President Obama on Measles: ‘You Should Get Your Kids Vaccinated’

In a wide-ranging exclusive interview, President Barack Obama tells TODAY’s Savannah Guthrie parents have “every reason” to get their children immunized against measles and zero reasons against it.

Read the rest of this story at Today.com.

NBC’s TODAY is the news program that informs, entertains, inspires and sets the agenda each morning for Americans. Airing live from 7 am to 11 am ET, TODAY reaches more than 5 million people every day through its broadcast, and millions more through TODAY.com, the TODAY app, and social media platforms. Matt Lauer, Savannah Guthrie, Al Roker, Natalie Morales, Willie Geist, Tamron Hall, Carson Daly, Hoda Kotb, and Kathie Lee Gifford are the anchors and hosts, Jamie Horowitz is the SVP and general manager and Don Nash is the executive producer.

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Workers May Be Afraid to Discuss Job-Related Asthma

TUESDAY, Feb. 3, 2015 (HealthDay News) — Only 15 percent of working adults with asthma discuss with their doctor how their jobs might affect their breathing, even though nearly half have asthma that is possibly work-related, a new study reveals.

The researchers also found that doctors often don’t bring up the topic with patients.

People may be reluctant to talk about work-related asthma because they’re worried about how it might affect their job and income, said the authors of the study published Feb. 3 in the journal Annals of Allergy, Asthma and Immunology.

“Work-related asthma is underdiagnosed and under-recognized,” lead author Dr. Jacek Mazurek, of the U.S. National Institute for Occupational Safety and Health, said in a journal news release.

“A thorough occupational history is critical to first establishing a diagnosis of work-related asthma, and then putting measures in place to prevent further exposure, or to treat it,” Mazurek noted. “Unfortunately, many people may believe that nothing can be done, or may worry about losing their jobs, so are reluctant to address the topic with their doctor.”

The survey included more than 50,000 employed adults with asthma in 40 states and the District of Columbia. For 46 percent of workers with asthma, the condition appeared to be work-related, the researchers said.

“Hundreds of different workplace airborne exposures have been identified to cause or aggravate asthma,” said Dr. Mark Dykewicz, chair of the occupational health committee of the American College of Allergy, Asthma and Immunology.

“Problem exposures may include chemicals, dusts, fumes, insects and animals that are encountered not only in factories, but also farms, offices, medical and research settings,” he explained in the news release. “If someone already has asthma, it can be worsened by airborne substances at work,” Dykewicz added.

Once workplace-related asthma develops, continued exposure to job-related asthma triggers can lead to permanent lung problems, and the risk can increase the longer the exposure continues, according to the news release. Early testing is recommended, the study authors said.

One in 12 U.S. adults has asthma, according to the American Lung Association.

More information

The American Lung Association has more about asthma in the workplace.

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Electronic Devices May Disrupt Teen Sleep, Study Reports

TUESDAY, Feb. 3, 2015 (HealthDay News) — Spending too much time using electronic devices during the day harms teens’ sleep, a new study suggests.

The research included nearly 10,000 Norwegian teens, aged 16 to 19, who were asked how much screen time (computer, smartphone, tablet, video game console, television, MP3 player) they got during the day outside of school, and about the amount and quality of their sleep.

The use of any electronic device during the day and in the hour before bedtime was associated with an increased risk of taking longer than 60 minutes to fall asleep. In particular, the use of a computer, smartphone or MP3 player in the hour before bedtime was strongly linked with taking longer to fall asleep.

It’s important to note, however, that although the study tied use of these devices to sleep problems, it wasn’t designed to prove whether or not the devices actually caused the sleep disruptions.

Dr. Mari Hysing, of the Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health in Bergen, Norway, and colleagues published their findings online Feb. 2 in the journal BMJ Open.

The new study also found that daytime screen use of more than 4 hours was associated with a 49 percent higher risk of taking longer than 60 minutes to fall asleep. In addition, more than 2 hours of screen time after school was strongly linked with taking longer to fall asleep and shorter length of sleep.

On average, the teens said they needed 8 to 9 hours of sleep to feel rested. But the study found that teens who spent more than 2 hours emailing or chatting online had a more than a threefold risk of sleeping less than 5 hours. Teens who got more than 4 hours of any type of screen time were 3.5 times more likely to get less than 5 hours of sleep, according to the study.

