Posts
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The following is a response to actor Jim Carrey following his TV appearance with his wife (and former Playboy bunny) Jenny McCarthy and his very vocal assertions that vaccines cause, or are a causative agent of autism. Mr. Carrey, and especially his wife, have been very outspoken about their belief that vaccines, or a component of vaccines, are associated with autism.
This idea was first proposed by a British doctor who published a "study" allegedly proving that vaccines (specifically the MMR) caused autism. This article has since been proven to be a fake: 10 of the article's co-authors have admitted that they faked their numbers because they were silently being paid by a legal firm that wanted to file a class-action lawsuit. The main author of the study has had his license to practice medicine stripped by Great Britain because of the gross fraudulence involved in the study.
No controlled, double blinded study has EVER linked ANY vaccine with autism and every major health organization in the world (not just the US) has come out in support of vaccinations, and all of them have stated that all evidence is conclusive that vaccines are NOT associated with autism in any way.
Autism, which in reality is a group of different but related problems, is a genetic entity. I can understand that Ms. McCarthy has difficulty accepting that she may have contributed genetically to her child's problems, and that it is FAR more convenient to blame the evil vaccine industry, but facts are facts.
Don't be mislead by emotion, no matter how powerful. Listen to the facts. And now, back to our "discussion" with Jim Carrey.
Jim Carrey And The Autism Argument
By Kevin Leitch , Parent and Autism Activist - April 22, 2009
Today on The Huffngton Post, actor Jim Carrey posted his thoughts about autism and vaccines. With his very first paragraph it became apparent how little Carrey understood the issues involved:
Recently, I was amazed to hear a commentary by CNN’s Campbell Brown on the controversial vaccine issue. After a ruling by the ‘special vaccine court’ saying the Measles, Mumps, Rubella shot wasn’t found to be responsible for the plaintiffs’ autism, she and others in the media began making assertions that the judgment was in, and vaccines had been proven safe. No one would be more relieved than Jenny and I if that were true. But with all due respect to Ms. Brown, a ruling against causation in three cases out of more than 5000 hardly proves that other children won’t be adversely affected by the MMR…
Point one Mr Carrey. The vaccine issue is only controversial to adherents of your belief system. Within scientific, medical, legal, autistic and parental circles its not even slightly controversial.
Point two, the three cases chosen were chosen – by the plaintiffs legal team – to represent their absolute best chance of winning. If they had won, there was an excellent chance all the cases that were suggesting MMR as causation would have just ‘won’ automatically. Thats why its called an Omnibus.
Point three, regarding the MMR, it has been firmly established that:
a) The data supporting the MMR hypothesis was fixed.
b) The science supporting the MMR theory was badly wrong – both badly done and exposed to contaminants.
You might also note that the court was not attempting to see if the children were ‘adversely affected by the MMR’, it was looking to see – using the three cases the legal team representing the families thought were the absolute best – if MMR caused autism. It didn’t. Thats probably why your Campbell Brown found it easy to say the MMR hypothesis was dead and buried.
You go to say Mr Carrey that:
Not everyone gets cancer from smoking, but cigarettes do cause cancer. After 100 years and many rulings in favor of the tobacco companies, we finally figured that out.
Yes, we did – and do you know how? With good science – just like the science that established in the three MMR test cases that the MMR didn’t cause autism. And its fascinating that you bring up this parallel to the smoking issue and then later in your blog post invoke the name of Bernadine Healy. Healy – who’s ‘more sensible voice’ you say you’d rather listen to. Did you know Healy used to be a member of TASSC:
TASSC was created in 1993 by the APCO Worldwide public relations firm, and was funded by tobacco company Philip Morris (now Altria)....
According to Sheldon Rampton and John Stauber in their article How Big Tobacco Helped Create “the Junkman”, one of the forerunners of TASSC at Philip Morris was a 1988 “Proposal for the Whitecoat Project,” named after the white laboratory coats that scientists sometimes wear. The project had four goals: “Resist and roll back smoking restrictions. Restore smoker confidence. Reverse scientific and popular misconception that ETS (passive smoking) is harmful. Restore social acceptability of smoking.”
Is that what you consider a sensible voice Mr Carrey? Someone who supported the tobacco agenda?
Moving on, you say:
If we are to believe that the ruling of the ‘vaccine court’ in these cases mean that all vaccines are safe, then we must also consider the rulings of that same court in the Hannah Polling and Bailey Banks cases, which ruled vaccines were the cause of autism and therefore assume that all vaccines are unsafe. Clearly both are irresponsible assumptions, and neither option is prudent.
First and foremost, the vaccine court did not rule at all in the Hannah Poling case. HHS conceded. And what they conceded was that Hannah Poling was damaged by vaccines resulting in ‘autism like features’. In fact, when we look at the the one piece of medical science carried out on Hannah Poling (co-authored by her own father), we see that only three of the symptoms described as being the result of vaccine injury appear on the DSM (IV) diagnostic criteria for autism.
As for Bailey Banks, this is a perfect illustration of both how the vaccine court in the USA was designed to work and also how terrible the evidence was in the three MMR test cases.
The Banks ruling (subtitled ‘Non-autistic developmental delay’ by the way) drew a line of causation from vaccine to PDD-NOS. It is able to do this as the burden of proof for any science presented to the vaccine court is ‘50% plus a feather’. In other words, it just has to be plausible, no causation needs to be shown.
What doesn’t seem in doubt is that Bailey was injured by a vaccine which resulted in a condition called ADEM. The judge in the case then went on to accept the plaintiffs position that the ADEM in turn caused PDD-NOS. He did this seemingly because there was no evidence to the contrary – e.g. no evidence that ADEM doesn’t cause PDD-NOS.
In any scientific situation – including civil court in the US - this would never have been accepted. The plaintiff would have had to have demonstrated that ADEM did cause PDD-NOS. And a search of PubMed reveals nothing for ‘ADEM autism’ or ‘ADEM PDD’.
So, in the Banks case, because there was no evidence that ADEM does not cause PDD-NOS, they won. In every situation bar the vaccine court, the Banks’ would not have won their case. There is no science to support the idea ADEM causes autism.
Bearing this ‘50% plus a feather’ concept in mind it is clear just how utterly dreadful the evidence was to support the idea MMR caused autism. Not only could plaintiffs not provide any evidence that MMR causes autism, respondents produced reams of evidence to show it clearly doesn’t.
You carry on Mr Carrey to say:
I’ve also heard it said that no evidence of a link between vaccines and autism has ever been found. That statement is only true for the CDC, the AAP and the vaccine makers who’ve been ignoring mountains of scientific information and testimony. There’s no evidence of the Lincoln Memorial if you look the other way and refuse to turn around. But if you care to look, it’s really quite impressive. For a sample of vaccine injury evidence go to www.generationrescue.org/lincolnmemorial.html.
Your analogy is ridiculous. I could go to any library and find evidence for the Lincoln Memorial without ever seeing it. In fact, what your analogy does is demonstrate exactly how blinkered and able to only face one direction at one time you and your colleagues are.
The evidence you present as that being supportive of evidence between a link between vaccines and autism is equally ridiculous and blinkered. I simply don;t have the time to tackle the mountain of misinformation presented on the page you link to suffice to say there’s not a single section that doesn’t have a major error. Most of them have been tackled on this and other blogs over the years.
Next you say:
In all likelihood the truth about vaccines is that they are both good and bad. While ingredients like aluminum, mercury, ether, formaldehyde and anti-freeze may help preserve and enhance vaccines, they can be toxic as well. The assortment of viruses delivered by multiple immunizations may also be a hazard. I agree with the growing number of voices within the medical and scientific community who believe that vaccines, like every other drug, have risks as well as benefits and that for the sake of profit, American children are being given too many, too soon. One thing is certain. We don’t know enough to announce that all vaccines are safe!
Mr Carrey, vaccines do not contain anti-freeze – for goodness sake, even Jay Gordon, Evan’s Paediatrician knows that! Did you also know that (to quote myself):
There’s also Aluminium in breast milk so lets compare the two.
According to this paper (which is from 1990 – any more up to date papers welcomed) the amount of Aluminium in breast milk is 49 ?g/L. The average amount of breast milk expressed per day is 0.85 liters. This means that 41.65?g Aluminium per day is in breast milk. Now, according to this paper, there is between 125 – 850?g of Aluminium per dose in a vaccine.
So, for a 6 year old, total Aluminium is between 2,125 – 14,450?g. In real terms this means that after between 51 and 346 days breast feeding, a 6 year old will have taken onboard the same amount of Aluminium as from the total US vaccine schedule.
Now I couldn’t find out what vaccines contained the lower amount or which contained the higher amount. Even so, this means that if every vaccine a 6 year old has that contains Aluminium contains the highest possible amount, within a year of breast feeding they will have matched that. Or to put it another way, an anti-vax tree-hugger soccer mom who doesn’t vaccinate her baby will have given him the same amount of Aluminium he would’ve had in six years after one year of breast feeding.
And thats of course, not even touched on the fact that:
In the Earth’s crust, aluminium is the most abundant (8.13%) metallic element, and the third most abundant of all elements (after oxygen and silicon)
And is found naturally occurring in sea water, fresh water, the human body etc etc.
[Regarding Formaldehyde]..There’s also Formaldehyde in Apples, Apricots, Banana’s and….ah, I lost interest. Lots of stuff. Including the human body. So – how much is in vaccines? According to this and using it in combination with the US vaccine schedule referenced above, we can see that the total amount of Formaldehyde in vaccines from the vaccine schedule for a 6 year old child is 1.2016mg (again, do your own maths, correct me if I’m wrong).
For comparison to that 1.2mg in all vaccines for a 6 year old, 1 (one) banana contains 16.3mg Formaldehyde. Mr Carrey, you’ve got to stop throwing these scaremongering nonfacts around. Its damned irresponsible for a start.
Lastly Mr Carrey, you say:
If the CDC, the AAP and Ms. Brown insist that our children take twice as many shots as the rest of the western world, we need more independent vaccine research not done by the drug companies selling the vaccines or by organizations under their influence. Studies that cannot be internally suppressed.
In terms of autism, if you want to make a big deal out of the fact that ‘our children take twice as many shots as the rest of the western world’ then please consider this – the UK has less shots than you. We also have a higher prevalence than you. 1 in 100 vs 1 in 150.
And please also don’t invoke silly conspiracy theories. Think about how science works. A study is done, funded by Eli Lily for example. It is peer reviewed and found to be good quality and it is published in, lets say NEJM. Now, every single reader of that study can see exactly what methods and means were used to reach the studies conclusions. I ask you Mr Carrey, how much more independent can you get? How much more transparent? Basically anyone, anywhere can try and replicate that same studies results. If they can and a few others can – the results are good. If nobody can (think Andrew Wakefield) then the results must be bad.
And for goodness sake man, grow up, who is ‘suppressing’ what study exactly? Have you any evidence at all that any study ever has been internally suppressed? Or are you just throwing this stuff out to scare people?
Mr Carrey, I loved the Truman Show but this isn’t it. There’s no god like figure overseeing every aspect of your life and wanting to control it. I ask you – get in contact with an actual scientist and go through your concerns with them. At the very least they’ll be able to stop you saying silly things like there’s anti-freeze in vaccines.
Wednesday, November 25, 2009
Holiday Hazards
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Holiday Poisoning Hazards
Preparations for the holidays are happy, hectic times that can double the risk of toxic exposures. Not only are attractive items brought into the home, but the disruption of the household routine means less supervision of curious children. Even safe homes can become hazardous when visitors bring purses with pills in them. Other hazards include:
Poinsettia: This plant is actually not very toxic, but the sap can be irritating. If a piece has been chewed, clear the mouth of plant material and offer something to drink.
Christmas Berry: The leaves and crushed pits are poisonous if a large amount is swallowed.
Holly: Eating a few berries can cause vomiting, cramps and diarrhea.
Mistletoe: Eating berries can cause vomiting, cramps and diarrhea. Large amounts can cause high blood pressure, seizures and confusion.
Christmas trees: The evergreens are non-toxic with the exception of the Yew, which has red cup-like fruits on its branches. The leaves and seed pits are toxic. Be careful what is added to the water in the Christmas tree stand. Pets may drink it and some preservatives are toxic.
Christmas tree ornaments: Antique or imported ornaments may have a lead-based paint which would be a hazard if ingested.
Tinsel: While non-toxic, these shiny icicles can cause airway or intestinal blockage if eaten by children or pets. Veterinarians perform at least one operation each Christmas season to remove tinsel from pets’ intestines.
Angel Hair: This tree decoration is made of spun glass that causes irritation upon contact.
Bubble Lights: These lights contain a poisonous liquid called methylene chloride that can be a danger if the fluid from several lights is swallowed.
Alcohol: Alcohol poisons children by causing a drop in their blood sugar and by making them dangerously drowsy. A combination of these two factors can cause coma. Holiday alcohol is available in many forms: perfume given as a gift, mixed drinks leftover after a party, or even mouthwash by the bathroom sink.
For an emergency or question about poisons, call the Poison Center toll-free 24 hour hotline 1-800-222-1222
For a free poison prevention information package, call our administrative line at (813) 844-7044 or write:
FL Poison Information Center,
Tampa General Hospital, P.O.Box 1289,
Tampa, FL 33601
The Florida Poison Information Center wishes you and your family
a healthy and happy holiday season!
Holiday Poisoning Hazards
Preparations for the holidays are happy, hectic times that can double the risk of toxic exposures. Not only are attractive items brought into the home, but the disruption of the household routine means less supervision of curious children. Even safe homes can become hazardous when visitors bring purses with pills in them. Other hazards include:
Poinsettia: This plant is actually not very toxic, but the sap can be irritating. If a piece has been chewed, clear the mouth of plant material and offer something to drink.
Christmas Berry: The leaves and crushed pits are poisonous if a large amount is swallowed.
Holly: Eating a few berries can cause vomiting, cramps and diarrhea.
Mistletoe: Eating berries can cause vomiting, cramps and diarrhea. Large amounts can cause high blood pressure, seizures and confusion.
