Cold and flu season

December 20th, 2011

We are in the thick of it now.
So how many “colds” are too many? The answer is most definitely not the same for every person. An elementary school teacher or child who attends school (or has siblings who attend school) will have more frequent viral upper respiratory infections than an empty nester with an office job involving infrequent person to person contact. The average US grade school age child is exposed to 6-9 distinct upper respiratory viruses per cold and flu season. Most of these infections are mild, some even unrecognized by the child or a parent. Others may result in prolonged symptoms of coughing, nasal congestion, sore throat, low fevers, and occasionally gastrointestinal symptoms (i.e. adenovirus). The most common trigger for an asthma exacerbation in a child is a viral infection–the common cold virus being the primary culprit (rhinovirus). Although these viruses are similar each year, dozens of distinct strains exist around the world, resulting in incomplete immunity even after decades of exposures.
Some children progress from frequent viral upper respiratory infections to sinusitis, bronchitis, pneumonia, and otitis media (ear infections) more frequently than the average child. These children may need additional work up for immunodeficiency, allergies, asthma, adenoid hypertrophy, and (rarely) cystic fibrosis.
We often hear the complaint that despite a flu shot, “I get sick every year anyway!” You’re right! The flu shot only improves protection against influenza, which is one of MANY viruses that circulate in our community each season.
Do viruses have a protective effect in small children in terms of allergy and asthma onset? The jury is still out on this question, with significant ongoing investigation in basic and clinical science that should help us understand the answer in the near future. Some data suggest that early life viral infections may reduce the incidence of respiratory allergies. Other studies signal a specific increase in asthma onset due to a small handful of viruses if exposure occurs at key time points during infancy (especially rhinovirus, RSV, and possibly metapneumovirus). Stay tuned on this question!
Kevin Parks MD

Nasal saline irrigation

December 19th, 2011

Does it work for allergies?
The data are mixed, but one thing we do know… it can’t hurt. Or can it? A recent story hit major news outlets linking Neti Pot use to Primary Amoebic Meningoencephalitis (PAME), which can be fatal. 2 patients who used tap water in the Southern US (a key point) may have acquired the amoeba during nasal saline irrigation using a Neti Pot with tap water. Though unconfirmed, these would be the first documented cases of PAME via treated municipal water. The organism of concern, Naegleria fowleri, is typically acquired through recreational activity in natural water sources–usually lakes in the Southern US.  When I was  a resident at UNC Chapel Hill, we had one case of an unfortunate boy with PAME who passed away shortly after swimming in a local lake. The amoeba is typically introduced through forced water into the nose/sinuses (i.e. diving, water-skiing, etc.) in bodies of standing water.
Reasons this is unlikely in Southern Oregon:
1. Naegleria fowleri infection has not been documented as a result of participation in water sports in local lakes.
2. If you follow the instructions on your Neti Pot or Sinus Rinse bottle and use DISTILLED WATER, you can’t acquire the amoeba.
3. We have no community reports of any amoebic disease as a result of municipal water supplies in Southern Oregon. If you have a well, you should have it evaluated periodically for microorganisms and metal content.

The bottom line is, allergic rhinitis sufferers benefit from regular nasal saline irrigation using a buffered solution in conjunction with allergen avoidance strategies, appropriate use of medications, and allergen-specific immunotherapy in select cases. Talk to us about this at your next visit if have additional questions.
Kevin Parks MD