When the researchers looked at individual devices, they found that computers had the strongest link with insufficient sleep, and were also the most widely used types of electronic devices.

Multitasking teens who used more than one device were more likely to take longer to get to sleep and to get less sleep than those who used only one device, the study authors noted in a journal news release. And teens who used four or more devices were 26 percent more likely to take an hour or more to fall asleep than those who used one device.

Compared to those who used one device, teens who used two to three devices were 50 percent more likely to sleep for less than 5 hours. Teens who used four or more devices were 75 percent more likely to sleep less than 5 hours a night, according to the study.

The researchers offered a number of explanations for their findings. The use of electronic devices may simply leave less time for sleep, the devices may interfere with sleep by stimulating the nervous system, or the light the devices emit may disrupt the body’s internal clock.

The results show the need to update guidelines on teens’ use of electronic devices, as well as provide guidance for parents on quantity and timing of electronic media use, the study authors said.

“The current recommendation is not to have a TV in the bedroom. It seems, however, that there may be other electronic devices exerting the same negative influence on sleep, such as PCs and mobile phones. The results confirm recommendations for restricting media use in general,” the researchers concluded.

More information

The U.S. National Institute of Child Health and Human Development has more about sleep.

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1 in 5 Younger Diabetics Lacks Good Medical Care, Study Says

TUESDAY, Feb. 3, 2015 (HealthDay News) — One in every five young American adults with diabetes hasn’t seen a doctor in the past 6 months, a new government report indicates.

The study, from researchers at the U.S. Centers for Disease Control and Prevention, also found that those aged 18 to 39 with diabetes were much less likely than older patients to have gotten their blood pressure or cholesterol checked in the previous year.

“Ongoing medical care is recommended for persons of any age who have diabetes in order to manage levels of glucose [blood sugar], obtain preventive care services and treat diabetes-related complications,” wrote the team, led by Maria Villarroel of the CDC’s National Center for Health Statistics (NCHS).

According to the agency, almost one in every 10 American adults (9 percent) has some form of diabetes. Most cases will be type 2, which is often linked to obesity and comprises about 95 percent of diabetes cases. The rest are type 1 disease, which often arises in childhood and occurs when the pancreas cannot produce enough insulin.

To manage diabetes, the American Diabetes Association currently recommends that people visit a doctor every 6 months to help manage fluctuating blood sugar levels. For those with unstable blood sugar, the recommendation is to meet with a doctor more frequently.

The new report looked at 2013 government health data on nearly 3,600 adults with diabetes. It found that adherence to care recommendations rose with age: 81 percent of people aged 18 to 39 had seen a health care professional over the past six months, compared to about 89 percent of those aged 40 to 64, and more than 93 percent of those aged 65 or older.

Medications such as insulin and other drugs can help manage diabetes. Again, the CDC study found that the number of patients taking a diabetes medication rose with age — from about 71 percent of those aged 18 to 39, to 86.5 percent of those over 65.

“Retinal [eye] damage and nerve damage to the feet are diabetes-related complications that contribute to major [illness] and disability among adults with diabetes,” the CDC team also noted. Twice-a-year doctor exams are recommended to spot such problems. But the research showed that young patients were much less likely to have consulted with either an eye or foot doctor over the past year, compared to older patients.

One expert noted that those kinds of complications are what makes diabetes so deadly in the long run.

“All of these complications are the main reasons why diabetics are more likely to get heart attacks, strokes, amputations, blindness and dialysis, just to name a few,” said Dr. Maria Pena, director of the Center for Weight Management at North Shore-LIJ’s Syosset Hospital, in Syosset, N.Y. “Development of these dreaded complications is what leads to impaired quality of life and life expectancy, as well as adding to our health system’s financial burden.”

But regular doctors’ visits could bring big health payoffs for young people with diabetes, Villarroel’s team said. Increasing rates of compliance with recommended care when a patient is still young “may favorably impact health outcomes and quality of life in later years,” the researchers wrote.

Another expert said that, while more needs to be done, more younger patients with diabetes are getting care than in decades past.