Christmas trees: The evergreens are non-toxic with the exception of the Yew, which has red cup-like fruits on its branches. The leaves and seed pits are toxic. Be careful what is added to the water in the Christmas tree stand. Pets may drink it and some preservatives are toxic.
Christmas tree ornaments: Antique or imported ornaments may have a lead-based paint which would be a hazard if ingested.
Tinsel: While non-toxic, these shiny icicles can cause airway or intestinal blockage if eaten by children or pets. Veterinarians perform at least one operation each Christmas season to remove tinsel from pets’ intestines.
Angel Hair: This tree decoration is made of spun glass that causes irritation upon contact.
Bubble Lights: These lights contain a poisonous liquid called methylene chloride that can be a danger if the fluid from several lights is swallowed.
Alcohol: Alcohol poisons children by causing a drop in their blood sugar and by making them dangerously drowsy. A combination of these two factors can cause coma. Holiday alcohol is available in many forms: perfume given as a gift, mixed drinks leftover after a party, or even mouthwash by the bathroom sink.
For an emergency or question about poisons, call the Poison Center toll-free 24 hour hotline 1-800-222-1222
For a free poison prevention information package, call our administrative line at (813) 844-7044 or write:
FL Poison Information Center,
Tampa General Hospital, P.O.Box 1289,
Tampa, FL 33601
The Florida Poison Information Center wishes you and your family
a healthy and happy holiday season!
The Gardasil Vaccination for HPV and Cervical Cancer
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I also took this from Snopes.com. It's not a medical site, per se, but the information about the Gardasil vaccine is accurate. Gardasil prevents infection by the Human Papilloma Virus which is the cause of cervical cancer. Some cancers, such as cervical cancer and liver cancer, are caused by viral infections. So, you don't get the virus, then you don't get the cancer. Gardasil prevents infections from 2 of the HPVs that are responsible for about 70% of all cases of cervical cancer. This virus also causes genital warts, so the vaccine will also help prevent these minor STDs, but in my mind this is not the real reason to get the Gardasil vaccine.
At Meyer Pediatrics, we do recommend this vaccine, although it is NOT required for any school. The vaccine, which is given as a series of 3 shots spread out over 6 months, is available for girls age 9 to 26 and we will probably initiate a conversation with you at your daughter's 9 year old well check. She will never be required to get this vaccine. Boys are not currently eligible for the Gardasil (although it would not harm them to get it, and from a standpoint of social responsibility, it probably should be considered, but insurance companies are unlikely to ever pay for it), and from the look of things, they may never be.
Gardasil Vaccine Side-Effects
The following text is from an e-mail circulating the Internet right now:
32 Girls Have Died
11,916 adverse events already reported to the CDC ... and counting.
Pain and swelling. Life-threatening muscle weakness. Blood clots in the heart and lungs.
And the deaths of 32 innocent girls and young women.
You might think I'm talking about a deadly new disease or a global epidemic ...
I'm not.
Sadly, it's more sinister than that. The health threats listed above have all been linked with Gardasil, the so-called "cervical cancer vaccine." And thanks to Pharma giant Merck, desperate parents and naive young women believe this vaccine saves lives! Tthey couldn't be more wrong.
That's why HSI's Jenny Thompson has released a new video in which she exposes the deception for what it is — and reveals some truly shocking information no one else is talking about.
And you are the very first to see it.
Please, if you have daughters, granddaughters or friends who might be considering this terrible vaccine, you must watch this video. And please forward it to anyone you think would benefit from the vital information it contains.
If you think you know the whole story on Gardasil, I think you'll be shocked by what you're about to see. Just click here to start watching the video. It's just a few minutes long. and those few minutes might just save a young girl's life.
Origins:
Gardasil is a vaccine intended for girls and young women between the ages 9 to 26 to protect against human papillomavirus (HPV), a virus which is currently linked to an estimated 70% of known cervical cancer cases. Because Gardasil prevents only the onset of HPV infections (rather than curing those who have already been infected by HPV), health officials have advocated that girls be vaccinated for HPV prior to adolescence (or as soon as possible thereafter) in order to head off the occurrence of cervical cancer later in life.
The message quoted above warns that the Centers for Disease Control (CDC) has already received nearly 12,000 complaints about adverse medical issues related to Gardasil vaccinations, and that 32 young women died after receiving Gardasil vaccinations. Although this information is accurate in a strictly literal sense, it is raw data that does not in itself establish a causal connection between Gardasil and the posited medical dangers.
The CDC, in conjunction with the Food and Drug Administration (FDA), operates a program known as the Vaccine Adverse Event Reporting System (VAERS). The VAERS program collects and analyzes reports on adverse events following immunizations in order to help track the safety and efficacy of various vaccines. It is important to note that reports collected by VAERS are raw data; they do not in themselves establish causal connections between vaccines and adverse medical issues — such determinations cannot be made until the reports have been investigated, evaluated, and analyzed.
(To illustrate this concept, we offer the following [admittedly far-fetched] scenario: A man who received a flu vaccination and then accidentally hit his hand with a hammer a few hours later might legitimately report that soon after he received the flu vaccine, his hand began to throb painfully. Although such a report would be literally true, it would not establish any causal connection between the flu vaccine and the adverse medical symptom of a throbbing, painful hand.) It WOULD, however, be listed in the package insert as a potential complication of the flu vaccine because that's the way medication side-effect law is written.
As the CDC states in their article on "Reports of Health Concerns Following HPV Vaccination," before the HPV vaccine was licensed, it was studied in five clinical trials involving over 21,000 girls and women ages 9 through 26, and since the licensing the "CDC and FDA have been closely monitoring the safety of the HPV vaccine." The article notes that as of 31 December 2008, more than 23 million doses of Gardasil had been distributed in the United States, and VAERS afterwards collected 11,916 reports of adverse events following Gardasil vaccination. However, the article also notes that 94% of those reports were classified as "non-serious":
This works out to only one adverse event for every 1930 doses given, and only one in 17 of these adverse events was considered serious. So, only one in 32,169 doses of Gardasil resulted in a serious side-effect.
And not all of these could be directly attributed to the vaccine. Since these numbers were taken from the raw VAERS data, there is no way to know how many of these serious side-effects actually occurred because of the vaccine, and how many were unrelated occurrences that simply followed the administration of the Gardasil vaccination.
The vast majority (94%) of the adverse events reports following Gardasil have been non-serious. Reports of non-serious adverse events after Gardasil vaccination have included fainting, pain and swelling at the injection site (the arm), headache, nausea and fever. Fainting is common after injections and vaccinations, especially in adolescents. Falls after fainting may sometimes cause serious injuries, such as head injuries, which can be easily prevented by closely observing the vaccinated person for 15 minutes after vaccination.
Moreover, the article also noted that the relatively small percentage (6%) of reports classified as "serious" (including those involving deaths) could not be definitively linked to the use of the Gardasil vaccine:
All serious reports (6%) for Gardasil have been carefully analyzed by medical experts. Experts have not found a common medical pattern to the reports of serious adverse events reported for Gardasil that would suggest that they were caused by the vaccine.
As of December 31, 2008, there have been 32 U.S. reports of death among females who have received the vaccine. There was no common pattern to the deaths that would suggest that they were caused by the vaccine.
The article concludes by stating that:
Based on all of the information we have today, CDC and FDA continue to recommend Gardasil vaccination for the prevention of 4 types of HPV. As with all approved vaccines, CDC and FDA will continue to closely monitor the safety of Gardasil. Any problems detected with this vaccine will be reported to health officials, healthcare providers, and the public, and needed action will be taken to ensure the public's health and safety.
The video featuring Jenny Thompson of Health Sciences Institute that is linked at the end of the warning reproduced above deals mainly with subjects such as the political and moral issues involved with requiring HPV vaccinations for young girls, the notion that vaccinated girls might mistakenly believe they had been immunized against contracting sexually transmitted diseases (other than HPV), and the claim that cervical cancer deaths can be effectively eliminated through means other than HPV vaccinations. It offers no real evidence that Gardasil vaccinations are dangerous other than to cite the raw VAERS data referenced above (without noting that analysis of those reports failed to establish a causal link between HPV vaccinations and the reported serious adverse events).
Last updated: 22 April 2009
The URL for this page is http://www.snopes.com/medical/drugs/gardasil.asp
Urban Legends Reference Pages © 1995-2009 by Barbara and David P. Mikkelson.
This material may not be reproduced without permission.
snopes and the snopes.com logo are registered service marks of snopes.com.
Sources:
Harris, Gardiner. "Panel Unanimously Recommends Cervical Cancer Vaccine for Girls 11 and Up."
The New York Times. 30 June 2006.
Houppert, Karen. "Who's Afraid of Gardasil?"
The Nation. 8 March 2007.
Litwin, Grania. "Vaccine Can Save Vast Number of Lives, Says Cancer Specialist."
The Victoria Times Colonist. 22 April 2009.
Centers for Disease Control. "Reports of Health Concerns Following HPV Vaccination."
3 March 2009.
Reuters. "Allergic Reactions to Gardasil Uncommon: Study."
canada.com. 22 April 2009.
U.S. Food and Drug Administration. "FDA Approves Expanded Uses for Gardasil."
12 September 2008.
I also took this from Snopes.com. It's not a medical site, per se, but the information about the Gardasil vaccine is accurate. Gardasil prevents infection by the Human Papilloma Virus which is the cause of cervical cancer. Some cancers, such as cervical cancer and liver cancer, are caused by viral infections. So, you don't get the virus, then you don't get the cancer. Gardasil prevents infections from 2 of the HPVs that are responsible for about 70% of all cases of cervical cancer. This virus also causes genital warts, so the vaccine will also help prevent these minor STDs, but in my mind this is not the real reason to get the Gardasil vaccine.
At Meyer Pediatrics, we do recommend this vaccine, although it is NOT required for any school. The vaccine, which is given as a series of 3 shots spread out over 6 months, is available for girls age 9 to 26 and we will probably initiate a conversation with you at your daughter's 9 year old well check. She will never be required to get this vaccine. Boys are not currently eligible for the Gardasil (although it would not harm them to get it, and from a standpoint of social responsibility, it probably should be considered, but insurance companies are unlikely to ever pay for it), and from the look of things, they may never be.
Gardasil Vaccine Side-Effects
The following text is from an e-mail circulating the Internet right now:
32 Girls Have Died
11,916 adverse events already reported to the CDC ... and counting.
Pain and swelling. Life-threatening muscle weakness. Blood clots in the heart and lungs.
And the deaths of 32 innocent girls and young women.
You might think I'm talking about a deadly new disease or a global epidemic ...
I'm not.
Sadly, it's more sinister than that. The health threats listed above have all been linked with Gardasil, the so-called "cervical cancer vaccine." And thanks to Pharma giant Merck, desperate parents and naive young women believe this vaccine saves lives! Tthey couldn't be more wrong.
That's why HSI's Jenny Thompson has released a new video in which she exposes the deception for what it is — and reveals some truly shocking information no one else is talking about.
And you are the very first to see it.
Please, if you have daughters, granddaughters or friends who might be considering this terrible vaccine, you must watch this video. And please forward it to anyone you think would benefit from the vital information it contains.
If you think you know the whole story on Gardasil, I think you'll be shocked by what you're about to see. Just click here to start watching the video. It's just a few minutes long. and those few minutes might just save a young girl's life.
Origins:
Gardasil is a vaccine intended for girls and young women between the ages 9 to 26 to protect against human papillomavirus (HPV), a virus which is currently linked to an estimated 70% of known cervical cancer cases. Because Gardasil prevents only the onset of HPV infections (rather than curing those who have already been infected by HPV), health officials have advocated that girls be vaccinated for HPV prior to adolescence (or as soon as possible thereafter) in order to head off the occurrence of cervical cancer later in life.
The message quoted above warns that the Centers for Disease Control (CDC) has already received nearly 12,000 complaints about adverse medical issues related to Gardasil vaccinations, and that 32 young women died after receiving Gardasil vaccinations. Although this information is accurate in a strictly literal sense, it is raw data that does not in itself establish a causal connection between Gardasil and the posited medical dangers.
The CDC, in conjunction with the Food and Drug Administration (FDA), operates a program known as the Vaccine Adverse Event Reporting System (VAERS). The VAERS program collects and analyzes reports on adverse events following immunizations in order to help track the safety and efficacy of various vaccines. It is important to note that reports collected by VAERS are raw data; they do not in themselves establish causal connections between vaccines and adverse medical issues — such determinations cannot be made until the reports have been investigated, evaluated, and analyzed.
(To illustrate this concept, we offer the following [admittedly far-fetched] scenario: A man who received a flu vaccination and then accidentally hit his hand with a hammer a few hours later might legitimately report that soon after he received the flu vaccine, his hand began to throb painfully. Although such a report would be literally true, it would not establish any causal connection between the flu vaccine and the adverse medical symptom of a throbbing, painful hand.) It WOULD, however, be listed in the package insert as a potential complication of the flu vaccine because that's the way medication side-effect law is written.
As the CDC states in their article on "Reports of Health Concerns Following HPV Vaccination," before the HPV vaccine was licensed, it was studied in five clinical trials involving over 21,000 girls and women ages 9 through 26, and since the licensing the "CDC and FDA have been closely monitoring the safety of the HPV vaccine." The article notes that as of 31 December 2008, more than 23 million doses of Gardasil had been distributed in the United States, and VAERS afterwards collected 11,916 reports of adverse events following Gardasil vaccination. However, the article also notes that 94% of those reports were classified as "non-serious":
This works out to only one adverse event for every 1930 doses given, and only one in 17 of these adverse events was considered serious. So, only one in 32,169 doses of Gardasil resulted in a serious side-effect.
And not all of these could be directly attributed to the vaccine. Since these numbers were taken from the raw VAERS data, there is no way to know how many of these serious side-effects actually occurred because of the vaccine, and how many were unrelated occurrences that simply followed the administration of the Gardasil vaccination.
The vast majority (94%) of the adverse events reports following Gardasil have been non-serious. Reports of non-serious adverse events after Gardasil vaccination have included fainting, pain and swelling at the injection site (the arm), headache, nausea and fever. Fainting is common after injections and vaccinations, especially in adolescents. Falls after fainting may sometimes cause serious injuries, such as head injuries, which can be easily prevented by closely observing the vaccinated person for 15 minutes after vaccination.
