From EatingWell: July/August 2011 A Caribbean-inspired marinade for these chicken-and-pineapple kebabs is flavored with pineapple juice, soy sauce, plenty of spices and spiked with rum. It’s moderately spicy from the use of jalapeño, but not nearly as spicy as the well-known jerk marinade, which uses the extremely hot Scotch bonnet chile. If spicy-hot is not your thing, leave the jalapeño out or use half. The creamy banana salad is a soothing counterpoint, but skip it if you like.
Tuesday, 2 July 2013
Monday, 1 July 2013
Start your Independence Day celebration off on a delicious note with these healthy, easy July 4th appetizer recipes. If you want a patriotic theme, start with our Red, White and Blue Corn Chip Bites, or serve Salsa Rojo with blue corn tortilla chips. Many of these easy July 4th appetizer recipes come together in minutes and call for ingredients you already have on hand. Happy July 4th!
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Robert A. Nathan, MD, is a clinical professor of medicine at the University of Colorado Health Sciences Center and director of the Asthma and Allergy Associates and Research Center in Colorado Springs, Colo. Q: What's the difference between asthma that is due to allergies and asthma that is not?
A: Allergic asthma is an overreactive immunologic response that occurs because a person's body makes too much of an immune system component called immunoglobulin E (IgE). People with allergic asthma are bothered by common allergens like animal dander, dust mites, pollen, mold, or cockroaches, and they are often allergic to more than one of these things.
When a person has asthma that isn't related to allergies, but is instead triggered by factors that act directly on the lungs, such as infections, exercise, cold air, pollution, and stress, they have non-allergic asthma. Many people with asthma have a combination of non-allergic and allergic asthma. Of the nearly 19 million adults in the United States with asthma, about half have asthma that's related to allergies. But just 20% of adults with asthma have symptoms triggered by just allergies alone.
Q: How can you tell if your asthma is due to allergies?
A: First and foremost is the medical history. If a patient says he only has symptoms when he's near a cat or dog, for example, or only during pollen season, it's likely to be due to allergies.
Q: How can you know for sure what's triggering your asthma?
A: Skin tests, also known as 'skin prick tests,' are the gold standard. They involve putting a tiny amount of the allergen into the very top layer of your skin. The area will then swell, itch, and turn red if you are sensitive to that allergen.
Q: Do you need to see an allergist or a pulmonologist to be diagnosed with allergic asthma, or can your primary care doctor do the job?
A: Pulmonologists deal with a myriad of lung diseases, but allergists deal primarily with asthma and other allergic conditions, so they are better prepared to diagnose and treat allergic asthma. Most importantly, we're trying to identify triggers and help the patient understand how to deal with those triggers. The primary care physician may suspect that asthma is related to allergies, but it's the allergist who can confirm the diagnosis by using objective measures, like the skin test.
Q: Is asthma harder or easier to treat if it's due to allergies?
A: Avoidance is the main way to treat any allergic disease. In a way, it's easier to treat allergic asthma than non-allergic asthma, because you can just stay away from the allergen. But this depends on what the allergen is, and how sensitive you are to it. The ace in the hole that patients with allergic asthma have that patients with non-allergic asthma don't have is immunotherapy, or as it's more commonly known, allergy shots. It is potentially curative, whereas medication can only address symptoms.
Q: Does allergic asthma ever get better on its own?
A: While some children will 'grow out of' their allergic asthma once they reach puberty, it's exceedingly rare for an adult's disease to go into remission.
Q: Can allergic asthma be life threatening?
A: It's rare but certainly possible, depending on the extent of exposure, how bad an attack gets, and how long it takes for you to get treatment. Every year, 3,500 Americans die from asthma, and some will have had allergy-induced asthma.
Q: Will allergy shots help? What do they entail?
A: Allergy shots, or immunotherapy, can definitely help, but they're a major commitment. For allergy shots to be effective, a person needs to visit an allergist regularly for several years. And while insurers typically cover immunotherapy, copayment costs can add up.
At first, a person undergoing immunotherapy will go to the allergist once or twice a week, for three to six months, receiving slightly larger amounts of the allergen with each visit. The shot itself is very quick, but patients must wait in their doctor's office for 20 to 30 minutes to see if a reaction occurs. After this initial phase, the patient's visits are spread out to every two to four weeks. This maintenance phase can take two to five more years. A person is considered to be free of an allergy if he or she can go for two years without symptoms, which in essence means not having to take allergy medication.
Q: At what age do people typically develop allergic asthma?
A: Usually symptoms start before age 10, but a person can develop allergic asthma at any point in his or her life. It's rare for someone in their 60s or older to develop allergic asthma for the first time.
Inhalers can be a lifeline for people with asthma. When coughing, wheezing, or shortness of breath occurs, a quick hit of a bronchodilator can often make those symptoms go away. 
In particular, the medications known as short-acting beta2-agonists (a type of bronchodilator) can provide quick relief from asthma symptoms—but they can also be damaging if they are used too often. Using short-acting beta2-agonists too often is a sign that asthma is out of control.
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Nearly one-third, or 28%, of adults and children hospitalized with H1N1, also known as swine flu, have asthma. That’s more than any other chronic condition, according to a recent analysis of cases published in the New England Journal of Medicine. (The next most common complications on the list were diabetes and a weakened immune system, at 15% each.)