However, Dr. Gerald Bernstein added that the new statistics only look at the “tip of the iceberg,” because “underneath are millions of people with pre-diabetes, most of whom are not diagnosed.”

Bernstein directs the diabetes management program at Mount Sinai Beth Israel Hospital in New York City. “During the pre-diabetic phase there is festering deterioration, especially the cardiovascular system, so that by the time the diagnosis of clinical diabetes is made, many already have impairment that was preventable,” he said.

“If we don’t prevent the diseases, there will be serious medical and economic consequences,” he said.

The study was published online Feb. 3 in the NCHS Data Brief.

More information

You can find out more about type 1 and 2 diabetes at the American Diabetes Association.

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Seniors Need 2 Pneumonia Vaccines, CDC Advisory Panel Says

By Steven Reinberg

HealthDay Reporter

TUESDAY, Feb. 3, 2015 (HealthDay News) — Adults 65 and older need two vaccines to better protect them from bacterial infection in the blood (called sepsis), meningitis and pneumonia, according to a revised vaccination schedule from the 2015 Advisory Committee on Immunization Practices (ACIP).

The ACIP is the vaccine advisory panel for the U.S. Centers for Disease Control and Prevention.

Such infections are caused by pneumococcal bacteria, and older people have an increased risk of life-threatening infection from these bacteria.

“All adults aged 65 years or older should talk to their health care providers about getting pneumococcal vaccines for protection against pneumococcal diseases,” said Dr. David Kim, the CDC’s deputy associate director for adult immunizations.

The new recommendations were published in the Feb. 3 Annals of Internal Medicine.

The committee recommended that seniors get both the Prevnar 13 and the Pneumovax 23 vaccines. As their names imply, Prevnar 13 protects against 13 types of pneumococcal bacteria, and the Pneumovax 23 protects against 23 types of pneumococcal bacteria.

Why not just get the vaccine that covers more strains? Because the two vaccines work in different ways, which appears to offer broader protection, according to Dr. Sandra Fryhofer. She is an adjunct associate professor of medicine at Emory University School of Medicine in Atlanta and author of an accompanying editorial in the journal.

Additional protection is especially important for older adults because they’re much more vulnerable to serious infections, she noted.

“The risk of invasive pneumococcal disease in older adults is nearly 10 times that of young adults,” Fryhofer said.

According to the National Foundation of Infectious Diseases (NFID), about 1 million U.S. adults get pneumococcal pneumonia every year. As many as 7 percent die from these infections. Although fewer people get pneumococcal meningitis or sepsis, the death rate is higher — 10 percent or more, according to the foundation.

Overall, pneumococcal pneumonia, meningitis and bloodstream infections kill tens of thousands annually in the United States. Of those deaths, 18,000 are adults ages 65 and older, the foundation said.

Pneumococcal disease is also responsible for serious illness and complications that may last a lifetime. These complications include heart problems, hearing loss, seizures, blindness and paralysis, the foundation said.

Fryhofer said that since these new recommendations come from the CDC’s vaccination committee, both vaccines should be covered by health insurance companies. And, as of Feb. 2, Medicare should cover them as well.

However, both shots must be given at different times.

“These vaccinations cannot be given at the same time, because they induce an immune response in a different way,” Fryhofer said.

For older adults, the Prevnar 13 vaccine is generally given first and then the Pneumovax 23 vaccine 12 months later, she said.

If someone has already had the Pneumovax 23, they can get the Prevnar 13 immunization 12 months later, according to the editorial.

More information

For more information on pneumococcal vaccine, visit the U.S. Centers for Disease Control and Prevention.

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Greek Fiscal Crisis Tied to Rise in Suicides

MONDAY, Feb. 2, 2015 (HealthDay News) — Economic crises and government cost-cutting may have prompted sharp spikes in suicides in Greece between 2008 and 2012, a new study suggests.

Researchers found a 13 percent rise in suicides among men beginning in October 2008, when Greece’s economy took a sharp turn for the worse.

A 36 percent, sustained increase in suicides among men and women occurred in June 2011, when the Greek government passed unpopular spending cuts, which were followed by bank closures and strikes that halted most public services, according to the study.