Moreover, the article also noted that the relatively small percentage (6%) of reports classified as "serious" (including those involving deaths) could not be definitively linked to the use of the Gardasil vaccine:
All serious reports (6%) for Gardasil have been carefully analyzed by medical experts. Experts have not found a common medical pattern to the reports of serious adverse events reported for Gardasil that would suggest that they were caused by the vaccine.
As of December 31, 2008, there have been 32 U.S. reports of death among females who have received the vaccine. There was no common pattern to the deaths that would suggest that they were caused by the vaccine.
The article concludes by stating that:
Based on all of the information we have today, CDC and FDA continue to recommend Gardasil vaccination for the prevention of 4 types of HPV. As with all approved vaccines, CDC and FDA will continue to closely monitor the safety of Gardasil. Any problems detected with this vaccine will be reported to health officials, healthcare providers, and the public, and needed action will be taken to ensure the public's health and safety.
The video featuring Jenny Thompson of Health Sciences Institute that is linked at the end of the warning reproduced above deals mainly with subjects such as the political and moral issues involved with requiring HPV vaccinations for young girls, the notion that vaccinated girls might mistakenly believe they had been immunized against contracting sexually transmitted diseases (other than HPV), and the claim that cervical cancer deaths can be effectively eliminated through means other than HPV vaccinations. It offers no real evidence that Gardasil vaccinations are dangerous other than to cite the raw VAERS data referenced above (without noting that analysis of those reports failed to establish a causal link between HPV vaccinations and the reported serious adverse events).
Last updated: 22 April 2009
The URL for this page is http://www.snopes.com/medical/drugs/gardasil.asp
Urban Legends Reference Pages © 1995-2009 by Barbara and David P. Mikkelson.
This material may not be reproduced without permission.
snopes and the snopes.com logo are registered service marks of snopes.com.
Sources:
Harris, Gardiner. "Panel Unanimously Recommends Cervical Cancer Vaccine for Girls 11 and Up."
The New York Times. 30 June 2006.
Houppert, Karen. "Who's Afraid of Gardasil?"
The Nation. 8 March 2007.
Litwin, Grania. "Vaccine Can Save Vast Number of Lives, Says Cancer Specialist."
The Victoria Times Colonist. 22 April 2009.
Centers for Disease Control. "Reports of Health Concerns Following HPV Vaccination."
3 March 2009.
Reuters. "Allergic Reactions to Gardasil Uncommon: Study."
canada.com. 22 April 2009.
U.S. Food and Drug Administration. "FDA Approves Expanded Uses for Gardasil."
12 September 2008.
Febrile Seizures (Fever-Induced Convulsions)
--
This is taken from a book written by Dr. Barton Schmidt and deals with febrile seizures. The 2 big take-home points about seizures, or convulsions, that are induced by fever are these: simple febrile seizures that last less than 30 minutes do NOT harm the child's brain (YOU may faint, but your child will be fine) and the 4% of children that have febrile seizures are not just any 4% of the population. They are genetically predisposed to febrile (occurring with a fever) seizures. That means that if your child is not in that 4% of the population that is susceptible to them, he or she will not have a seizure no matter how high the fever goes.
If your child is 2 or 3 years old and is having the 5th or 6th high fever of her life, then there is almost no chance that she's in that 4% and there is no need to worry. One final point: febrile seizures do NOT predispose your child to epilepsy. About 1% of children with febrile seizures will go on and develop epilepsy, which is exactly the same incidence as occurs in the general population, since about 1% of ALL people will one day develop epilepsy.
What are febrile convulsions?
Convulsions are also called seizures. Febrile convulsions are seizures triggered by high fever. They are the most common type of convulsion and are usually harmless. The average body temperature at which they occur is 104°F (40°C). The fever itself can be caused by an infection in any part of the body.
Children who have febrile convulsions are usually 6 months to 5 years old. A child's first febrile convulsion usually occurs by 3 years of age.
During a convulsion, your child may:
• become stiff
• become unconscious or not know where they are
• have jerking or twitching movements
• have the eyes roll backward
• have noisy breathing
• after the seizure, your child may be sleepy and confused for a while.
How long will the effects last?
Each convulsion usually lasts 1 to 10 minutes without any treatment. Febrile convulsions do not cause any brain damage. However, a few children (3%) will have convulsions without fever sometime in the future.
Febrile convulsions occur in 4% of children. Most of these children have just one febrile convulsion in a lifetime. About one-third of children who have had a febrile convulsion have 1 to 3 recurrences over the next few years. Febrile convulsions usually stop happening by the time a child is 5 or 6 years old.
What should I do when my child has a convulsion?
• Reduce the fever. Bringing your child's fever down as quickly as possible may shorten the seizure. Remove your child's clothing and apply cold washcloths to the face and neck. If the seizure persists, sponge the rest of the body with cool water. As the water evaporates, your child's temperature will fall. When the convulsion is over and your child is awake, give the usual dose of acetaminophen or ibuprofen for your child's weight and age, and encourage your child to drink cool fluids.
• Protect your child's airway. If your child has anything visible in the mouth, clear it with a finger to prevent choking. Place your child on the side or stomach (face down) to help drain secretions. If the child vomits, help clear the mouth. Use a suction bulb if available. If your child's breathing becomes noisy, pull the jaw and chin forward. NEVER put your fingers or a spoon into the mouth of a child who is seizing; your fingers will be bitten off, or the child will shatter his teeth on a metallic object such as a spoon.
Call a rescue squad (911) IMMEDIATELY if the febrile convulsion continues more than 10 minutes.
• Driving to a medical facility. If you are told to drive to a medical facility, dress your child lightly (weather permitting). (Warning: Prolonged seizures due to persistent fever have been caused by bundling up sick infants during a long drive.)
• Common mistakes in first aid of convulsions. During the convulsion, don't try to restrain your child or stop the seizure movements. Once started, the seizure will run its course no matter what you do. Don't try to resuscitate your child just because breathing stops momentarily for 5 to 10 seconds. Instead, try to clear the airway. Don't try to force anything into your child's mouth. This is unnecessary and can cut the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger. Don't try to hold the tongue. Children may rarely bite the tongue during a convulsion, but they can't swallow the tongue.
How can I take care of my child?
• Oral fever-reducing medicines: Febrile convulsions usually occur during the first day of an illness. Although research is lacking, preventing high fevers may prevent some febrile seizures. Begin acetaminophen (Tylenol) or ibuprofen (Advil) at the first sign of any fever (a temperature over 100°F, or 37.8°C) and give it continuously for the first 48 hours of the illness. Because fever is common after DTaP immunizations, begin acetaminophen or ibuprofen in our office when your child is immunized and continue it for at least 24 hours.
• Fever-reducing suppositories: Have some acetaminophen suppositories on hand in case your child ever has another febrile seizure (same dosage as oral medicine). These suppositories may be kept in a refrigerator at the pharmacy, so you may have to ask for them.
• Light covers or clothing: Avoid covering your child with more than one blanket when they are sick. Bundling during sleep can push the temperature up 1 or 2 extra degrees.
• Lots of fluids: Keep your child well hydrated by offering plenty of fluids.
How can I help prevent convulsions?
The only way to prevent future febrile convulsions completely is for your child to take an anticonvulsant medicine on a daily basis until the age of 3 or 4 years. Because anticonvulsants have side effects and febrile seizures are generally harmless, anticonvulsants are rarely prescribed unless your child has other neurologic problems. We will discuss this decision with you.
When should I call Meyer Pediatrics (365-5898)?
Call us IMMEDIATELY after the seizure is over. If your child has had one or more febrile seizures in the past, you may feel comfortable waiting until the following morning to notify us, but feel free to call us whenever you have questions.
________________________________________
Published by McKesson Provider Technologies.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright © 2005 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
This is taken from a book written by Dr. Barton Schmidt and deals with febrile seizures. The 2 big take-home points about seizures, or convulsions, that are induced by fever are these: simple febrile seizures that last less than 30 minutes do NOT harm the child's brain (YOU may faint, but your child will be fine) and the 4% of children that have febrile seizures are not just any 4% of the population. They are genetically predisposed to febrile (occurring with a fever) seizures. That means that if your child is not in that 4% of the population that is susceptible to them, he or she will not have a seizure no matter how high the fever goes.
If your child is 2 or 3 years old and is having the 5th or 6th high fever of her life, then there is almost no chance that she's in that 4% and there is no need to worry. One final point: febrile seizures do NOT predispose your child to epilepsy. About 1% of children with febrile seizures will go on and develop epilepsy, which is exactly the same incidence as occurs in the general population, since about 1% of ALL people will one day develop epilepsy.
What are febrile convulsions?
Convulsions are also called seizures. Febrile convulsions are seizures triggered by high fever. They are the most common type of convulsion and are usually harmless. The average body temperature at which they occur is 104°F (40°C). The fever itself can be caused by an infection in any part of the body.
Children who have febrile convulsions are usually 6 months to 5 years old. A child's first febrile convulsion usually occurs by 3 years of age.
During a convulsion, your child may:
• become stiff
• become unconscious or not know where they are
• have jerking or twitching movements
• have the eyes roll backward
• have noisy breathing
• after the seizure, your child may be sleepy and confused for a while.
How long will the effects last?
Each convulsion usually lasts 1 to 10 minutes without any treatment. Febrile convulsions do not cause any brain damage. However, a few children (3%) will have convulsions without fever sometime in the future.
Febrile convulsions occur in 4% of children. Most of these children have just one febrile convulsion in a lifetime. About one-third of children who have had a febrile convulsion have 1 to 3 recurrences over the next few years. Febrile convulsions usually stop happening by the time a child is 5 or 6 years old.
What should I do when my child has a convulsion?
• Reduce the fever. Bringing your child's fever down as quickly as possible may shorten the seizure. Remove your child's clothing and apply cold washcloths to the face and neck. If the seizure persists, sponge the rest of the body with cool water. As the water evaporates, your child's temperature will fall. When the convulsion is over and your child is awake, give the usual dose of acetaminophen or ibuprofen for your child's weight and age, and encourage your child to drink cool fluids.
• Protect your child's airway. If your child has anything visible in the mouth, clear it with a finger to prevent choking. Place your child on the side or stomach (face down) to help drain secretions. If the child vomits, help clear the mouth. Use a suction bulb if available. If your child's breathing becomes noisy, pull the jaw and chin forward. NEVER put your fingers or a spoon into the mouth of a child who is seizing; your fingers will be bitten off, or the child will shatter his teeth on a metallic object such as a spoon.
Call a rescue squad (911) IMMEDIATELY if the febrile convulsion continues more than 10 minutes.
• Driving to a medical facility. If you are told to drive to a medical facility, dress your child lightly (weather permitting). (Warning: Prolonged seizures due to persistent fever have been caused by bundling up sick infants during a long drive.)
• Common mistakes in first aid of convulsions. During the convulsion, don't try to restrain your child or stop the seizure movements. Once started, the seizure will run its course no matter what you do. Don't try to resuscitate your child just because breathing stops momentarily for 5 to 10 seconds. Instead, try to clear the airway. Don't try to force anything into your child's mouth. This is unnecessary and can cut the mouth, injure a tooth, cause vomiting, or result in a serious bite of your finger. Don't try to hold the tongue. Children may rarely bite the tongue during a convulsion, but they can't swallow the tongue.
How can I take care of my child?
• Oral fever-reducing medicines: Febrile convulsions usually occur during the first day of an illness. Although research is lacking, preventing high fevers may prevent some febrile seizures. Begin acetaminophen (Tylenol) or ibuprofen (Advil) at the first sign of any fever (a temperature over 100°F, or 37.8°C) and give it continuously for the first 48 hours of the illness. Because fever is common after DTaP immunizations, begin acetaminophen or ibuprofen in our office when your child is immunized and continue it for at least 24 hours.
• Fever-reducing suppositories: Have some acetaminophen suppositories on hand in case your child ever has another febrile seizure (same dosage as oral medicine). These suppositories may be kept in a refrigerator at the pharmacy, so you may have to ask for them.
• Light covers or clothing: Avoid covering your child with more than one blanket when they are sick. Bundling during sleep can push the temperature up 1 or 2 extra degrees.
• Lots of fluids: Keep your child well hydrated by offering plenty of fluids.
How can I help prevent convulsions?
The only way to prevent future febrile convulsions completely is for your child to take an anticonvulsant medicine on a daily basis until the age of 3 or 4 years. Because anticonvulsants have side effects and febrile seizures are generally harmless, anticonvulsants are rarely prescribed unless your child has other neurologic problems. We will discuss this decision with you.
When should I call Meyer Pediatrics (365-5898)?
Call us IMMEDIATELY after the seizure is over. If your child has had one or more febrile seizures in the past, you may feel comfortable waiting until the following morning to notify us, but feel free to call us whenever you have questions.
________________________________________
Published by McKesson Provider Technologies.
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright © 2005 McKesson Corporation and/or one of its subsidiaries. All Rights Reserved.
Teen Drivers' Greatest Danger: Distractions
I took this from a series of articles that originally ran in USA Today several years ago. It highlights the dangers posed by cell phones, video games and even other teen passengers when an inexperienced (ie, teen) driver is at the wheel. Sixteen year old drivers kill almost 1,000 people every year including themselves, their passengers, other drivers and even pedestrians. In terms of driving fatalities as a marker for driving ineptitude, 16 year olds are the worst drivers on the road (big surprise, huh?) Seventeen year olds are the third worst, and the group in the middle are 80 years old and up. So, a 78 year old, statistically, is a better driver than a 16 or 17 year old. And it's not even really all that close.
Distractions challenge teen drivers
Posted 1/25/2007 6:01 AM ET
By Larry Copeland, USA TODAY
Teenagers understand the danger of drinking and driving but still don't grasp the risks of driver distractions such as cellphones, loud music and young passengers, says an extensive new study of teen habits behind the wheel.