“Asthma was the most common underlying medical condition that we saw,” says Seema Jain, MD, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). Dr. Jain’s team analyzed 272 people who were hospitalized with H1N1 for more than 24 hours between April and June.
Twenty-five percent were admitted to the intensive care unit and 7% died. Overall, 29% of children and 27% of in adults in the study had asthma, while only about 8% of the U.S. population has asthma, according to Dr. Jain.
Richard Gower, MD, the president of the American College of Allergy, Asthma, and Immunology, says about 25 million people in the United States have the chronic lung condition, including 8 million children.
Asthma is an accident waiting to happen
Asthma is more common in children than in adults, and swine flu seems to strike younger people more often than older ones—a complete flip-flop from seasonal flu.
In the study, 45% of the hospitalized patients were under age 18, and only 5% were 65 or older. “If you are a young adult and you have asthma, you are in double jeopardy,” says Dr. Gower.
For many people, swine flu symptoms include fever, congestion, and possibly nausea, diarrhea, and vomiting, which are some of the symptoms that differ from seasonal flu. (Seasonal flu rarely causes nausea or an upset stomach). Most of the time, the symptoms can be successfully battled with time, liquids (chicken soup, anyone?), and bed rest.
But for people at high risk, including those with asthma, an H1N1 infection can be a different story.
“Asthma is sort of an accident waiting to happen,” says Dr. Gower, who is also an allergist/immunologist at Marycliff Allergy Specialists, in Spokane, Wash. People with asthma are at risk for breathing trouble with infections in general, not just H1N1.
The lungs of people with asthma tend to bronchospasm, meaning they tighten in response to triggers, such as pollen, pet allergens, bacteria, viruses, or other insults. In the case of an infection like H1N1, the lungs produce mucus in response to the germ, and the mucus can get trapped in the narrow airways, setting the stage for pneumonia.
“You add an insult and it just triples, quadruples, gets 10 times worse very suddenly, and flares the asthma,“ says Dr. Gower. “The bronchospasm occurs and it squeezes the airways dramatically down to narrow, narrow passages—and, in fact, closure—and the mucus that is dramatically increased gets trapped and that’s a setup for pneumonia.”
So what should you be doing about H1N1 if you—or your children—have asthma?
Take your medication
People with chronic asthma often need to take controller medications that fight underlying lung inflammation. The problem is, they need to take this type of medication every day, even if they are feeling fine. It can help protect the lungs from triggers like infections.
But many people forget to take the medicine or skip doses when they aren’t having asthma symptoms.
If you have a young child with asthma, make sure they take their medication as directed, says Dr. Gower. It gets tricky if your child is a teen, because they are notorious for skipping asthma medication, and may lie about it too, he says.
Parents need to talk to teens and explain that although they may have gotten away with skipping asthma drug doses in the past, “this is a brand new ball game,” he says. “They really should raise the threshold of their lungs by taking chronic medicines if they have chronic asthma.”
Dr. Gower also recommends that patients have—and use—a peak flow meter, which is a device that you can blow into to gauge lung function.
“It empowers the patient or the parents,” says Dr. Gower. “Even if the patient says they are doing fine and they are giving their best effort to blow into the peak flow meter and it’s going down and it gets into the yellow zone then into the red zone, that’s a real warning sign that that asthma is getting worse no matter what you are doing.”
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Do you cough, wheeze, or get short of breath when you exercise in cold weather? You could have asthma, but you’ve got plenty of company. Exercise-induced asthma is surprisingly common among people who work out in cold climates, whether they’re jogging around the neighborhood or gunning for gold in Vancouver. This week, for example, Norwegian cross-country skier Marit Bjørgen won the bronze medal in the women’s 10-kilometer race, even though she uses asthma medication. In fact, half of cross-country skiers and one-quarter of aspiring winter Olympians in general have exercise-induced asthma according to a 2000 study of 170 athletes conducted by the United States Olympic Committee.
"Any [exercise] outdoors on a mountaintop is a culprit, but just jogging in Central Park will do it as well," says Len Horovitz, MD, a pulmonary specialist with Lenox Hill Hospital, in New York City. Exercise-induced asthma doesn’t have to slow you down, however. With the right medications and precautions, exercise-induced asthma won’t keep you from your daily workout, or even from competing at an elite level.
How cold and exercise cause asthma
Wheezing, chest tightness, and the other symptoms of exercise-induced asthma generally begin several minutes after you begin working out. For some people, the symptoms start soon after they finish exercising.
"Both cold air and exercise in and of themselves can trigger asthma symptoms, but doing them together is more likely to trigger an exacerbation," says Thomas M. Leath, MD, an assistant professor of pediatrics at Texas A&M Health Science Center College of Medicine.
When the air is dry—as it often is in cold climates during the winter—your lungs can become even more irritated, Dr. Horovitz adds. "The evaporative loss and cooling of the airways triggers the process of bronchial constriction," he says. "One sport you don’t see exercise-induced asthma in so much is swimming. The humidity at water level is such that there isn’t as much evaporation as in running or winter sports." (Chlorine, however, can trigger asthma symptoms, Dr. Horovitz notes.)
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