term health consequences of these products is lacking. Despite this limitation, a few of the studies conducted have indicated that substances contained in the e-cigarettes are harmful to the body. Propylene glycol, the main ingredient of e-cigarettes, is one example of these harmful substances. When propylene glycol is heated, it forms propylene oxide, which has been linked to respiratory irritation, central nervous system impairment, and even various types of cancer.1

A recent article in JAMA Pediatrics evaluated the benefit of e-cigarettes in helping smokers quit.2 The researchers employed a cross-sectional analysis from the National Youth Tobacco Survey data (NYTS). The NYTS was conducted on a representative sample of US middle and high school students from all 50 states between 2011 and 2012. The number of students surveyed were 17, 353 in 2011 and 22, 529 in 2012. Respondents were asked a series of questions about their cigarette smoking habits and which product(s) they use (conventional, e-cigarette, or both). The researchers found that e-cigarette use did not discourage the use of conventional cigarettes. This suggests that e-cigarettes are not effective in helping smokers quit. Moreover, it was also found that e-cigarettes led to instances of nicotine addiction and an increased risk of switching to conventional cigarette smoking (for those who hadn’t used traditional cigarettes prior to e-cigarettes). This study is not without limitations, however. Because the survey was entirely self-reported, the information obtained may not be valid and accurate due to the fact that those who took the survey may not have been completely truthful. For instance, they may smoke more than what they reported. Additionally, their conclusion cannot be generalized to the general public because the sample only included middle and high school students.

Contrary to the findings in this article, one study has reported that e-cigarettes are effective in helping smokers quit. Some healthcare providers are even recommending e-cigarettes to their patients. A recent study conducted in North Carolina examined physician’s attitude toward the use of e-cigarettes.4 The researchers reported that over two thirds (67.2%) of the physicians indicated that e-cigarettes are a helpful tool for patients wanting to quit smoking.4 More surprisingly, 35.2% of physicians said that they have recommended them to their patients.4 This study tells us that e-cigarettes are gaining momentum not only among the public but also among health care providers.

Smokers wishing to quit have a variety of nicotine replacement therapy products from which to choose, including inhalers, lozenges, chewing gum, and nasal spray.7 Smokers can also use prescription medications such as bupriopion and varenicline, as these medications have been proven to be safe and effective.7 Maintaining a healthy support network is also one way smokers can quit smoking. Socializing with people, exercising, going to movies, and doing outdoor activities can help people quit smoking.8 Seeking professional counselling from a primary care physician or pharmacist might also help smokers quit smoking. Pharmacists can play a pivotal role in helping people quit smoking by providing patients with the health consequences of smoking and the benefits of quitting, as well as assisting the patient is selecting an appropriate nicotine replacement product. Given the number of number of smoking cessation options that have been proven safe and effective, until further research is conducted on the long-term consequences of e-cigarettes and their safety is established, I believe patients should refrain from using these products.

Do you think e-cigarettes might be an appropriate smoking-cessation aid for you, or someone you know who is wanting to quit smoking?

References

  1. Grana, R., Benowitz, N., & Glantz, S. A. (2014). E-cigarettes: A scientific review. Circulation, 129(19) 72-86.
  2. Dutra L, Glantz S. Electronic cigarettes and conventional cigarette use among U.S. adolescents: a cross-sectional study. JAMA Pediatrics [serial online]. July 2014;168(7):610-617. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 24, 2014.
  3. Trumbo C, Harper R. Use and Perception of Electronic Cigarettes Among College Students. Journal Of American College Health . April 2013;61(3):149-155. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 21, 2014.
  4. Kandra, K. L., Ranney, L. M., Lee, J. G., & Goldstein, A. O. (2014). Physicians’ attitudes and use of E-cigarettes as cessation devices, North Carolina, 2013. PloS One, 9(7).
  5. Pepper, J. K., McRee, A., & Gilkey, M. B. (2014). Healthcare providers’ beliefs and attitudes about electronic cigarettes and preventive counseling for adolescent patients. Journal of Adolescent Health, 54(6), 678-683.
  6. S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress. A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2014 October 21].
  7. Electronic cigarettes (e-cigarettes). CA: A Cancer Journal For Clinicians [serial online]. May 2014;64(3):169-170. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 2, 2014.
  8. Glynn, T., & Manley, M. W. (1992). How to help your patients stop smoking: A manual for physicians.DIANE Publishing

Magnesium and physical activity – does it make a difference?