“Suicides closely followed the announcements of specific government economic programs in Greece, and grew to their highest levels in 2012 as economic austerity measures and public outcries accumulated in number and scale,” senior study author Charles Branas, a professor of epidemiology at the University of Pennsylvania’s School of Medicine, said in a university news release.

The sustained increase in suicides was larger among women than among men, a finding that challenges previous research showing that economic problems lead to larger increases in suicides among men, not women, the study authors said.

The researchers also found a large, but temporary, 30 percent rise in suicides in April 2012, after the highly publicized suicide of a male pensioner in Athens’ main square. That suicide was believed to be linked to government austerity measures.

The researchers noted that there was a sudden, but temporary, 27 percent fall in suicide rates among men in Greece when the country began using the Euro currency in January 2002. That suggests that positive economic news can have a positive impact on mental health, according to the authors of the study published online Feb. 2 in the BMJ Open.

“Tragically, the impact of austerity measures on suicides is more significant and lasting than prosperity-related events, such as the launch of the Euro in Greece, and appears to affect both men and women, though the trend is more pronounced in men,” Branas said.

The study only showed an association between fiscal crises and suicide rates, not a cause-and-effect link.

More information

The U.S. Substance Abuse and Mental Health Services Administration offers tips for dealing with tough economic times.

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Beyoncé Launches Vegan Meal Delivery Service With Her Trainer

Photo: Getty Images

Attention, all the vegan ladies—Beyoncé and her trainer recently announced they’re launching a vegan meal delivery program.

After participating in the 22 Days Nutrition challenge with husband Jay Z in 2013, Beyoncé was inspired to team up with her trainer Marcos Borges, also the company’s founder, for the meal service.

The meals, which range in price from $9.76 to $16.50, are entirely plant-based and do not include gluten, soy, dairy, or GMOs.

“I am so grateful that I took the challenge and credit Marco with leading by example,” Beyoncé said in a statement. “He came up with a great program to get people motivated to make better nutritional choices. All you have to do is try. If I can do it, anyone can. I am excited to partner with him.”

This article originally appeared on Time.com.

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Many Americans Face Pain, Depression in Their Final Year

By Amy Norton

HealthDay Reporter

MONDAY, Feb. 2, 2015 (HealthDay News) — For a growing number of Americans, the final year of life is marked by pain, depression and other distressing symptoms, a new study finds.

Experts said the study, published Feb. 2 in Annals of Internal Medicine, highlights disturbing shortcomings in the U.S. health care system.

Researchers found that between 1998 and 2010, the number of Americans who suffered pain in their last year of life rose from 54 percent to 61 percent.

Meanwhile, the prevalence of depression rose from 45 percent to 57 percent, while other symptoms — such as breathlessness, confusion, severe fatigue and incontinence — either increased or did not improve.

“These findings are troubling,” said senior researcher Dr. Karl Lorenz, of the Pardee RAND Graduate School and the University of California, Los Angeles.

The increase in end-of-life symptoms, Lorenz said, has occurred despite national efforts to improve end-of-life care, dating back to the 1990s.

Those efforts have made a difference. The number of Americans in hospice care doubled between 2000 and 2009, the study noted. Hospice care focuses on easing symptoms and improving quality of life for people with a terminal illness.

But often hospice care isn’t offered until the last few weeks or days of life, Lorenz said.

“It’s often ‘tacked on’ to more-intensive care,” he said.

However, another expert said the findings are not actually about the typical American’s final year of life — because many people with chronic diseases are suffering these symptoms long-term.

“I think the findings are very valid, but the conclusions about what they mean are not,” said Dr. Sean Morrison, who directs the Hertzberg Palliative Care Institute at Mount Sinai Icahn School of Medicine in New York City.

“I think you’d see a high prevalence of these symptoms if you looked at older adults’ last two years of life, or last three, or last five,” Morrison said.

The issue, he said, is that more and more Americans are living longer with chronic ills — from heart and lung disease, to painful arthritis, to Alzheimer’s disease. At the same time, the health care system has grown increasingly specialized and “organ-specific,” with less focus on primary care.

“We’re doing a very poor job addressing the multiple health conditions so many older Americans have,” Morrison said. “We’re focusing on treating organs, and not on improving people’s quality of life.”