About 90% of the teens surveyed say they rarely or never drink and drive, although 50% say they have seen other teens do so, according to the study released today by the Children's Hospital of Philadelphia and State Farm Insurance Companies. Much higher percentages say they have seen peers speeding, driving while fatigued or dealing with distractions such as loud music and "passengers acting wild."
The research sought to get inside vehicles with young drivers and their passengers by surveying 5,665 ninth-, 10th- and 11th-graders from 68 randomly selected schools across the nation. The survey is part of a growing effort by child- and auto-safety advocates, insurance companies and others to cut teen driving deaths.
"Probably the most significant finding is that the environment inside the vehicle is very different from what adults might expect," says Laurette Stiles, State Farm's vice president for strategic resources. "Teens have a very challenging (driving) environment, which would challenge even an experienced driver."
Vehicle crashes are the leading cause of death for 15- to 20-year-olds, according to the National Highway Traffic Safety Administration. The nation's 12.5 million young drivers — those ages 15 to 20 — account for 6.3% of 198.9 million licensed drivers in the USA, according to 2005 NHTSA data, the most recent available. But 12.6% of all drivers involved in fatal crashes were in that age group.
Earlier research has shown that teen drivers carrying one teen passenger face double the risk of a fatal crash as teens driving alone. That risk increases to five times as likely for teen drivers with two or more passengers.
Sandy Coble, 47, of Jackson, Tenn., knows all about that risk. His only son, MacKenzie Allen Coble, 15, was one of three teens killed in a 2005 crash. None of the teens was wearing seat belts, he says. "Instead of picking out school clothes, I was picking out a casket."
Distractions challenge teen drivers
Posted 1/25/2007 6:01 AM ET
By Larry Copeland, USA TODAY
Teenagers understand the danger of drinking and driving but still don't grasp the risks of driver distractions such as cellphones, loud music and young passengers, says an extensive new study of teen habits behind the wheel.
About 90% of the teens surveyed say they rarely or never drink and drive, although 50% say they have seen other teens do so, according to the study released today by the Children's Hospital of Philadelphia and State Farm Insurance Companies. Much higher percentages say they have seen peers speeding, driving while fatigued or dealing with distractions such as loud music and "passengers acting wild."
The research sought to get inside vehicles with young drivers and their passengers by surveying 5,665 ninth-, 10th- and 11th-graders from 68 randomly selected schools across the nation. The survey is part of a growing effort by child- and auto-safety advocates, insurance companies and others to cut teen driving deaths.
"Probably the most significant finding is that the environment inside the vehicle is very different from what adults might expect," says Laurette Stiles, State Farm's vice president for strategic resources. "Teens have a very challenging (driving) environment, which would challenge even an experienced driver."
Vehicle crashes are the leading cause of death for 15- to 20-year-olds, according to the National Highway Traffic Safety Administration. The nation's 12.5 million young drivers — those ages 15 to 20 — account for 6.3% of 198.9 million licensed drivers in the USA, according to 2005 NHTSA data, the most recent available. But 12.6% of all drivers involved in fatal crashes were in that age group.
Earlier research has shown that teen drivers carrying one teen passenger face double the risk of a fatal crash as teens driving alone. That risk increases to five times as likely for teen drivers with two or more passengers.
Sandy Coble, 47, of Jackson, Tenn., knows all about that risk. His only son, MacKenzie Allen Coble, 15, was one of three teens killed in a 2005 crash. None of the teens was wearing seat belts, he says. "Instead of picking out school clothes, I was picking out a casket."
The CDC Addresses Vaccination Concerns
In my continuing effort to take information from other sources and make it available to the patients of Meyer Pediatrics, I have copied here the handout from the Centers for Disease Control (CDC) that addresses some of the common concerns that parents might have about the safety of routine childhood vaccines.
The bottom line is that NONE of the required vaccines for children contain mercury (thimerisol), there has NEVER been a single case of mercury toxicity from vaccines EVER reported, and autism is a genetic entity and there are NO well-done studies that suggest a link between vaccines and autism. Read on!
Common Concerns About Childhood Vaccinations
Infants and children get a lot of shots (vaccinations) to prevent against many different diseases. For this reason, parents or caregivers sometimes ask their healthcare provider to space apart, separate, or even not give some vaccines. Parents are worried that their child cannot handle so many shots at the same time. This is one of many concerns that parents may have about vaccinations. This handout provides the facts about vaccines, to help parents make an informed decision about what's best for their child.
CONCERN
"Infants get too many shots at once."
FACTS
Infants do get a lot of shots. But, they could handle even more. Each day, infants come into contact with millions of particles such as pollen, viruses, and bacteria that trigger their immune system. The "immune system triggers" in vaccines are only a very small amount compared to those found in your child's environment. Vaccines will not "overload" your child's immune system.
Some parents think that it would be better if their child didn't get so many shots at the same time. But delaying or not giving some vaccinations is not a good idea. Doing this could leave your child unprotected against certain diseases. Many childhood diseases are dangerous for young children. So it's best to make sure your baby is protected by not delaying their shots. Also, it is much easier to stay up to date with your child's shots, than to try and catch up.
CONCERN
"Vaccines have too many side effects. Besides, vaccine-prevented illnesses are not that serious."
FACTS
Before vaccines were available, many infants and children died from diseases we can now prevent. The diseases that vaccines prevent can be very dangerous. In fact, diseases such as whooping cough, polio, measles, etc. could be much worse and more dangerous for your child than the side effects of any vaccine. Even chickenpox can be serious. One in 200,000 unvaccinated infants who get chickenpox die...one in 100,000 older kids die...and one in 500 are hospitalized.
CONCERN
"Everyone else gets vaccines, so my child doesn't need them."
FACTS
It is true that your child has less of a chance of getting sick when your child plays with other children who have had their shots. But this doesn't mean that your child can't get sick. To be protected, your child must also get their shots. A good example of this is measles and whooping cough. Even though most children get vaccinated, children who do not get their shots have gotten measles or whopping cough, and some have even died.
Also, children who don't get vaccines may get the disease, and then spread it to people who can't be vaccinated or who could become seriously ill (e.g., newborn infants, pregnant women, older people).
CONCERN
"Vaccines are not tested enough."
FACTS
Just like medicines, vaccines are tested in many children for a long time before they are given to all children. Most vaccines are tested in even more children and for an even longer time than most medicines that you give your child.
CONCERN
"Vaccines contain things which are not safe for my child."
FACTS
Shots that are given to infants and children are safe. Shots for infants and children do not have mercury in them anymore. Some shots do have aluminum in them, but the amount of aluminum is much smaller than the amount of aluminum found in baby formula.
CONCERN
"Vaccines cause autism."
FACTS
Some people think that the thimerosal or mercury in vaccines causes autism. But this has never been proven. Actually, common pediatric vaccines, with the exception of some flu shots, no longer contain thimerosal or mercury and haven't since 2001. Those flu shots that do have thimerosal or mercury contain a very small amount, AND it’s a different form than the mercury that is linked with brain and nerve injury. One is methyl mercury, and the other is ethyl mercury. Different entities entirely.
PROTECT YOUR CHILD AND VACCINATE
Infants and children receive more vaccines than ever before. But, these vaccines are safe and protect our children from serious diseases. If you have concerns about any vaccine your child is to get, talk to Dr Ted or Nurse Kay. Remember, vaccines save lives! Do not let the extremists who mistakenly believe that ALL vaccines are bad trick you into making a dangerous mistake. Your child's health literally is at stake.
The bottom line is that NONE of the required vaccines for children contain mercury (thimerisol), there has NEVER been a single case of mercury toxicity from vaccines EVER reported, and autism is a genetic entity and there are NO well-done studies that suggest a link between vaccines and autism. Read on!
Common Concerns About Childhood Vaccinations
Infants and children get a lot of shots (vaccinations) to prevent against many different diseases. For this reason, parents or caregivers sometimes ask their healthcare provider to space apart, separate, or even not give some vaccines. Parents are worried that their child cannot handle so many shots at the same time. This is one of many concerns that parents may have about vaccinations. This handout provides the facts about vaccines, to help parents make an informed decision about what's best for their child.
CONCERN
"Infants get too many shots at once."
FACTS
Infants do get a lot of shots. But, they could handle even more. Each day, infants come into contact with millions of particles such as pollen, viruses, and bacteria that trigger their immune system. The "immune system triggers" in vaccines are only a very small amount compared to those found in your child's environment. Vaccines will not "overload" your child's immune system.
Some parents think that it would be better if their child didn't get so many shots at the same time. But delaying or not giving some vaccinations is not a good idea. Doing this could leave your child unprotected against certain diseases. Many childhood diseases are dangerous for young children. So it's best to make sure your baby is protected by not delaying their shots. Also, it is much easier to stay up to date with your child's shots, than to try and catch up.
CONCERN
"Vaccines have too many side effects. Besides, vaccine-prevented illnesses are not that serious."
FACTS
Before vaccines were available, many infants and children died from diseases we can now prevent. The diseases that vaccines prevent can be very dangerous. In fact, diseases such as whooping cough, polio, measles, etc. could be much worse and more dangerous for your child than the side effects of any vaccine. Even chickenpox can be serious. One in 200,000 unvaccinated infants who get chickenpox die...one in 100,000 older kids die...and one in 500 are hospitalized.
CONCERN
"Everyone else gets vaccines, so my child doesn't need them."
FACTS
It is true that your child has less of a chance of getting sick when your child plays with other children who have had their shots. But this doesn't mean that your child can't get sick. To be protected, your child must also get their shots. A good example of this is measles and whooping cough. Even though most children get vaccinated, children who do not get their shots have gotten measles or whopping cough, and some have even died.
Also, children who don't get vaccines may get the disease, and then spread it to people who can't be vaccinated or who could become seriously ill (e.g., newborn infants, pregnant women, older people).
CONCERN
"Vaccines are not tested enough."
FACTS
Just like medicines, vaccines are tested in many children for a long time before they are given to all children. Most vaccines are tested in even more children and for an even longer time than most medicines that you give your child.
CONCERN
"Vaccines contain things which are not safe for my child."
FACTS
Shots that are given to infants and children are safe. Shots for infants and children do not have mercury in them anymore. Some shots do have aluminum in them, but the amount of aluminum is much smaller than the amount of aluminum found in baby formula.
CONCERN
"Vaccines cause autism."
FACTS
Some people think that the thimerosal or mercury in vaccines causes autism. But this has never been proven. Actually, common pediatric vaccines, with the exception of some flu shots, no longer contain thimerosal or mercury and haven't since 2001. Those flu shots that do have thimerosal or mercury contain a very small amount, AND it’s a different form than the mercury that is linked with brain and nerve injury. One is methyl mercury, and the other is ethyl mercury. Different entities entirely.
PROTECT YOUR CHILD AND VACCINATE
Infants and children receive more vaccines than ever before. But, these vaccines are safe and protect our children from serious diseases. If you have concerns about any vaccine your child is to get, talk to Dr Ted or Nurse Kay. Remember, vaccines save lives! Do not let the extremists who mistakenly believe that ALL vaccines are bad trick you into making a dangerous mistake. Your child's health literally is at stake.
Autism
This was taken from Medscape.com. It is an interview with Dr. Eric Hollander and reviews a lot of good information on what is currently known about autism. This interview IS nearly 5 years old, but if anything, the support for autism as a genetic entity and the complete lack of corroboration with vaccines as a cause is even stronger today. Read this and see for yourself, particularly if you are at all worried about vaccines and their refuted link to autism.
Autism: An Interview With Eric Hollander MD
From Medscape Psychiatry & Mental Health
Autism: An Expert Interview With Eric Hollander, MD
Published: 02/03/2005
Editor's Note:
Requests for services related to autism are increasing, although there is controversy over whether this reflects a change in the prevalence of the disorder, better detection, or differences in definition. What is autism? How common is it? What are the best ways to treat it? What makes doing research on autism spectrum disorders exciting today? Elizabeth Saenger, PhD, Medscape Psychiatry & Mental Health, interviewed Eric Hollander, MD, Professor of Psychiatry, Director, Seaver and New York Autism Center of Excellence, Mount Sinai School of Medicine, New York, NY.
Medscape: How would you define autism?
Dr. Hollander: Autism is a developmental disorder that presents before the age of 3 years. It's characterized by impairment in 3 core symptom domains, which include social deficits, communication difficulties, narrow restricted interests, and repetitive behaviors. In addition to that, there are also other associated symptoms that frequently coexist.
Medscape: What are those other symptoms?
Dr. Hollander: The other associated symptom domains can include factors like inattention and motor hyperactivity, impulsivity and aggression, mood instability, EEG abnormalities or seizure related type problems, and cognitive difficulties.
Medscape: How common is this disorder?
Dr. Hollander: It used to be felt to be very rare. The best estimates now are that about 0.6% of the population, a little under 1%, may meet criteria for the broader autism phenotype, or an autism spectrum disorder. Within that spectrum, we include autism, the Asperger syndrome, and pervasive developmental disorder or PDD NOS -- not otherwise specified.
Medscape: How do you treat autism spectrum disorders?
Dr. Hollander: There are a few different treatment approaches. There are behavioral approaches, educational approaches, and medication approaches. We intervene early. There is some evidence that the earlier you pick up the problem and start to intervene with behavioral, educational, speech, and occupational therapy, the better the long-term developmental trajectory. So the idea now is to start to identify people at around 18 months if possible and often to slide people into the educational programs that incorporate a lot of speech and occupational therapy plus behavioral interventions like acute ABA-type treatments -- applied behavioral analysis. And there is evidence that these kinds of treatments actually can be associated with better long-term outcome.
We are also finding that medicines may be very helpful in 2 types of approaches. One is a targeted treatment approach where we select a group of individuals who score high on a particular target symptom like lots of narrow, restricted interests, repetitive behaviors, self-stimulation-type behaviors, and compulsive behaviors, and then treat them, for example, with very low doses of selective serotonin reuptake inhibitors like fluoxetine or fluoxetine in a liquid form. We found that will significantly improve the core symptom domain and improve overall functioning.