December 1st, 2014

By Matthew Johnson, Pharm.D. Student.

Magnesium is a mineral involved in many bodily functions such as muscle and nerve regulation, blood sugar control, energy production, and the making of proteins.Recommended Dietary Allowance (RDA) is the average daily amount needed to meet the body’s needs of a dietary substance for most healthy people.The RDA for magnesium varies by age and gender. For women 19-30 years old it is 310 mg (men 400 mg). For women aged 31 years and older the value is 320 mg (420 mg for males). A deficiency of magnesium can result in seizures, abnormal heart rhythms, low blood calcium and potassium levels, and muscle contractions/cramps. Furthermore, magnesium deficiency has been linked to both lower physical activity and exercise ability.2  This is even more important for the elderly population because of the impact the aging process has on physical activity.Specifically, the aging population is at greater risk for magnesium deficiency than young people due to low dietary intake, reduced absorption, and a greater amount excreted in stools and urine. It is important to note, however, that excessive magnesium intake from supplements may cause diarrhea, abdominal pain, and/or cramping. Furthermore, intake of amounts greater than 5000mg per day can lead to magnesium toxicity and death. 4

The current standard of care for improving physical activity is sufficient aerobic and muscle-strengthening activities.5  The Center for Disease Control and Prevention recommends for adults 65 years and older to do muscle-strengthening activities that work all of the major groups of muscles (hips, back, shoulders, arms, legs, chest and abdomen) on two or more days per week. Muscle-strengthening activities include lifting weights, resistance band usage, push-ups, sit-ups, yoga, and gardening activities such as digging or shoveling. The CDC also recommends that all adults 18 years and older get either 5 hours of moderate-intensity aerobic activity or 2 hours and 30 minutes of vigorous-intensity aerobic activity. Moderate activity is a 5 or 6 on a 10-point scale in which 0 is defined as sitting and 10 is full effort activity. Vigorous activity is a 7 or 8 on this same scale.

A study recently published in the American Journal of Clinical Nutrition looked at the effects of oral magnesium supplementation on physical performance.3  This study only involved healthy elderly women that were involved in a weekly exercise program. There were two groups of healthy women in the study: one group received oral magnesium supplements of 900mg magnesium oxide/day for 12 weeks while the second group did not receive supplements or any other differences in treatment. The purpose of the study was to see if magnesium supplementation would improve physical performance. Short Physical Performance Battery (SPPB) tests were used in part to examine physical performance. A SPPB test involves checking lower limb activities such as walking and balance. The study found better physical performance in the group taking the magnesium supplements. There were no harmful effects seen in either of the groups. One major factor that limited the results of the study was that it only included healthy elderly women that exercised and so the same results may or may not occur in populations such as adolescents, men, or people that do not exercise. A different study published earlier this year in the Journal of Sports Sciences supports the findings that magnesium supplementation can improve physical performance.6

For individuals seeking to improve physical activity, it appears that magnesium supplements in the appropriate RDA range can be taken to boost physical activity performance.  Have you tried magnesium supplements before? If so, what form did you take and did you notice any differences after taking them?

