Focus on Allergy

The media often report about the effect of stress on the immune system. What research supports the idea that certain individuals are more susceptible to stress than others, and how can physicians recognize patients who might be experiencing an immunological response to stress? What mechanisms might link rhinitis, asthma and chronic urticaria to stress? Dr. Gailen Marshall, professor of medicine and pediatrics at the University of Mississippi Medical Center, discusses the fascinating relationship between a patient's mental state and immunity. Dr. Todd Mahr hosts.

More than 40 thousand people, including fire and rescue workers, were exposed to toxic dust in the wake of the attacks on the World Trade Center in New York City in September, 2001. Fast-forward more than a decade, and nearly a quarter of those first responders still have breathing issues. Dr. Norman Edelman, chief medical officer of the American Lung Association, joins host Dr. Shira Johnson to disuss what needs to be done for those who continue to suffer, as well as how children living in nearby neighborhoods have also been affected. The two also look at air quality and allergy and its affect on Americans.

Congenital cytomegalovirus (CMV) infection causes auditory, cognitive and neurologic impairment in thousands of infants each year in the United States. Recognition of infection in pregnant women is difficult because CMV often produces few symptoms, and antiviral treatment during pregnancy may have toxic effects. Could a new experimental vaccine hold the key to preventing maternal CMV infection during pregnancy and decrease the incidence of congenital CMV infection and its sequelae? Host Dr. Jennifer Shu evaluates the progress toward a CMV vaccine with Dr. Robert Pass, professor of pediatrics and microbiology at the University of Alabama at Birmingham School of Medicine. Dr. Pass also explains the proposed mechanism of action for the vaccine.

Despite medical advancements in drugs and delivery devices for asthma and allergy sufferers, some patients are not getting appropriate dosages. But new advances are being worked on that could improve care for many through nanotechnology. Rob Neville, executive chairman of Savara Pharmaceuticals, tells host Bruce Japsen about the use of nanotechnology as an emerging way to administer drugs more effectively for improved respiratory care.

What evidence links gastroesophogeal reflux to worsened asthma, and does prescribing a proton pump inhibitor to patients with asthma help alleviate their asthma symptoms? Dr. Robert Wise, professor of medicine at Johns Hopkins University School of Medicine, discusses the role of proton pump inhibitors for patients with asthma. In patients with poorly controlled asthma and asymptomatic reflux, is a proton pump inhibitor beneficial?

How does a PA handle the situation when a parent does not want to vaccinate their child? Christina Robohm, physician assistant and associate professor of pediatrics at the University of Colorado at Denver, tackles this growing issue with host Lisa Dandrea Lenell. The two discuss how PAs make sure parents receive accurate information in order to make an informed decision whether or not they want their children to receive vaccinations, the pros and cons of not vaccinating, and what it means for other children around them and the community at large. They also look at the controversy over vaccinations and autism.

Vaccines have been described as one of the greatest medical advances in history. Yet some segments of the population view them as a potential vehicle for causing more harm than good to young patients. What led to this change in perception about vaccines, and how can physicians best counsel patients who harbor concerns? For answers to these critical questions and much more, Dr. Jennifer Shu welcomes one of the foremost figures in the debate over vaccine safety, Dr. Paul Offit, chief of the division of infectious diseases and director of the Vaccine Education Center at the Children's Hospital of Philadelphia, and the Maurice R. Hilleman Professor of Vaccinology and a professor of pediatrics at the University of Pennsylvania School of Medicine.

Most parents support the immunization of their kids according to the recommended vaccine schedule. But increasing numbers are choosing to forgo this routine entirely or follow an alternative vaccine schedule. How are these vaccine practices impacting the health of our young patients and more broadly, the health of the general public? Host Dr. Jennifer Shu examines the key questions surrounding the alternative vaccine schedules and how to guide young patients and their families through this process, with Dr. Paul Offit, chief of the division of infectious diseases and director of the Vaccine Education Center at the Children's Hospital of Philadelphia, and the Maurice R. Hilleman Professor of Vaccinology at the University of Pennsylvania School of Medicine.

The incidence of asthma has doubled in the past two decades, though the cause of this rise is difficult to pinpoint. While the hygiene hypothesis has, for years, served as one possible explanation, newer studies show a possible link between asthma and vitamin levels or exposure to certain chemicals or medications. How might this knowledge help us prevent the development of asthma, and what research still needs to be performed to determine the key factors here, and put an end to the increasing incidence of asthma? Dr. Harold Nelson, professor of medicine at the University of Colorado School of Medicine and National Jewish Health hospital in Denver, lays out the evidence for these potential risk factors, from the child's date of birth, to acetaminophen use, to vitamin D levels, to exposure to cleaning sprays and other household chemicals. Dr. Jennifer Shu hosts.

Long-acting, single-agent beta agonists should be used in tandem with a corticosteroid for the treatment of asthma. Despite a black box warning from the Food and Drug Administration (FDA) to this effect, evidence suggests nearly half of our patients do not take these medications together, which appears to result in more severe asthma attacks and an increased mortality risk. In theory, longer-acting beta agonists (LABAs) should help with compliance, but if these single-agent drugs aren't taken as recommended, is there a role for them in the treatment of asthma? Dr. Jesse Joad, professor of pediatrics at the University of California, Davis School of Medicine and a former member of the FDA's Pulmonary and Allergy Drug Advisory Committee, talks with host Dr. Jennifer Shu about the pharmacologic and logistical differences between LABAs taken as monotherapy and LABAs taken in combination with a steroid. Dr. Joad …