Other treatment approaches involve stratifying the population, picking up the subgroup with a lot of disruptive behavior, such as impulsivity and aggression, tantruming, self-injury, and treating them with low doses of atypical antipsychotics, such as risperidone. We also have treatment approaches using the mood-stabilizing, anticonvulsant-type treatments like valproic acid or levetiracetam, finding that these medicines may be helpful in a lot of mood instability, a lot of the disruptive behavior like impulsive, aggressive, or self-injurious behavior. Sometimes for language-related functioning, and particularly those with some abnormal EEGs, patients have a very robust response to the anticonvulsant-type medicines.
Medscape: How successful are these interventions in helping people become what society generally considers normal?
Dr. Hollander: It probably depends on the baseline characteristics of the patient, because it turns out that autism is pretty heterogeneous. You have some individuals who have very high IQs and others with severe mental retardation. You have some individuals who have really outstanding verbal skills and others who have no language at all. You have some people who have accompanying seizure problems or other neurologic problems and others who don't.
So as a group it's fairly heterogeneous. And we know that individuals who start off with a higher IQ and better speech and language tend to have a better long-term outcome than those who have more severe impairment at baseline.
But we know that with early interventions, both behavioral and pharmacologic, people really can do a lot better, that the symptoms that cause distress can be significantly reduced and their overall functional ability can improve.
Medscape: One thing I'm curious about is the paradox in a way of the idiot savant. Can you say something about that?
Dr. Hollander: What's interesting is that within individuals you see a scattering of peaks and valleys in terms of skill levels. And you have some individuals who have extraordinary skills in certain areas. That may go along with their narrow restricted interests, where they become preoccupied with certain things and have all the information in the world about those things. And sometimes people can calculate statistics or memorize calendars or have some extraordinary mathematical or physics ability, or even certain visual/spatial abilities, musical abilities, verbal abilities. We think that there may be some positive attributes that may be coheritable with certain autism symptom domains. The idea is that either there are a number of these core and associated symptom domains that need to come together in order to produce the full syndrome of autism, and that in the first-degree family members, and even in the general population, we frequently see impairment in individual symptom domains. These individuals don't have the full disorder, however, unless they get multiple domains coming together.
Some of the symptom domains that may make up the disorder may also be associated with high abilities in mathematical or visual, spatial, or musical abilities, and it's not unusual to see in first-degree family members a high skill, for example, in physics, math, or computers. It's also not unusual to see many family members who have extraordinary technical skills, for example. Within individuals with autism, you do see individuals with these islands of extraordinary skills also coupled with areas of the real impairment. And it seems that many people with autism have difficulties with the higher order of processing of information. They may be excellent in terms of their raw sensory information or their ability to manipulate the sensory information, but they have more difficulty with the higher-order processing or generating abstract conclusions from the sensory information.
Medscape: In other words, they would be like Raymond in the film, Rain Man, where Raymond could do difficult calculations involving the cards in the casino and win a lot of money or figure out how many toothpicks have been spilled on the floor, but in terms of figuring out how much change he would get if he went to the grocery store to buy something, he was a failure.
Dr. Hollander: Yes. I would say that often there are deficits in certain pragmatic skills -- how to interact with the world in a social fashion to get what you want from the world -- but that they can still have extraordinary specific skills.
Medscape: Can you tell us a little bit about your own research with people who have autism?
Dr. Hollander: Yes. Here at Mount Sinai we have the Seaver and New York Autism Center of Excellence. We have been doing business for over 10 years, initially funded by the Seaver Foundation and now funded by one of the NIH STAART Autism Centers of Excellence. We're very focused on breaking autism down into the different core and associated symptom domains and finding relevant genes, understanding the specific brain circuits, and developing specific treatments for each of the different symptom domains. For example, we found genetic factors that may be associated with speech and language problems or with the repetitive behaviors. We've elucidated the metabolic activity in the limbic system associated with autism. And we have developed new treatments for the symptom domains, particularly the repetitive behaviors and the impulse of aggression. We've also been interested in peptides like oxytocin and the role that those peptides play in social attachment and in the repetitive behaviors; we have done some interesting alterations of that system and found that we can improve social attachment and repetitive behaviors by influencing the oxytocin system. We've also done research on immune abnormalities that may run in families, and related these immune abnormalities to different symptoms.
We've been very interested in the serotonin system and the role that that serotonin system plays in the repetitive behaviors and then how treatments for the serotonin system can improve the repetitive behaviors.
Medscape: This seems to tie into what you once said about the need to look at specific behaviors and then target them with specific medications to improve somebody's behavior and life.
Dr. Hollander: That's right. We think that there are basically 2 approaches with medicines. One is the targeted treatment approach where you stratify the population and you select individuals who have specific types of target behaviors that cause distress and interfere with functioning. You start with low doses of medicines and improve those target symptoms to see how that affects the overall level of functioning. Another approach that we're starting to get into is early interventions to see if we can change the developmental trajectory. In a similar way, early behavioral interventions might improve IQ or social reciprocity with speech and language.
Medscape: The idea of improving IQ seems interesting. Can you tell us more about that?
Dr. Hollander: There are some behavioral treatment studies that suggest that early intervention with behavioral approaches will show an improvement in IQ if you follow individuals over long periods of time.
Some of those studies may be flawed because there wasn't good randomization and people started with different IQ levels at baseline. But generally people feel that early intervention can be associated with improvement. And when you get clinical improvement, you also see a significant improvement in IQ.
Some of the studies that the STAART Centers are looking at now are early interventions with serotonin reuptake inhibitors that follow people over time to see if we can get improvement in IQ. Recently we've also been interested in looking at certain medicines that work on the glutamate system that are used specifically for cognition and memory to see if we can improve cognitive functioning and IQ with those approaches.
Medscape: You mentioned that early intervention in autism means catching a child or a baby at 18 months. How often is autism or potential autism recognized that early?
Dr. Hollander: It used to be very rare, so people usually identified it at around age 3 years when children weren't talking. Nowadays, there's a push to identify earlier problems like eye gaze, not interacting appropriately with other children or peers, or not having good joint attention with parents. And sometimes there can be subtle motor abnormalities that may be present at an earlier stage. There are suggested screening instruments, such as the Checklist For Autism in Toddlers -- CHAT. Cure Autism Now has suggested that pediatricians routinely administer this to all children at 18 months to try to pick up people with developmental delays who should be screened more carefully afterwards.
Medscape: Are pediatricians doing that?
Dr. Hollander: I think that for the most part now, teachers, pediatricians, parents, and other mental health practitioners are doing a better job screening. There is a bit of a controversy in the field as to whether autism is dramatically increasing because the rates were much, much lower before. That may be because everybody is doing a better job screening, so we're picking up the milder cases at an earlier stage. The alternative explanation is that there are environmental factors that interact with strong genetic factors to be associated with an increased risk for people presenting with these problems.
Medscape: I know that's quite controversial. Can you tell us about some of the possible environmental factors that people are thinking about?
Dr. Hollander: Well, there's been a lot of debate about vaccines -- initially the MMR vaccine, and then more recently the thimerosal preservative, which is an ethylmercury preservative that was in certain multidose vials of vaccines. I think that the best available data really suggest that these vaccines are not associated specifically with an increased rate for autism. That's because there have been good studies, for example, in England, shortly after the MMR vaccine was first introduced, that showed that there was no dramatic increase after it was introduced. The Institute of Medicine recently issued a report suggesting that it doesn't look like vaccine played a role. It's clear that mercury can be neurotoxic. It's not good for the developing brain, but probably is not specifically related to the development of autism.
People have hypothesized all kinds of other factors. We were interested in the role that pitocin played in inducing labor and delivery as a possible risk factor. And other people have postulated that things like folate, for example, that are frequently given, may be an epigenetic factor that can turn on and turn off certain genes that could be associated with a greater risk.
Medscape: How did you get interested in this research area?
Dr. Hollander: Originally we were interested in other disorders that present with repetitive behaviors. And then we had the opportunity to partner with the Seaver Foundation and develop a new autism center.
Studying autism is really a great opportunity because if you understand what goes wrong in autism, you understand a little bit more about what makes people human. It gives you insight into issues around being able to see things from other people's perspectives and issues around social attachment, which are really what make us human.
Medscape: What do you see on the horizon in terms of research on autism and social movements about autism?
Dr. Hollander: The media have been talking about autism a lot lately. There are a number of debates, for example, about funding issues in terms of ABA. It's very costly. Does the existing database justify ABA, for example?
There are some controversies about whether autism -- for example, Asperger's disorder -- is just an alternative way of being and whether trying to get rid of target symptoms is not allowing certain patients with Asperger's to fully express who they are.My sense is that it's pretty clear that if we can reduce certain target symptoms, then people will have significantly less distress and their overall level of functioning will improve.
Medscape: Is there anything else you would like to add?
Dr. Hollander: I think this is an exciting time now. The NIH has taken a big interest in autism and launched STAART Autism Centers of Excellence. Many centers are working together to develop important new treatments. And integrated treatments are probably one wave of the future, integrating the behavioral and the medication treatments together.I think there is a lot of exciting work coming out on genetic findings. Mt. Sinai and the Seaver Center have started to actually see specific genes that may play a role in autism. It's clear that there's no single gene, but it may be that if you have a few of these different genes interacting together, you're going to be at high risk for getting the syndrome. Each of the genes may code for the different symptom domains that need to come together to get the full syndrome.
I think that there are new imaging techniques, like functional MRIs, that are allowing us to design specific kinds of experiments to understand the specific neurocircuits that are involved in the different symptom domains of the disorder.
And finally, there's a good partnership between academic medical centers and autism advocacy groups. I think the autism advocacy groups have been extremely effective -- Cure Autism Now (CAN), National Alliance for Autism Research (NAAR), and Autism Society of America (ASA), for example -- in terms of increasing awareness and increasing support for this important area.
Medscape: Thank you very much for sharing your thoughts with Medscape.
Supported by an independent educational grant from Janssen
Autism: An Interview With Eric Hollander MD
From Medscape Psychiatry & Mental Health
Autism: An Expert Interview With Eric Hollander, MD
Published: 02/03/2005
Editor's Note:
Requests for services related to autism are increasing, although there is controversy over whether this reflects a change in the prevalence of the disorder, better detection, or differences in definition. What is autism? How common is it? What are the best ways to treat it? What makes doing research on autism spectrum disorders exciting today? Elizabeth Saenger, PhD, Medscape Psychiatry & Mental Health, interviewed Eric Hollander, MD, Professor of Psychiatry, Director, Seaver and New York Autism Center of Excellence, Mount Sinai School of Medicine, New York, NY.
Medscape: How would you define autism?
Dr. Hollander: Autism is a developmental disorder that presents before the age of 3 years. It's characterized by impairment in 3 core symptom domains, which include social deficits, communication difficulties, narrow restricted interests, and repetitive behaviors. In addition to that, there are also other associated symptoms that frequently coexist.
Medscape: What are those other symptoms?
Dr. Hollander: The other associated symptom domains can include factors like inattention and motor hyperactivity, impulsivity and aggression, mood instability, EEG abnormalities or seizure related type problems, and cognitive difficulties.
Medscape: How common is this disorder?
Dr. Hollander: It used to be felt to be very rare. The best estimates now are that about 0.6% of the population, a little under 1%, may meet criteria for the broader autism phenotype, or an autism spectrum disorder. Within that spectrum, we include autism, the Asperger syndrome, and pervasive developmental disorder or PDD NOS -- not otherwise specified.
Medscape: How do you treat autism spectrum disorders?
Dr. Hollander: There are a few different treatment approaches. There are behavioral approaches, educational approaches, and medication approaches. We intervene early. There is some evidence that the earlier you pick up the problem and start to intervene with behavioral, educational, speech, and occupational therapy, the better the long-term developmental trajectory. So the idea now is to start to identify people at around 18 months if possible and often to slide people into the educational programs that incorporate a lot of speech and occupational therapy plus behavioral interventions like acute ABA-type treatments -- applied behavioral analysis. And there is evidence that these kinds of treatments actually can be associated with better long-term outcome.
We are also finding that medicines may be very helpful in 2 types of approaches. One is a targeted treatment approach where we select a group of individuals who score high on a particular target symptom like lots of narrow, restricted interests, repetitive behaviors, self-stimulation-type behaviors, and compulsive behaviors, and then treat them, for example, with very low doses of selective serotonin reuptake inhibitors like fluoxetine or fluoxetine in a liquid form. We found that will significantly improve the core symptom domain and improve overall functioning.
Other treatment approaches involve stratifying the population, picking up the subgroup with a lot of disruptive behavior, such as impulsivity and aggression, tantruming, self-injury, and treating them with low doses of atypical antipsychotics, such as risperidone. We also have treatment approaches using the mood-stabilizing, anticonvulsant-type treatments like valproic acid or levetiracetam, finding that these medicines may be helpful in a lot of mood instability, a lot of the disruptive behavior like impulsive, aggressive, or self-injurious behavior. Sometimes for language-related functioning, and particularly those with some abnormal EEGs, patients have a very robust response to the anticonvulsant-type medicines.
Medscape: How successful are these interventions in helping people become what society generally considers normal?
Dr. Hollander: It probably depends on the baseline characteristics of the patient, because it turns out that autism is pretty heterogeneous. You have some individuals who have very high IQs and others with severe mental retardation. You have some individuals who have really outstanding verbal skills and others who have no language at all. You have some people who have accompanying seizure problems or other neurologic problems and others who don't.
So as a group it's fairly heterogeneous. And we know that individuals who start off with a higher IQ and better speech and language tend to have a better long-term outcome than those who have more severe impairment at baseline.
But we know that with early interventions, both behavioral and pharmacologic, people really can do a lot better, that the symptoms that cause distress can be significantly reduced and their overall functional ability can improve.
Medscape: One thing I'm curious about is the paradox in a way of the idiot savant. Can you say something about that?
Dr. Hollander: What's interesting is that within individuals you see a scattering of peaks and valleys in terms of skill levels. And you have some individuals who have extraordinary skills in certain areas. That may go along with their narrow restricted interests, where they become preoccupied with certain things and have all the information in the world about those things. And sometimes people can calculate statistics or memorize calendars or have some extraordinary mathematical or physics ability, or even certain visual/spatial abilities, musical abilities, verbal abilities. We think that there may be some positive attributes that may be coheritable with certain autism symptom domains. The idea is that either there are a number of these core and associated symptom domains that need to come together in order to produce the full syndrome of autism, and that in the first-degree family members, and even in the general population, we frequently see impairment in individual symptom domains. These individuals don't have the full disorder, however, unless they get multiple domains coming together.