Morrison said the health care system — including medical schools — needs to pay much more attention to palliative care.

Palliative care refers to therapy that focuses on easing physical or psychological symptoms, rather than curing a disease. Hospice care, which is intended for people with a limited time to live, is one form of palliative care.

Other forms, though, can start as soon as a serious medical condition is diagnosed, and given along with treatments aimed at battling the disease. Usually, a team of providers, including nurses, nutritionists and social workers, is involved.

But Morrison said that to many people, including doctors, “palliative” is synonymous with dying. So it’s often not offered, even if it’s locally available.

“Other research shows that the overwhelming majority of Americans do not have access to high-quality palliative care,” Morrison said.

The current findings are based on a periodic health survey of older Americans. Between 1998 and 2010, slightly more than 7,200 study participants died, and their family members were asked about symptoms their loved one had suffered in the last year of life.

Over time, problems like pain, depression, periodic confusion and incontinence grew more common. Other symptoms, such as fatigue and severe weight loss, held fairly stable.

Lorenz said part of the increase could be due to awareness. More doctors may be asking family members about those symptoms — which would be a good thing, he said.

But the fact that pain and other distressing symptoms are so common is disturbing, he said.

Morrison agreed. “This really is an indictment of the health care system,” he said. “And the public should be outraged.”

He and Lorenz suggested that older adults ask their doctors about any palliative services available for their symptoms — at any point in the course of a disease.

Medicare covers hospice care, and many Medicare Advantage plans pay for other palliative services, Morrison noted.

But relatively few research dollars, he added, go into palliative care. “We invest so much in finding disease cures,” Morrison said. “We should also be investing in making life better for the people living with these diseases right now.”

More information

The Center to Advance Palliative Care has resources for finding palliative care.

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Are Too Many Heart Failure Patients Getting IV Fluids?

MONDAY, Feb. 2, 2015 (HealthDay News) — Potentially harmful intravenous (IV) fluids are being given to too many patients with severe heart failure, a new study suggests.

As researchers from Yale University explained, heart failure patients in the hospital typically receive drugs called diuretics to prevent excess fluid buildup and to improve their symptoms.

However, many will also receive IV fluids early in a hospital stay. This influx of IV fluids to heart failure patients may actually worsen their condition, the investigator said.

In the study, a team led by Dr. Behnood Bikdeli, a research scholar at Yale University’s Center for Outcomes Research and Evaluation, looked at data from more than 130,000 hospitalizations of severe heart failure patients.

All of the patients received IV fluids during their first two days in hospital, and more than 11 percent were treated with IV fluids in addition to diuretics.

That’s “a big number,” Bikdeli said in a university news release.

Compared to those who received diuretics alone, patients who received diuretics and IV fluids were more likely to have serious problems such as a need for feeding tubes, dialysis, and admission to a critical care unit, the study found. They were also more likely to die.

While it’s not known if IV fluids actually caused these problems, the findings point to the need for further investigation, the researchers said.

“Our findings are surprising and provocative,” Bikdeli said. “We need to better understand who these patients are, why they received intravenous fluids, and whether use of intravenous fluids was the cause of their worse outcomes. In the interim, it would be helpful for hospital administrators to promote policies that help reduce inadvertent use of intravenous fluids for patients with heart failure.”

Two experts said the results were unexpected and deserved further research.

“This is a surprising and concerning finding,” said Dr. Robert Pilchik, chief of the division of cardiology at Northern Westchester Hospital in Mount Kisco, N.Y.

“Patients in acute heart failure are fluid-overloaded, and the whole point is to assist the body in eliminating that excess fluid,” he said. “Why would you give the patient more fluid? It defeats the purpose.”

Pilchik noted that the study did not include “those patients whose blood pressure and heart rate were stable, thus eliminating the small percentage of acute heart failure patients who might actually benefit from the administration of small amounts of additional fluid, albeit given cautiously and slowly.”

Dr. Justine Lachman is director of the Congestive Heart Failure program at Winthrop-University Hospital in Mineola, N.Y. She called the findings “important.”

“When hospital staff members observe common conditions associated with heart failure — such as low blood pressure or worsening kidney function — one of the most common reactions medical staff have is to administer intravenous fluids,” Lachman explained.

