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April 2003

Well, spring has arrived! It was a long, snowy winter, filled with lots of illness. This was our busiest flu and strep season in a number of years. Spring has also brought the beginnings of a complete makeover of our office. Our goal is to bring a nice fresh look that is clean and fun for children of all ages. In the coming months we will be refurbishing the floor and completely redoing our examining rooms. We hope you like it!

Dr. Barenfeld

Allergies--------------------------------------------------

Entertainment News

Oscar has nothing over me, so here are the Doctor awards (my opinions only) for the top movies of the year:

  1. Lord of the Rings
  2. The Emperor's Club
  3. Road to Perdition
  4. Goldmember
  5. Die Another Day
  6. My Big Fat Greek Wedding
  7. Catch Me If You Can
  8. Shanghai Knights
  9. Harry Potter & the Chamber of Secrets
  10. Star Wars

And a few more I enjoyed: 8 Mile, Analyze That, Spy Kids 2, Spiderman, About a Boy & Ice Age.

Springtime. Warm weather . . . birds chirping . . . flowers blooming. People sneezing, wheezing, and coughing. That's right - it's allergy season. Allergic rhinitis (nasal allergy) or hay fever occur secondary to environmental inhalants (i.e. pollens, molds, animals). In the U.S. an estimated 6 million children are affected. Typical symptoms include sneezing, nasal congestion, reddened, itchy and watery eyes and a sensation of clogged ears. It is the complications of allergies that often bring the patient to the doctor. These include chronic ear infections, sinus infections and asthma. Some children become mouth breathers due to chronic nasal obstruction.

A variety of tests can be useful in evaluating the child with allergies. For most patients with typical symptoms no tests are needed. For those children with more severe allergies, and those with allergic complications, 2 tests can be used. Although skin testing may be performed on any child, children less than 1 year old may not have a positive reaction since it may take 2 or more seasons of exposure before the test will become positive. Skin testing can be done using all of the common inhalant allergens including dust mites, animal dander, molds and pollens. Even in the best of hands skin testing is not always reliable. Although skin testing is the preferred method, a blood test (RAST test) may be preferable. The RAST test should be used in children with abnormal skin such as severe eczema, in a highly allergic child in whom a skin test may produce a severe allergic reaction, and in a young child who is uncooperative. Also patients who are taking certain antihistamines should have a RAST test because the skin test reaction will be decreased. The RAST test is much more expensive and less reliable than skin testing.

What is This Thing Called HIPAA And What Does it Mean to Me?

What is it?

HIPAA (the Health Insurance Portability and Accountability Act) is federal legislation passed to protect patients from unwarranted exposure of their private health information. The Privacy rules will go into effect on April 14, 2003. This rule establishes minimum standards for the protection of your (and your child's) health information and gives patients more control as to whom and where this information can be sent.

How Will This Affect Me?

On your first visit after April 14 you will receive a copy of our Notice of Privacy Practices outlining how we will treat and protect the medical information of your child. We will also post a copy of this notice in the waiting room. We will ask you to sign that you did receive this notice.

The main way the new rules could affect you is with the transfer of your child's health information to other parties including schools and camps. We will no longer be allowed to give information with just a phone call. We will need written authorization to do this. To avoid inconveniences we may ask you to sign an authorization to release information to the school for the school year at your child's annual physical. That way we won't have to bother you each time the school needs an update, a note for medication or other information.

As these laws are new and in flux we will try to answer any questions you may have about them.

The most effective therapy for allergic rhinitis is often the most difficult: that is avoidance of the offending allergens. Avoidance of pollen allergy is impossible. Avoidance of household pets by removal may pose a family crisis. However, because all pharmacologic therapy involves expense and risk, avoidance is the preferred treatment.

Dust control in the allergic child's bedroom can be accomplished. (See table)

Dust control in the bedroom
  1. Encase pillows, mattress and box spring in zippered, dust proof covers.
  2. Remove all carpeting. If this is not possible, allergy control solutions may be used.
  3. Avoid heavy curtains and venetian blinds. Use window shades instead.
  4. Substitute wood or plastic for upholstered furniture
  5. Wash blankets in hot water every 2 weeks. Avoid wool and down.
  6. "H.E.P.A." air filters can remove airborne dust particles.
  7. Air conditioners will prevent the heat and humidity which stimulate mite growth.
  8. Keep windows closed during the pollen season.
  9. Dust collectors such as stuffed toys should be removed.
  10. Maintain relative humidity under 50%.

When avoidance measures fail to help symptoms adequately, oral medications are recommended. Initially antihistamines and decongestants should be used. We now have several excellent prescription medications that can be used with a minimum of side effects, even for young children.

If this fails then the use of nasal sprays that control airway inflammation should be used. The advantages and disadvantages of each should be discussed with your physician.

If all this fails then immunotherapy (allergy shots) should be considered. This process involves a series of injections with increasing amounts of specific allergens over a long period of time. Initially shots are given weekly for several months and then decreased over time for up to several years.

©Pediatric Arts of Monroe 1976 - 2004
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