Some of the symptom domains that may make up the disorder may also be associated with high abilities in mathematical or visual, spatial, or musical abilities, and it's not unusual to see in first-degree family members a high skill, for example, in physics, math, or computers. It's also not unusual to see many family members who have extraordinary technical skills, for example. Within individuals with autism, you do see individuals with these islands of extraordinary skills also coupled with areas of the real impairment. And it seems that many people with autism have difficulties with the higher order of processing of information. They may be excellent in terms of their raw sensory information or their ability to manipulate the sensory information, but they have more difficulty with the higher-order processing or generating abstract conclusions from the sensory information.
Medscape: In other words, they would be like Raymond in the film, Rain Man, where Raymond could do difficult calculations involving the cards in the casino and win a lot of money or figure out how many toothpicks have been spilled on the floor, but in terms of figuring out how much change he would get if he went to the grocery store to buy something, he was a failure.
Dr. Hollander: Yes. I would say that often there are deficits in certain pragmatic skills -- how to interact with the world in a social fashion to get what you want from the world -- but that they can still have extraordinary specific skills.
Medscape: Can you tell us a little bit about your own research with people who have autism?
Dr. Hollander: Yes. Here at Mount Sinai we have the Seaver and New York Autism Center of Excellence. We have been doing business for over 10 years, initially funded by the Seaver Foundation and now funded by one of the NIH STAART Autism Centers of Excellence. We're very focused on breaking autism down into the different core and associated symptom domains and finding relevant genes, understanding the specific brain circuits, and developing specific treatments for each of the different symptom domains. For example, we found genetic factors that may be associated with speech and language problems or with the repetitive behaviors. We've elucidated the metabolic activity in the limbic system associated with autism. And we have developed new treatments for the symptom domains, particularly the repetitive behaviors and the impulse of aggression. We've also been interested in peptides like oxytocin and the role that those peptides play in social attachment and in the repetitive behaviors; we have done some interesting alterations of that system and found that we can improve social attachment and repetitive behaviors by influencing the oxytocin system. We've also done research on immune abnormalities that may run in families, and related these immune abnormalities to different symptoms.
We've been very interested in the serotonin system and the role that that serotonin system plays in the repetitive behaviors and then how treatments for the serotonin system can improve the repetitive behaviors.
Medscape: This seems to tie into what you once said about the need to look at specific behaviors and then target them with specific medications to improve somebody's behavior and life.
Dr. Hollander: That's right. We think that there are basically 2 approaches with medicines. One is the targeted treatment approach where you stratify the population and you select individuals who have specific types of target behaviors that cause distress and interfere with functioning. You start with low doses of medicines and improve those target symptoms to see how that affects the overall level of functioning. Another approach that we're starting to get into is early interventions to see if we can change the developmental trajectory. In a similar way, early behavioral interventions might improve IQ or social reciprocity with speech and language.
Medscape: The idea of improving IQ seems interesting. Can you tell us more about that?
Dr. Hollander: There are some behavioral treatment studies that suggest that early intervention with behavioral approaches will show an improvement in IQ if you follow individuals over long periods of time.
Some of those studies may be flawed because there wasn't good randomization and people started with different IQ levels at baseline. But generally people feel that early intervention can be associated with improvement. And when you get clinical improvement, you also see a significant improvement in IQ.
Some of the studies that the STAART Centers are looking at now are early interventions with serotonin reuptake inhibitors that follow people over time to see if we can get improvement in IQ. Recently we've also been interested in looking at certain medicines that work on the glutamate system that are used specifically for cognition and memory to see if we can improve cognitive functioning and IQ with those approaches.
Medscape: You mentioned that early intervention in autism means catching a child or a baby at 18 months. How often is autism or potential autism recognized that early?
Dr. Hollander: It used to be very rare, so people usually identified it at around age 3 years when children weren't talking. Nowadays, there's a push to identify earlier problems like eye gaze, not interacting appropriately with other children or peers, or not having good joint attention with parents. And sometimes there can be subtle motor abnormalities that may be present at an earlier stage. There are suggested screening instruments, such as the Checklist For Autism in Toddlers -- CHAT. Cure Autism Now has suggested that pediatricians routinely administer this to all children at 18 months to try to pick up people with developmental delays who should be screened more carefully afterwards.
Medscape: Are pediatricians doing that?
Dr. Hollander: I think that for the most part now, teachers, pediatricians, parents, and other mental health practitioners are doing a better job screening. There is a bit of a controversy in the field as to whether autism is dramatically increasing because the rates were much, much lower before. That may be because everybody is doing a better job screening, so we're picking up the milder cases at an earlier stage. The alternative explanation is that there are environmental factors that interact with strong genetic factors to be associated with an increased risk for people presenting with these problems.
Medscape: I know that's quite controversial. Can you tell us about some of the possible environmental factors that people are thinking about?
Dr. Hollander: Well, there's been a lot of debate about vaccines -- initially the MMR vaccine, and then more recently the thimerosal preservative, which is an ethylmercury preservative that was in certain multidose vials of vaccines. I think that the best available data really suggest that these vaccines are not associated specifically with an increased rate for autism. That's because there have been good studies, for example, in England, shortly after the MMR vaccine was first introduced, that showed that there was no dramatic increase after it was introduced. The Institute of Medicine recently issued a report suggesting that it doesn't look like vaccine played a role. It's clear that mercury can be neurotoxic. It's not good for the developing brain, but probably is not specifically related to the development of autism.
People have hypothesized all kinds of other factors. We were interested in the role that pitocin played in inducing labor and delivery as a possible risk factor. And other people have postulated that things like folate, for example, that are frequently given, may be an epigenetic factor that can turn on and turn off certain genes that could be associated with a greater risk.
Medscape: How did you get interested in this research area?
Dr. Hollander: Originally we were interested in other disorders that present with repetitive behaviors. And then we had the opportunity to partner with the Seaver Foundation and develop a new autism center.
Studying autism is really a great opportunity because if you understand what goes wrong in autism, you understand a little bit more about what makes people human. It gives you insight into issues around being able to see things from other people's perspectives and issues around social attachment, which are really what make us human.
Medscape: What do you see on the horizon in terms of research on autism and social movements about autism?
Dr. Hollander: The media have been talking about autism a lot lately. There are a number of debates, for example, about funding issues in terms of ABA. It's very costly. Does the existing database justify ABA, for example?
There are some controversies about whether autism -- for example, Asperger's disorder -- is just an alternative way of being and whether trying to get rid of target symptoms is not allowing certain patients with Asperger's to fully express who they are.My sense is that it's pretty clear that if we can reduce certain target symptoms, then people will have significantly less distress and their overall level of functioning will improve.
Medscape: Is there anything else you would like to add?
Dr. Hollander: I think this is an exciting time now. The NIH has taken a big interest in autism and launched STAART Autism Centers of Excellence. Many centers are working together to develop important new treatments. And integrated treatments are probably one wave of the future, integrating the behavioral and the medication treatments together.I think there is a lot of exciting work coming out on genetic findings. Mt. Sinai and the Seaver Center have started to actually see specific genes that may play a role in autism. It's clear that there's no single gene, but it may be that if you have a few of these different genes interacting together, you're going to be at high risk for getting the syndrome. Each of the genes may code for the different symptom domains that need to come together to get the full syndrome.
I think that there are new imaging techniques, like functional MRIs, that are allowing us to design specific kinds of experiments to understand the specific neurocircuits that are involved in the different symptom domains of the disorder.
And finally, there's a good partnership between academic medical centers and autism advocacy groups. I think the autism advocacy groups have been extremely effective -- Cure Autism Now (CAN), National Alliance for Autism Research (NAAR), and Autism Society of America (ASA), for example -- in terms of increasing awareness and increasing support for this important area.
Medscape: Thank you very much for sharing your thoughts with Medscape.
Supported by an independent educational grant from Janssen
Myths About Aspartame (NutraSweet)
I stole this from Snopes.com but I think the information is very good.
http://www.snopes.com/medical/toxins/aspartame.asp
Aspartame
Claim: The artificial sweetener aspartame has been proved responsible for an epidemic of cancer, brain tumors, and multiple sclerosis.
Status: False.
Origins:
To date, FDA has not determined any consistent pattern of symptoms that can be attributed to the use of aspartame, nor is the agency aware of any recent studies that clearly show safety problems.
Aspartame and the Internet (The Lancet):
Our research revealed over 6000 web sites that mention aspartame, with many hundreds alleging aspartame to be the cause of multiple sclerosis, lupus erythematosis, Gulf War Syndrome, chronic fatigue syndrome, brain tumours, and diabetes mellitus, among many others. Virtually all of the information offered is anecdotal, from anonymous sources and is scientifically implausible.
ACSH Debunks Internet Health Hoax (American Council on Science and Health):
Health scare artists have found a whole new medium for terrorizing the public — the Internet. Individuals in search of accurate health information may literally become caught in the Web, where health hoaxes and urban medical myths run rampant. The health scare messages are always the same — whatever it is, it will make you sick.
Beware The E-Mail Hoax: The Evils Of Nutrasweet (Aspartame) (Dr. Dean Edell):
A highly inaccurate "chain letter" is being circulated via e-mail warning the reader of the health dangers of aspartame (Nutrasweet) diet drinks. There is so much scientific untruth in it, it’s scary. Be careful, because others know how to manipulate you by this. Just because something is beyond your comprehension doesn’t mean it is scientific.
FDA Statement on Aspartame (FDA):
Analysis of the National Cancer Institute's public data base on cancer incidence in the United States — the SEER Program — does not support an association between the use of aspartame and increased incidence of brain tumors.
Study Reaffirms Safety of Aspartame (MIT News):
Even daily large doses of the high-intensity sweetener aspartame, also known as NutraSweet, had no adverse effect on study subjects' health and well-being, a visiting scientist at MIT reported in the American Journal of Clinical Nutrition last week. "We conclude that aspartame is safe for the general population," said Paul A. Spiers, visiting scientist in the Clinical Research Center (CRC).
A Web of Deceit (TIME magazine):
A widely disseminated e-mail by a "Nancy Markle" links aspartame to Alzheimer's, birth defects, brain cancer, diabetes, Gulf War syndrome, lupus, multiple sclerosis and seizures. Right away, the long list warrants skepticism. Just as no single chemical cures everything, none causes everything.
Last updated: 25 September 2007
The URL for this page is http://www.snopes.com/medical/toxins/aspartame.asp
Urban Legends Reference Pages © 1995-2008 by snopes.com.
This material may not be reproduced without permission.
snopes and the snopes.com logo are registered service marks of snopes.com.
http://www.snopes.com/medical/toxins/aspartame.asp
Aspartame
Claim: The artificial sweetener aspartame has been proved responsible for an epidemic of cancer, brain tumors, and multiple sclerosis.
Status: False.
Origins:
To date, FDA has not determined any consistent pattern of symptoms that can be attributed to the use of aspartame, nor is the agency aware of any recent studies that clearly show safety problems.
Aspartame and the Internet (The Lancet):
Our research revealed over 6000 web sites that mention aspartame, with many hundreds alleging aspartame to be the cause of multiple sclerosis, lupus erythematosis, Gulf War Syndrome, chronic fatigue syndrome, brain tumours, and diabetes mellitus, among many others. Virtually all of the information offered is anecdotal, from anonymous sources and is scientifically implausible.
ACSH Debunks Internet Health Hoax (American Council on Science and Health):
Health scare artists have found a whole new medium for terrorizing the public — the Internet. Individuals in search of accurate health information may literally become caught in the Web, where health hoaxes and urban medical myths run rampant. The health scare messages are always the same — whatever it is, it will make you sick.
Beware The E-Mail Hoax: The Evils Of Nutrasweet (Aspartame) (Dr. Dean Edell):
A highly inaccurate "chain letter" is being circulated via e-mail warning the reader of the health dangers of aspartame (Nutrasweet) diet drinks. There is so much scientific untruth in it, it’s scary. Be careful, because others know how to manipulate you by this. Just because something is beyond your comprehension doesn’t mean it is scientific.
FDA Statement on Aspartame (FDA):
Analysis of the National Cancer Institute's public data base on cancer incidence in the United States — the SEER Program — does not support an association between the use of aspartame and increased incidence of brain tumors.
Study Reaffirms Safety of Aspartame (MIT News):
Even daily large doses of the high-intensity sweetener aspartame, also known as NutraSweet, had no adverse effect on study subjects' health and well-being, a visiting scientist at MIT reported in the American Journal of Clinical Nutrition last week. "We conclude that aspartame is safe for the general population," said Paul A. Spiers, visiting scientist in the Clinical Research Center (CRC).
A Web of Deceit (TIME magazine):
A widely disseminated e-mail by a "Nancy Markle" links aspartame to Alzheimer's, birth defects, brain cancer, diabetes, Gulf War syndrome, lupus, multiple sclerosis and seizures. Right away, the long list warrants skepticism. Just as no single chemical cures everything, none causes everything.
Last updated: 25 September 2007
The URL for this page is http://www.snopes.com/medical/toxins/aspartame.asp
Urban Legends Reference Pages © 1995-2008 by snopes.com.
This material may not be reproduced without permission.
snopes and the snopes.com logo are registered service marks of snopes.com.
A Snapshot of ADHD in the US
Denise Mann
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
CINCINNATI, Sept.4 -- Almost 9% of U.S. children ages 8 to 15 meet standard diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but less than half of them receive treatment.
Only 47.9% of the 2.4 million who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for ADHD had reportedly had their conditions diagnosed by a health care professional or been treated with medication, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine.
A research team led by Tanya E. Froehlich, M.D., of Cincinnati Children's Hospital Medical Center did a cross-sectional phone survey of the parents or caregivers of 3,082 eight- to 15-year old children who were participants in the National Health and Nutrition Examination Survey.