Sources:

  1. S. Department of Health & Human Services, Nation Institutes of Health, Office of Dietary Supplements. Magnesium Fact Sheet for Health Professionals. http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/ Reviewed November 04, 2013. Accessed October 2014.
  2. Lukaski HC. Magnesium, zinc, and chromium nutriture and physical activity. Am J Clin Nutr. 2000;72(suppl):585S–93S.
  3. Nicola V, Berton L, Carraro S, et al. Effect of oral magnesium supplementation on physical performance in healthy elderly women involved in a weekly exercise program:a randomized controlled trial. Am J Clin Nutr. 2014; 100: 974-981.
  4. Kutsal E, Aydemir C, Eldes N, et al. Severe hypermagnesemia as a result of excessive cathartic ingestion in a child without renal failure. Pediatr Emerg Care. 2007;23:570-572.
  5. Center for Disease Control and Prevention. Physical activity: How much physical activity do older adults needs? http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html. Updated June 17, 2014. Accessed November 2, 2014.
  6. Setaro L, Santos-Silva P, Colli C, et al. Magnesium status and the physical performance of volleyball players: effects of magnesium supplementation. Journal Of Sports Sciences[serial online]. March 2014;32(5):438-445. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed November 12, 2014.

Will treating a fever lead to wheezing?

November 24th, 2014

By Aric Carroll, PharmD Student

A young child is very susceptible to getting sick, and with that sickness often comes fever. How do most parents treat their child’s fever? The answer for the past few decades has been acetaminophen. In many countries around the world, the first line drug approved for treating fever in children is acetaminophen.1 It has been estimated from one study that up to 75% of all children in Western countries are at some time treated with fever reducing drugs such as acetaminophen.2,3 In the United States acetaminophen use without a physician visit is approved for children as young as 2 years old.4,5 In the past decade, a lot of research has looked at a connection between the rise of acetaminophen use and the rise of asthma in young children.6

A recent study from the Journal of Korean Medical Science (JKMS)9 investigated the relationship between acetaminophen use and asthma prevalence, but took it a step further to try to see why acetaminophen use could be associated with the condition of asthma. The study particularly looked at a specific gene for a receptor in the body called toll-like receptor 4 (TLR4). This is one of the first studies to focus on the combination of TLR4 modification and acetaminophen use and the risk of asthma associated with that combination. In past studies, modification of the gene for TLR4 has been associated with a higher prevalence rate of asthma.7 It has been suggested that modification at this particular gene affects how the TLR4 functions. Modifications may cause the body to work harder at dealing with fine particles that are inhaled leading to physical symptoms associated with asthma.8 The authors of the recent JKMS study acknowledge that TLR4 facilitates the symptoms of asthma by contributing to the release of reactive oxygen species, which are molecules that cause excess stress on the body. This excess stress can then lead to the release of cells that cause inflammation, cause the airways to be inflamed, and cause bronchial hyperresponsiveness (BHR) or tightening of the airways. The study suggests that modification of the TLR4 gene could cause the receptor to be more abundant and lead to greater asthma symptoms.9

The study examined 2, 428 children aged between 8 and 13. The parents of each child were asked to fill out a questionnaire, which included questions about whether the child had used acetaminophen, and whether the child had been diagnosed with asthma. Tests were run on each child to determine a forced expiratory volume after a methocholine challenge, which is an indicator of BHR. Methocholine causes constriction of the airways. BHR to methocholine was defined as a PC20 (the concentration of methocholine re-quired to provoke a 20% reduction in FEV1) ≤ 16 mg/mL. Genetic tests were run on each child to determine modification of the TLR4 gene. The results showed that the use of acetaminophen was associated with risk of BHR; however, it was not associated with actual asthma diagnosis. Modification of the TLR4 receptor was not associated with asthma diagnosis or risk of BHR. A combination of acetaminophen use and TLR4 modification was significantly associated with asthma diagnosis as well as risk for BHR. The study concluded TLR4 gene modification may increase the risk of asthma in children who have used acetaminophen.9

While the study had a very large sample size of children, it had limitations that could have affected the study’s results. The study only looked at acetaminophen use in the past 12 months, but did not take into account whether children had used acetaminophen in earlier years. Also, the study looked at patients with a recall of an actual diagnosis of asthma in the children instead of asking about certain symptoms of asthma such as shortness of breath during physical exercise, wheezing, or increased coughing. Many children may have had symptoms of asthma but had never been diagnosed by a physician. The study also did not in any way establish a relationship between dose or duration of acetaminophen use. Acetaminophen use was defined as if they took acetaminophen longer than 3 days in the last 12 months. This was also solely based on patient recall. These limitations are significant and reduced the generalizability of the study. This type of observational study cannot determine a causative relationship. Thus, this kind of research can only suggest potential risks associated with exposure.