“Regretfully, it seems like trying to apply standard therapy that would benefit the average patient is detrimental to a heart failure patient,” she said.

The study was published Feb. 2 in the Journal of the American College of Cardiology: Heart Failure.

According to the U.S. Centers for Disease Control and Prevention, about 5 million Americans have heart failure.

More information

The American Academy of Family Physicians has more about heart failure.

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When It Comes to Jogging, Easy Does It, Study Suggests

By Kathleen Doheny

HealthDay Reporter

MONDAY, Feb. 2, 2015 (HealthDay News) — A little jogging is good for your health, researchers say, but too much might not be.

“In this study, the dose of running that was most favorable for reducing mortality was jogging 1 to 2.4 hours per week, with no more than three running days per week,” said study researcher Jacob Marott of the Frederiksberg Hospital in Copenhagen, Denmark. The best pace was slow or average — about 5 miles per hour, he added.

Out of a pool of about 5,000 healthy Danish adults, Marott and his colleagues followed nearly 1,100 healthy joggers and 413 sedentary people for more than 12 years. The joggers noted their hours and frequency of jogging, and their perception of their pace.

The strenuous joggers, the investigators found, were as likely to die during that time period as the sedentary non-joggers. Light joggers and moderate joggers fared better, in that order, Marott’s team found.

The findings were released online Feb. 2 in advance of publication in the Feb. 10 print edition of the Journal of the American College of Cardiology.

What is it about strenuous running that might be harmful? “We believe that long-term strenuous endurance exercise may induce pathological structural remodeling of the heart and large arteries,” Marott said.

However, a U.S.-based researcher said the debate about the optimal dose of running for longevity is far from resolved.

The new study has limitations, said D.C. (Duck-chul) Lee, an assistant professor of kinesiology at Iowa State University, who co-authored an editorial accompanying the study.

In Lee’s own study of 55,000 adults, including more than 13,000 runners, he found a lower risk of death over the follow-up period in joggers with the highest running time and frequency — nearly three hours a week and at least six times a week — compared with non-runners. It was published in 2014, also in the Journal of the American College of Cardiology.

In the Copenhagen study, joggers self-reported their pace. Even the slow joggers were getting vigorous exercise, the researchers said.

“The reported pace was not an absolute pace in miles per hours, but the subjects’ own perception of pace as slow, average or fast,” Marott said. He said that’s more appropriate than an absolute scale when the age range is as wide as it was in their study (ages 20 to 95). In general, however, the slow or average pace was about 5 miles per hour or a 12-minute mile, and the fast pace was 7 miles per hour or about an 8-minute mile, he said.

In the United States, about 54 million people run regularly, according to background information with the study. In 2013, more than 540,000 people finished a marathon (26.2 miles), and nearly 2 million completed a half marathon.

One limitation of the current study, Lee said, is that a very small group logged the most jogging time. Just 47 joggers put in more than four hours a week, and only 80 ran more than three times a week. These small numbers could have affected the comparisons and results, Lee said.

Also, the researchers didn’t look at more than 3,500 active non-joggers who exercised in other ways, Lee said. The researchers looked only at death from all causes, he said, instead of looking to see if high jogging miles and times affected certain causes of death, which could have given more specific information about potential harms.

“More [running] may be worse only in cardiovascular disease,” he said. In another assessments on the effects of running and death rates, Lee’s group found that death from all causes was lower in runners compared with non-runners, regardless of how much they ran, but there was a slight trend for less benefit from higher doses when compared with lower doses.

The study’s good news, Lee said, is that the researchers found benefit even in jogging less than an hour a week, or even once a week, compared to not jogging at all. Perhaps this will motivate sedentary people to get moving, he said.

Although the study by Marott and colleagues found an association between light jogging and improved survival rates, it did not prove a cause-and-effect relationship.

“Basically, the study still shows it’s a much better option to

prescribe some form of running as a part of a healthy lifestyle and

that sedentary behavior is not a prescription for long-term health and

mortality,” said Dave Watt, executive director of the American

Running Association and the American Medical Athletic Association.

More information

For tips on starting to exercise, see the American Heart Association.