Survey respondents provided information about each child's ADHD symptoms between 2001 and 2004. They also provided sociodemographic information and information about whether the child had ever been diagnosed with ADHD or taken medicine to treat the disorder.
The researchers found that 8.7% (95% CI; 7.3%-10.1%) met the DSM-IV criteria for ADHD in the year before the survey took place. An additional 3.3% of children did not meet the criteria, but had a parent-reported prior diagnosis and had been treated with an ADHD medication at some point during the previous year. The latter group, however, was not included in the main analysis.
More boys than girls met the diagnostic criteria for ADHD, 11.8% versus 5.4%, respectively (P<0.001), but girls were less likely than boys to have had the disorder recognized.
There were also discrepancies in ADHD rates by race and ethnicity. Non-Hispanic white children were more likely to meet criteria for ADHD than were Mexican-American children or children of other races/ethnicities, the study showed. These findings held in both bivariate and multivariate analyses.
The study authors could not explain why Mexican-American children had lower rates of ADHD, but they speculate that this may be related to "differences in the prevalence of causal risk factors, genetic susceptibility, and/or rates of reporting ADHD symptoms across cultures."
Of the children who met the diagnostic criteria for ADHD, 38.8% had received medication to treat inattention, hyperactivity, or overactivity in the prior year and 32.0% had been taking medication for most of that year.
Regular medication use was more likely to be reported for older children than younger ones, the study showed.
Money also mattered in the new study. Children in the poorest quintile were more likely than those in the wealthiest quintile to have been diagnosed with ADHD (adjusted odds ratio [AOR] for PIR, first quintile vs fifth quintile, 2.3; 95% CI, 1.4-3.9)).
"Reasons for the increased likelihood of ADHD in poorer children may include the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group," the study authors write.
"In addition, given the high heritability of ADHD and its negative impact on social, academic and career outcomes, it is plausible that families with ADHD may cluster within the lower socioeconomic strata."
Although poor children were more likely to have ADHD, the poorest children were three to five times less likely to consistently receive medication when compared with their counterparts in other income groups, the researchers noted.
This finding "warrants further investigation and possible intervention to ensure that all children with ADHD have equitable access to treatment when appropriate," the authors conclude.
The researchers also analyzed ADHD by subtypes. Specifically, 4.4% of the children met the criteria for ADHD-1A, 2.2% for ADHD-CT and 3.0% for ADHD-HI.
The poorest children were more likely to have ADHD-HI than their wealthier counterparts (AOR for PIR, first vs fifth quintile, 3.1; 95% CI, 1.2-8.3
In addition, African Americans and Mexican Americans were less likely to have ADHD-1A, compared to their non-Hispanic white counterparts, the study showed.
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
CINCINNATI, Sept.4 -- Almost 9% of U.S. children ages 8 to 15 meet standard diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD), but less than half of them receive treatment.
Only 47.9% of the 2.4 million who met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for ADHD had reportedly had their conditions diagnosed by a health care professional or been treated with medication, according to a report in the September issue of the Archives of Pediatrics & Adolescent Medicine.
A research team led by Tanya E. Froehlich, M.D., of Cincinnati Children's Hospital Medical Center did a cross-sectional phone survey of the parents or caregivers of 3,082 eight- to 15-year old children who were participants in the National Health and Nutrition Examination Survey.
Survey respondents provided information about each child's ADHD symptoms between 2001 and 2004. They also provided sociodemographic information and information about whether the child had ever been diagnosed with ADHD or taken medicine to treat the disorder.
The researchers found that 8.7% (95% CI; 7.3%-10.1%) met the DSM-IV criteria for ADHD in the year before the survey took place. An additional 3.3% of children did not meet the criteria, but had a parent-reported prior diagnosis and had been treated with an ADHD medication at some point during the previous year. The latter group, however, was not included in the main analysis.
More boys than girls met the diagnostic criteria for ADHD, 11.8% versus 5.4%, respectively (P<0.001), but girls were less likely than boys to have had the disorder recognized.
There were also discrepancies in ADHD rates by race and ethnicity. Non-Hispanic white children were more likely to meet criteria for ADHD than were Mexican-American children or children of other races/ethnicities, the study showed. These findings held in both bivariate and multivariate analyses.
The study authors could not explain why Mexican-American children had lower rates of ADHD, but they speculate that this may be related to "differences in the prevalence of causal risk factors, genetic susceptibility, and/or rates of reporting ADHD symptoms across cultures."
Of the children who met the diagnostic criteria for ADHD, 38.8% had received medication to treat inattention, hyperactivity, or overactivity in the prior year and 32.0% had been taking medication for most of that year.
Regular medication use was more likely to be reported for older children than younger ones, the study showed.
Money also mattered in the new study. Children in the poorest quintile were more likely than those in the wealthiest quintile to have been diagnosed with ADHD (adjusted odds ratio [AOR] for PIR, first quintile vs fifth quintile, 2.3; 95% CI, 1.4-3.9)).
"Reasons for the increased likelihood of ADHD in poorer children may include the elevated prevalence of ADHD risk factors (i.e., premature birth and in utero or childhood exposures to toxic substances) in this group," the study authors write.
"In addition, given the high heritability of ADHD and its negative impact on social, academic and career outcomes, it is plausible that families with ADHD may cluster within the lower socioeconomic strata."
Although poor children were more likely to have ADHD, the poorest children were three to five times less likely to consistently receive medication when compared with their counterparts in other income groups, the researchers noted.
This finding "warrants further investigation and possible intervention to ensure that all children with ADHD have equitable access to treatment when appropriate," the authors conclude.
The researchers also analyzed ADHD by subtypes. Specifically, 4.4% of the children met the criteria for ADHD-1A, 2.2% for ADHD-CT and 3.0% for ADHD-HI.
The poorest children were more likely to have ADHD-HI than their wealthier counterparts (AOR for PIR, first vs fifth quintile, 3.1; 95% CI, 1.2-8.3
In addition, African Americans and Mexican Americans were less likely to have ADHD-1A, compared to their non-Hispanic white counterparts, the study showed.
Allergies and "Allergic Shiners"
Hi Again,
I was also asked by Jennifer, one of our Moms here at Meyer Pediatrics, about allergic shiners, those dark and puffy circles under kid's eyes that are often mistakenly thought to be due to lack of sleep. The're not related to sleep at all. They are a sign of allergies, as are the creases under the eyes called Denny's Lines and the raised pink bumps on the back wall of the throat called cobblestoning. If one parent has allergies, each child has about a 50% chance of having allergies (although what your child is allergic to is NOT inherited; that they have to do for themselves. Just because you are allergic to penicillin does not mean that your child is, or even ever will be). If both parents have allergies, then each child has about a 75% chance of having allergies.
I'm often asked when, or even if, a child should be tested for allergies. My short answer is that I would go through the relative trauma of skin testing (far more accurate than blood testing) only if the child's life is being changed by the allergies. If they can't go to a friends house because the friend has a dog, that may be a good reason to investigate.
There won't be just one or 2 things that your child is allergic to and therefore you could just avoid. It likely will be a dozen or more things. In most cases, you could just treat the allergies and skip the whole testing phase. Obviously, if you think that your child has had a serious reaction to something, or perhaps may even have had a potentially fatal reaction to something such as having had difficulty breathing after eating shellfish, then of course you would want to have this checked by an allergist so that you can know for sure.
It depends on the child, but I often find that for kids with significant allergies it usually takes a combination of Singulair (a prescription medication for airway inflammation) plus an allergy nasal spray such as Omnaris or Nasonex or Nasocort, plus a once-a-day, non-sedating antihistamine (such as Allegra or Clarinex) to control the allergy symptoms well. One or two of those medications just doesn't seem to work as well, in my experience.
I know that most parents don't like the idea of their children taking mutliple medications, and I do prefer just letting the child live with mild symptoms, but if we've made the decision to treat allergies with medication, I think we might as well do it the right way. Go for the win.
As a preventative, Singulair once a day can often be used as a maintenance plan during the time of year when your child is most symptomatic, with antihistamines used on an "as needed" basis. When your child is fully symptomatic, however, you're going to want to do everything, or nothing at all, in my opinion.
I hope that this little overview answered some of your questions about allergies. If not, or if there are other topics that you'd like to see me address, write me here at Dr. Ted's Blog and I'll try to get something written as soon as possible.
I was also asked by Jennifer, one of our Moms here at Meyer Pediatrics, about allergic shiners, those dark and puffy circles under kid's eyes that are often mistakenly thought to be due to lack of sleep. The're not related to sleep at all. They are a sign of allergies, as are the creases under the eyes called Denny's Lines and the raised pink bumps on the back wall of the throat called cobblestoning. If one parent has allergies, each child has about a 50% chance of having allergies (although what your child is allergic to is NOT inherited; that they have to do for themselves. Just because you are allergic to penicillin does not mean that your child is, or even ever will be). If both parents have allergies, then each child has about a 75% chance of having allergies.
I'm often asked when, or even if, a child should be tested for allergies. My short answer is that I would go through the relative trauma of skin testing (far more accurate than blood testing) only if the child's life is being changed by the allergies. If they can't go to a friends house because the friend has a dog, that may be a good reason to investigate.
There won't be just one or 2 things that your child is allergic to and therefore you could just avoid. It likely will be a dozen or more things. In most cases, you could just treat the allergies and skip the whole testing phase. Obviously, if you think that your child has had a serious reaction to something, or perhaps may even have had a potentially fatal reaction to something such as having had difficulty breathing after eating shellfish, then of course you would want to have this checked by an allergist so that you can know for sure.
It depends on the child, but I often find that for kids with significant allergies it usually takes a combination of Singulair (a prescription medication for airway inflammation) plus an allergy nasal spray such as Omnaris or Nasonex or Nasocort, plus a once-a-day, non-sedating antihistamine (such as Allegra or Clarinex) to control the allergy symptoms well. One or two of those medications just doesn't seem to work as well, in my experience.
I know that most parents don't like the idea of their children taking mutliple medications, and I do prefer just letting the child live with mild symptoms, but if we've made the decision to treat allergies with medication, I think we might as well do it the right way. Go for the win.
As a preventative, Singulair once a day can often be used as a maintenance plan during the time of year when your child is most symptomatic, with antihistamines used on an "as needed" basis. When your child is fully symptomatic, however, you're going to want to do everything, or nothing at all, in my opinion.
I hope that this little overview answered some of your questions about allergies. If not, or if there are other topics that you'd like to see me address, write me here at Dr. Ted's Blog and I'll try to get something written as soon as possible.
Tuesday, November 24, 2009
Does Your Four Year Old Still Wet the Bed?
I was asked about this in one of the comments, and I found that it is difficult to find my answer unless you already know where to look. So, I'm repeating myself here as a post to make it easier for everyone to find this information. We just started this blog about a month ago, and I'm still playing around with it to see how it all works. Below is my answer to Jennifer, one of our Moms here at Meyer Pediatrics who asked me about children who are late to get dry at night (and have never been dry before).
OK, at age 4, about 80% of all kids are dry at night. Those that aren't are the "late" group, and they will slowly become dry over the next 10 or so years, at the rate of about 10% per year. SO, at 5 years old, about 90% of them are still wetting, and at 6 about 80% and so on. It's NOT laziness or anything like that. It's because, for reasons unknown to me, these kids are slow to get the night-time rise in a hormone called ADH (Anti-Diuretic Hormone, which is naturally secreted by our brains) that those of us who stay dry get. Ultimately, just about all of them WILL get this night-time surge and they will become dry.
There ARE rare other causes of night-time wetting (and I am ONLY describing kids who have ALWAYS wet the bed here, not kids who WERE dry and then started wetting later). At any rate, these kids should have a good physical exam one time to be sure that there is nothing else causing the enuresis (the medical term for night-time wetting) as there are several treatments available, at least for sporadic use, such as when your child wants to have a spend-the-night party without others finding out. In these cases, there is a prescription medication called DDAVP that is a chewable pill taken before bedtime that in over 80% of cases is successfully able to keep a child dry for that night.
Therefore, to answer your question, I would recommend the pullups until they aren't needed anymore, whatever age that might happen to be. My patient who was the latest to get permanently dry was about 16 or 17. For the routine changeover from pull-ups to underwear, "big kid" underwear should be a reward, NOT an inducement. They should only be allowed to wear "big girl panties" when they can go a whole week without wetting.
OK, at age 4, about 80% of all kids are dry at night. Those that aren't are the "late" group, and they will slowly become dry over the next 10 or so years, at the rate of about 10% per year. SO, at 5 years old, about 90% of them are still wetting, and at 6 about 80% and so on. It's NOT laziness or anything like that. It's because, for reasons unknown to me, these kids are slow to get the night-time rise in a hormone called ADH (Anti-Diuretic Hormone, which is naturally secreted by our brains) that those of us who stay dry get. Ultimately, just about all of them WILL get this night-time surge and they will become dry.
There ARE rare other causes of night-time wetting (and I am ONLY describing kids who have ALWAYS wet the bed here, not kids who WERE dry and then started wetting later). At any rate, these kids should have a good physical exam one time to be sure that there is nothing else causing the enuresis (the medical term for night-time wetting) as there are several treatments available, at least for sporadic use, such as when your child wants to have a spend-the-night party without others finding out. In these cases, there is a prescription medication called DDAVP that is a chewable pill taken before bedtime that in over 80% of cases is successfully able to keep a child dry for that night.
Therefore, to answer your question, I would recommend the pullups until they aren't needed anymore, whatever age that might happen to be. My patient who was the latest to get permanently dry was about 16 or 17. For the routine changeover from pull-ups to underwear, "big kid" underwear should be a reward, NOT an inducement. They should only be allowed to wear "big girl panties" when they can go a whole week without wetting.
Potty Training
Hi,
I was asked by Jennifer, one of our Moms, about potty training. Since I get asked about that a lot, I thought it made a good topic for a post. I often tell parents who ask that there are basically two ways to potty train a child; the slow and easy way or the fast but difficult way.
The slow but easy way is to wait until your child shows an interest in wearing "big kid underwear." These should be a REWARD for staying dry, NOT an inducement to get dry, which does NOT work. The only downside of this approach is that the motivation for the kids to stop wearing pullups is being teased by their friends ("you're a little baby wearing diapers") which is obviously painful and embarrassing to your child.
