ITEMS IN AFP WITH MESH TERM:
Preconception Health Care - Article
ABSTRACT: Appropriate preconception health care improves pregnancy outcomes. When started at least one month before conception, folic acid supplements can prevent neural tube defects. Targeted genetic screening and counseling should be offered on the basis of age, ethnic background, or family history. Before conception, women should be screened for human immunodeficiency virus and syphilis infection and begin treatment to prevent the transmission of disease to the fetus. Immunizations against hepatitis B, rubella, and varicella should be completed, if needed. Women should be counseled on ways to prevent infection with toxoplasmosis, cytomegalovirus, and parvovirus B19. Environmental toxins such as cigarette smoke, alcohol, and street drugs, and chemicals such as solvents and pesticides should be avoided. In women with diabetes, it is important to optimize disease control through intensive management before pregnancy. Medications for hypertension, epilepsy, thromboembolism, depression, and anxiety should be reviewed and changed, if necessary, before the patient becomes pregnant. Counseling about exercise, obesity, nutritional deficiencies, and the overuse of vitamins A and D is beneficial. Physicians may also choose to discuss occupational and financial issues related to pregnancy and to screen patients for domestic violence.
ABSTRACT: Allergic disease affects millions of persons in the United States. Environmental control measures are essential for persons who are sensitive to dust mite and cat allergens and may be important in persons who are sensitive to cockroaches and fungus. The bedroom is the most important room in which to implement environmental control measures, such as encasing mattresses and pillows in vinyl or semipermeable covers. Patients with asthma (especially persistent asthma) should be considered for allergy testing and more aggressive environmental control measures. Carpet in the bedroom or over concrete should be removed. For persons who are sensitive to pet allergens, permanent removal of the pet is recommended. Dust mite and fungus growth can be controlled by keeping the household humidity level at less than 50 percent. Removing sources of food and water and using insecticides will help control cockroach populations. Patients who are sensitive to mold and outdoor air pollution should consider limiting outdoor activities when these levels are high. Patients with asthma should avoid exposure to tobacco smoke. (Am Fam Physician 2002;66:429-30.)
The Role of Allergens in Asthma - Article
ABSTRACT: The National Asthma Education and Prevention Program Expert Panel guidelines for the management of asthma recommend that patients who require daily asthma medications have allergy testing for perennial indoor allergens and that, when triggers are found, exposure to allergens and pollutants be controlled through avoidance and abatement. For patients whose symptoms are not controlled adequately with these interventions and who are candidates for immunotherapy, the guidelines recommend referral to an allergist. However, the data supporting these recommendations are not consistent. Although there is evidence that simple allergen avoidance measures are ineffective, there is good evidence for the effectiveness of a comprehensive approach based on known sensitization. Thus, allergen avoidance may include removal of pets, use of high-efficiency particulate air filtration and vacuum cleaners, use of allergen-impermeable mattress and pillow covers, cockroach extermination, smoking cessation, and measures to control mold growth in the home. All allergen-specific treatment is dependent on defining sensitization. This can be achieved through serum assays of immunoglobulin E antibodies or skin tests with aeroallergens. Information on sensitization can be used to educate patients about the role of allergens in their symptoms, to provide avoidance advice, or to design immunotherapy.
Health Effects from Pesticide Exposure - Editorials
Latex Allergy - Article
ABSTRACT: Natural latex from the rubber tree Hevea brasiliensis is an allergen in persons with significant cumulative latex exposure, such as those in the health care and rubber industries, as well as those undergoing repeated surgeries, especially if they undergo surgeries early in life. Symptoms of latex allergy may progress rapidly and unpredictably to anaphylaxis. The prevalence of latex allergy has increased as the use of rubber gloves in health care settings has increased. Airborne latex particles that adhere to the cornstarch used to powder gloves are a significant cause of respiratory symptoms and a source of sensitization. Once an individual has become sensitized, he or she may experience allergic symptoms when exposed to any product containing latex. Diagnosis is made initially by the history. Latex-specific IgE testing and skin prick testing may confirm the suspicion. The most effective strategy in the treatment of latex allergy is avoidance; however, there is a large group of sensitized people who have not been identified and who do not recognize that their symptoms are caused by latex allergy. Physicians caring for latex-sensitive persons must act as their advocates in building awareness of the problem and developing protocols for their safe care. Latex-sensitized persons should be educated about the latex content of common objects.
ABSTRACT: Although the cause or causes of sudden infant death syndrome (SIDS) remain unknown, the incidence of SIDS is on the decline in the United States and other countries. This decline has been accomplished largely through public education campaigns informing parents about several important factors associated with an increased risk of SIDS. These factors are prone and side infant sleeping positions, exposure of infants to cigarette smoke and potentially hazardous sleeping environments. Risk-reduction measures such as placing healthy infants to sleep in the supine position, avoiding passive smoke exposure both before and after birth and optimizing crib safety are beginning to lower the SIDS rate in this country. Through patient education, family physicians can further reduce the incidence of the number one cause of death in infants one week to one year old.
Multiple Chemical Sensitivity - Editorials
Lightening the Lead Load in Children - Article
ABSTRACT: More than 4 percent of preschool-aged children in the United States have blood lead levels above 10 microg per dL (0.50 pmol per L), and these levels have been associated with a decline in IQ. The Centers for Disease Control and Prevention advocates the use of a screening questionnaire to identify lead exposure or toxicity in all children. Primary prevention through the removal of lead from gasoline and paint has led to a reduction of blood lead levels in children. Secondary prevention through paint hazard remediation is effective in homes that have a high lead burden. Children with lead levels of 45 to 69 microg per dL (2.15 to 3.35 pmol per L) should receive chelation therapy using succimer (DMSA) or edetate calcium disodium (CaNa2EDTA). Use of both CaNa2EDTA and dimercaprol (BAL in oil) is indicated in children with blood lead levels higher than 70 microg per dL (3.40 micromol per L). Current treatment recommendations are based on the reduction of blood lead levels, which may not represent a significant overall reduction of the lead burden. Clinical trials of existing agents are needed to determine patient-oriented outcomes, such as the effect on IQ.
Radon and Lung Cancer - Editorials