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New Guidelines for People With Nasal Allergies

By Alan Mozes

HealthDay Reporter

MONDAY, Feb. 2, 2015 (HealthDay News) — For the one in six Americans bothered by nasal allergies, new guidelines have been issued to help doctors diagnose and treat their sniffles and sneezes.

The recommendations from the American Academy of Otolaryngology-Head and Neck Surgery Foundation spell out the do’s and don’ts for treating what’s formally known as “allergic rhinitis,” and often called hay fever.

“What we’re really talking about are allergies that are found all year-round and in every environment, whether urban or rural,” said guideline assistant chair Dr. Sandra Lin, an associate professor in the department of otolaryngology-head and neck surgery at Johns Hopkins School of Medicine in Baltimore.

“This is a really common problem for millions of Americans,” Lin said.

Allergy testing tops the “do” list; sinus imaging is a “don’t” for people with signs of hay fever, and the desensitization process known as immunotherapy can be recommended when other methods fail, the guidelines say.

The recommendations for those ages 2 and up appear in the Feb. 2 issue of Otolaryngology-Head and Neck Surgery.

Nasal inflammation caused by inhaling allergens can create a miserable combination of nasal congestion, itching, drainage and sneezing. There are constant triggers, such as mold, dust and dust mites; occasional triggers, such as dogs or cats; and seasonal concerns, such as pollen, the experts note.

“[Allergic rhinitis] comes in a wide range of symptoms, severities, type and frequency. What we’ve done here is develop recommendations based not only on specialists, but also the point of view of primary care doctors, pediatricians, internal medicine physicians, and patients themselves,” Lin said.

Medication management can help, she said. “We have excellent medications available to us, as opposed to generations before, and most have very low side effects,” Lin said. “It’s just a matter of choosing what is best for an individual patient.”

Key recommendations follow:

• For patients with a stuffy nose, nasal passage discoloration, and/or red and watery eyes, doctors should forgo sinus imaging process in favor of “specific IgE screening.” This involves exposing either skin or blood samples to a series of possible allergen triggers to definitively diagnose allergic rhinitis and its causes.


• “Environmental controls” for dealing with problematic triggers could include use of chemical agents to kill dust mites, installation of air filter systems, using bedding with allergen-barriers, or even saying goodbye to Fido.


• For people whose quality of life is affected by nasal allergies, other treatments include nasal steroid sprays taken alone or in combination with newer antihistamines, which are less likely to cause drowsiness than earlier versions.


• Drugs such as zafirlukast (Accolate) and montelukast (Singulair) — known as oral leukotriene receptor antagonists — are not advised as a first-line treatment for hay fever.


• Immunotherapy — either desensitization shots or under-the-tongue pills — are an option when medication and environmental controls don’t work well.


• Nasal surgery called turbinate reduction should be offered only when medical management fails.


• Acupuncture can be suggested to patients who want to avoid medications. Herbal supplements were not addressed.

Immunotherapy, which involves placing patients on a carefully controlled and slowly increasing regimen of allergen exposure, may be the treatment approach of the future. The natural immune response that ensues can dramatically reduce or even eliminate allergy symptoms in some people, Lin said.

“The degree of response varies, but I have patients who were never able to enter a house with a cat before immunotherapy, and now they can be there for a few hours,” said Lin. “And with the approval of [under-the-tongue] tablets in April, we now have an easier way of delivery that will be more comfortable for many patients, particularly children. That’s exciting.”

Dr. William Reisacher of New York City is also enthusiastic about immunotherapy.

“I think we’ve really maxed out on new meds,” said Reisacher, an associate professor of otolaryngology at New York Presbyterian/Weill Cornell Medical College.

“But what’s going to happen with immunotherapy in the next five to 10 years is going to be amazing,” Reisacher added. “We’re understanding more and more about inflammation on the cellular level, and we have powerful new desensitization tools coming down the pike and many more ways to deliver it, with skin patches, drops, tablets and even toothpaste.”

Immunotherapy now, he said, “is sort of a last resort, more or less. But it won’t be that way in the very near future.”

More information

There’s more on nasal allergies at the American Academy of Otolaryngology-Head and Neck Surgery.

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