While this study, along with others, have evidence to support a relationship between TLR4 modification and asthma, other similar studies have not found this relationship.10 The conflicting evidence on this specific mechanism makes it hard to conclude one way or another whether TLR4 modification is directly linked to asthma symptoms. Also, at this time there seems to be a lack of sufficient evidence to directly link acetaminophen use to asthma symptoms. More prospective research needs to be done looking at acetaminophen use and its relationship with asthma symptoms specifically in combination with TLR4 gene modification. It may be possible that acetaminophen has a greater adverse effect on children who have a TLR4 gene modification which would increase the risk of asthma specifically in those children. With what evidence is available at this time, it is difficult to say that treating a child with acetaminophen will cause them to develop asthma symptoms.

So, what are your thoughts? Even with this possibility of acetaminophen use in children leading to asthma symptoms, do you think it’s still reasonable for acetaminophen to be used to treat a child’s fever?

References

  1. Gonzalez-Barcala F, Pertega S, Silvarrey A, et al. Exposure to paracetamol and asthma symptoms. European Journal Of Public Health [serial online]. August 2013;23(4):706-710. Available from: Food Science Source, Ipswich, MA. Accessed October 15, 2014.
  2. Jensen J, Tønnesen L, Söderström M, Thorsen H, Siersma V. Paracetamol for feverish children: parental motives and experiences. Scandinavian Journal Of Primary Health Care [serial online]. June 2010;28(2):115-120. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed October 16, 2014.
  3. Sullivan J, Farrar H. Fever and antipyretic use in children. Pediatrics [serial online]. March 2011;127(3):580-587. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 16, 2014.
  4. Reducing fever in children: safe use of acetaminophen. FDA Consumer Health Information. http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm263989.htm. Published July 21, 2011. Updated June 6, 2014. Accessed October 15, 2014.
  5. Krinsky, D. L., Berardi, R. R., & Ferreri, S. P. (2011). Handbook of nonprescription drugs: An interactive approach to self-care (17th ed.). Washington, D.C: American Pharmacists Association.
  6. Farquhar H, Stewart A, Beasley R, et al. The role of paracetamol in the pathogenesis of asthma. Clinical & Experimental Allergy [serial online]. January 2010;40(1):32-41. Available from: Academic Search Complete, Ipswich, MA. Accessed October 15, 2014.
  7. Fagerås Böttcher M, Hmani-Aifa M, Vaarala O, et al. A TLR4 polymorphism is associated with asthma and reduced lipopolysaccharide-induced interleukin-12(p70) responses in Swedish children. The Journal Of Allergy And Clinical Immunology. September 2004;114(3):561-567. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 16, 2014.
  8. Kerkhof M, Postma D, Koppelman G, et al. Toll-like receptor 2 and 4 genes influence susceptibility to adverse effects of traffic-related air pollution on childhood asthma. Thorax [serial online]. August 2010;65(8):690-697. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed October 18, 2014.
  9. Lee S, Kang M, Hong S, et al. Association between Recent Acetaminophen Use and Asthma: Modification by Polymorphism at TLR4. Journal Of Korean Medical Science. March 2014;29(5):662-668. Available from: Science Citation Index, Ipswich, MA. Accessed October 10, 2014.
  10. Hussein Y, Awad H, Shalaby S, Ali A, Alzahrani S. Toll-like receptor 2 and Toll-like receptor 4 polymorphisms and susceptibility to asthma and allergic rhinitis: A case-control analysis. Cellular Immunology [serial online]. 2012;274(1-2):34-38. Available from: Science Citation Index, Ipswich, MA. Accessed October 18, 2014.

Flush Out Your Child’s Allergies!

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.