The fast but difficult way involves removing yourself from the diaper equation. A child over 3 years of age is perfectly capable of being dry at night. They are choosing to be in diapers or pullups because it's the "hot line" to Mommy. They can commandeer your time and attention simply by saying, "I gotta go NOW." SO, to force the issue, tell the child that you no longer do diapers (as long as they at least 3 years old) and that you will only help them if they go on the potty. This ONLY works, by the way, if you NEVER cave in and help them with pullups. Say to the child, "Here are the pullups, here's the toilet paper, here's where the dirty diapers go. Knock yourself out, but don't call me for ANY help unless you want to go on the potty. I don't do diapers now that you are three. I only will come help if you go on the potty."
This works because the child is not attached to the pullups so much as attached to you and using the pullups to command your time and attention. From a young child's perspective, NO ONE has EVER had enough attention, no matter how much they really get (and believe me, my patients typically get attention by the boat load). When forced to choose between you and diapers, a child will ALWAYS choose you, once they become convinced that you really mean it.
They will, of course, test you to see if you really mean it, but if you don't cave, they likely will voluntarily switch over to "big boy underwear" within a day or so. I promise that this works IF you stick to your guns! Good luck!
I was asked by Jennifer, one of our Moms, about potty training. Since I get asked about that a lot, I thought it made a good topic for a post. I often tell parents who ask that there are basically two ways to potty train a child; the slow and easy way or the fast but difficult way.
The slow but easy way is to wait until your child shows an interest in wearing "big kid underwear." These should be a REWARD for staying dry, NOT an inducement to get dry, which does NOT work. The only downside of this approach is that the motivation for the kids to stop wearing pullups is being teased by their friends ("you're a little baby wearing diapers") which is obviously painful and embarrassing to your child.
The fast but difficult way involves removing yourself from the diaper equation. A child over 3 years of age is perfectly capable of being dry at night. They are choosing to be in diapers or pullups because it's the "hot line" to Mommy. They can commandeer your time and attention simply by saying, "I gotta go NOW." SO, to force the issue, tell the child that you no longer do diapers (as long as they at least 3 years old) and that you will only help them if they go on the potty. This ONLY works, by the way, if you NEVER cave in and help them with pullups. Say to the child, "Here are the pullups, here's the toilet paper, here's where the dirty diapers go. Knock yourself out, but don't call me for ANY help unless you want to go on the potty. I don't do diapers now that you are three. I only will come help if you go on the potty."
This works because the child is not attached to the pullups so much as attached to you and using the pullups to command your time and attention. From a young child's perspective, NO ONE has EVER had enough attention, no matter how much they really get (and believe me, my patients typically get attention by the boat load). When forced to choose between you and diapers, a child will ALWAYS choose you, once they become convinced that you really mean it.
They will, of course, test you to see if you really mean it, but if you don't cave, they likely will voluntarily switch over to "big boy underwear" within a day or so. I promise that this works IF you stick to your guns! Good luck!
Monday, November 23, 2009
Seasonal Flu shot for ages 3 years and older have arrived!
We have recieved the Seasonal Flu shots for ages 3 years and older. If you want to have your child recieve this vaccine please call the office to schedule an appointment. We also still have H1N1 (Swine Flu) vaccines available for ages 6 months and up. It is recommended that children recieve both the Seasonal and H1N1 vaccines.
Thanksgiving Holiday Hours
Meyer Pediatrics will be closed on Thursday, November 26th and Friday, November 27th. We will reopen at 8.30a.m. Saturday, November 28th. We are always available 24 hours a day by phone/answering service. I hope everyone enjoys the Thanksgiving Holiday!
Friday, November 13, 2009
Update for Patients with Cigna Insurance
Please note patients, if you have Cigna insurance you are required to have your laboratory tests sent to Lab Corp, Cigna's preferred vendor. Labs included are Rapid Strep, Rapid Influenza A, Rapid Influenza B. However, you may choose to have the tests in our office with immediate results if you elect to self pay for the services. Rapid Strep is $25.00, Influenza A & B are $20.00 each.
Thursday, November 12, 2009
Contact Dermatitis: More Than You Ever Wanted to Know
Contact dermatitis is simply inflammation that results from the interaction of skin and an external substance (even water) that comes in contact with it. It is an altered state of skin reactivity induced by exposure to an external agent. For the vast majority of people, these substances are harmless. “Eczema” and “dermatitis” are often used synonymously to denote a polymorphic pattern of inflammation of the skin. In all cases the lesions of contact dermatitis are primarily confined to the site of contact. Contact dermatitis can look – and itch – very much like eczema. It usually presents as a rash of tiny blisters, inflamed reddened skin, sometimes dry, or sometimes moist and oozing.
Contact dermatitis is produced through one of two major pathways: irritant or allergic.
Irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) are two of the most common dermatologic conditions in industrialized societies, with a prevalence of up to 10%. The two conditions are clinically indistinguishable and often both conditions co-exist. Many of the allergens causing ACD are also irritants.
Irritant contact dermatitis predominates, accounting for 80% of all cases of contact dermatitis. ICD is a non-immunologic skin reaction that does not involve immune system sensitization (previous exposure to the allergen). It can occur in all members of the population depending on the "irritancy" of the chemical, the duration of contact and individual susceptibility. Atopics (who invariably have dry skin) are more prone to irritant dermatitis. Water is one of the most common irritants; therefore atopics who do a lot of wet work will often get irritant hand dermatitis. Another reason atopics get irritant dermatitis is that the skin gets injured from chronic scratching, allowing the otherwise harmless chemicals in cosmetics to enter the skin. The most common skin irritants include acids, alkalis, detergents, and solvents that disrupt the barrier function of the skin. Common cosmetics / skin care products causing skin irritation include:
• Bath soaps & shampoos
• Eye shadow & mascara
• Make-up removers,
• Antiperspirants,
• Permanent hair-waving solutions.
• Water present in cosmetics and skin care products is the most common irritant to very dry skin.
Irritant contact dermatitis is a risk factor for allergic contact dermatitis, as the penetration of contact allergens is enhanced when the skin barrier function is disturbed.
Allergic contact dermatitis (ACD), on the other hand, is an immunologic skin reaction that occurs in a genetically predisposed individual. The allergic response occurs only when a person’s immune system is sensitized to the allergen. The more contact the individual has with the allergen the greater the risk of sensitization. In sensitized individuals, allergic contact dermatitis appears or is exacerbated 24 to 96 hours after contact with the causative allergen. ACD is usually accompanied by intense itching. The edges of the lesions are usually well demarcated, but unlike irritant dermatitis it may propagate beyond the site of contact. This reaction is also known as delayed hypersensitivity reaction, since the rash usually develops more than 12 hours after contact with the allergen. The reaction usually peaks about 48 hours after exposure. The number of chemicals known to be capable of causing ACD is said to be near 3000 and constantly increasing.
Site of the skin reaction is usually the face especially around the eyes. In one study allergic contact dermatitis was found to be the cause in 74% of patients with eyelid dermatitis. In Saudi Arabia it is well known that men with dermatitis in the beard have an allergy to permanent hair dyes.
Common allergens in cosmetics and skin care products that cause contact dermatitis
Current reviews demonstrate that the most frequent allergenic groups causing cosmetic allergy are fragrances, preservatives, and paraphenylenediamine (PPD) found in permanent hair dyes.
Fragrance
The commonest allergen causing ACD is fragrance. More than 5000 different fragrances are used in cosmetics and skin care products. Seventy to eighty percent of fragrance allergy can be picked up by patch testing with Balsam of Peru and Fragrance Mix (which contains 8 common fragrances). Fragrance can also cause increased pigmentation of the affected skin, photodermatitis, or contact urticaria.
It is important to know that "unscented" does not mean "fragrance-free". Some unscented products might contain a fragrance to mask other chemical odours. To indicate that no fragrance is added to a product it must be marked "fragrance-free" or "without perfume".
In 1989, less than 10% of the patients patch tested in a multicentre project in Germany reacted to the fragrance mix (a mixture of 8 important fragrances). Between 1990 and 1994, a steady increase in the percentage of sensitizations diagnosed to more than 13% was noted (4).
Screening for Fragrance Allergy:
These are the fragrances tested in a standard patch test battery:
• Balsam of Peru
• Fragrance Mix:
1. Oak Moss
2. Cinnamic aldehyde
3. Cinnamic alcohol
4. Alpha amyl cinnamic alcohol
5. Geraniol
6. Hydroxycitronellal
7. Isoeugenol &
8. Eugenol
• Musk Ambrette and Moskene
In a worldwide multicenter investigation on fragrance contact dermatitis, reaction to fragrance mix occurred in 78% of patients patch tested
Balsam of Peru
Balsam of Peru (BP) is usually included in the standard screening patch-test series as an indicator of fragrance sensitivity. It is positive in 50% of cases of fragrance allergy. BP is a naturally occurring substance, obtained from fir trees. It is composed of many allergens including benzyl acetate, benzoyl alcohol, cinnamic acid, cinnamic alcohol, cinnamic aldehyde, eugenol, and isoeugenol.
Paraphenylenediamine (PPD) Hair dye Allergy
This is the most important dye used for permanent (oxidation) hair colouring and is the third most common ingredient after fragrances & preservatives that cause contact dermatitis from cosmetics. Permanent hair dyes are more sensitizing compared to other types of hair dye.
In most cases the reaction to the dye is itching of the scalp and some redness, but nothing more. These individuals might just think they have a bit of dandruff. In more severe cases the hair dye may trigger scaly skin & pain. The distribution of the affected skin can vary and may not match the exact area to which the dye was applied. In more severe cases there can be swelling around the eyes and scaly skin on the ears, face & neck. Sensitization to hair dye may gradually develop with repeated exposure.
In some European countries, PPD was banned because it was thought to be too hazardous. The regulations of the EEC, however, have allowed up to 6% PPD in hair dyes.
In the consumer, PPD produces acute dermatitis that involves the scalp, eyelids, face, and hairline and may extend to include the neck & upper portion of the trunk, but may spread to involve the whole body. In the hairdresser the most common region affected is the hand, but other exposed areas like the arms & face may be affected. Once the dye becomes fully oxidized it is no longer allergenic; thus dyed hair does not cause dermatitis.
Other damage to the scalp skin can make one more sensitive than normal to hair dye and other chemicals.
Substances related to PPD which should be avoided in PPD-sensitized people
• Benzocaine (found in some haemorrhoid preparations) & procaine – local anaesthetics.
• Azo dyes: used in temporary & semi-permanent hair dyes, pen inks,
• Textiles dyes – especially dark clothing & clothing made of synthetic fiber like polyester or nylon
• Some foods & pharmaceuticals coloured with azo dyes
• Sulfa drugs
• Para-aminobenzoic acid (PABA) – found in sunscreens
Hair dye open skin sensitivity Test (“Dab test”) or Open Patch Test
In many countries there is legislation that requires hair dye products to carry a warning about conducting patch test prior to using the dye. This is a precaution to make sure the individual is not sensitized to the dye.
Allergies to PPD can develop, even though there was no reaction during previous use. For this reason, it is important to take the allergy test 48 hours ahead of every use.
The test area used is either behind the ear or inside the arm at the elbow. A small amount of the “colour base” (or some companies recommend mixing the base with the developer first) is applied to the test area. Do not wash the test area. Wait 48 hours unless there is reddening, burning or other irritation. If there is no reaction on the unwashed patch test site after 48 hours, then one can proceed to the full application.
Three dermatological departments in Italy, Great Britain & Poland, have validated this test. They considered it an effective method to detect delayed hypersensitivity (contact allergy) to hair dyes, and as such are useful in the secondary prevention of hair dye allergy. (5)
Preservatives
Preservatives in cosmetics and skin care products are the second most common cause of skin reactions. Cosmetics that contain water must contain some preservative to prevent bacterial or fungal growth. Examples of cosmetics preservatives that cause allergy include:
• Parabens are the most commonly used preservatives in cosmetics
• Formaldehyde is an important sensitiser & is released by a number of biocides, it is mainly found in shampoos
• Imidazolidinyl urea (Germall 115)
• Quaternium-15 (Dowcill 200) is a formaldehyde releasing preservative found in many cosmetics including, eye makeup, foundations, shampoos, moisturizing lotions, sunscreens, body powders, and skin cleansers.
• Phenoxyethanol
• DMDM hydantoin (Glydant)
Cocamidopropyl Betaine (CAPB) was voted Contact Allergen of the year for 2004 by a committee of international experts. It is a non-ionic surfactant found primarily in rinse off cosmetics (shampoos, soaps, and bath gels). It is less irritating to the skin than older surfactants. For this reason patients may think that a less irritating product such as a baby shampoo is safer for the skin when it is more likely to cause allergic contact dermatitis.
A case was presented in the American Journal of Dermatology (Vol 15, No 1 (March), 2004: pp3-4) of a 37-year-old woman who presented with eyelid dermatitis that had been present for 5 months. She was instructed by her family doctor to apply baby shampoo to the eyelids daily (similar advice given in NZ as well). Patch testing revealed a + reaction to CAPB. CAPB was present in the baby shampoo she applied. Discontinuation of this product resulted in clearing of her allergic contact dermatitis.
CAPB is found in over 600 personal care products (according to FDA). The case of CAPB illustrates an important point regarding allergy to cosmetics. Because CAPB is “less irritating” than other surfactants, it may be preferred by consumers, manufacturers, and doctors. The fact that it is more allergenic came to light only after its widespread use.
The reported prevalence of allergic contact dermatitis (ACD) secondary to CAPB exposure ranges from 3.0 to 7.2% (6).
Lanoline or Wools alcohol
In North America lanoline was the fourth commonest cosmetic allergen (after fragrance, preservatives and PPD) causing contact dermatitis (7). It is felt that the prevalence of ACD to lanoline is decreasing because knowledge of its allergenicity has been known for a very long time.
It is a natural material obtained from the sebum of sheep. It is recovered from raw wool by solvent extraction. It is used in cosmetics because of its emollient, moisturizing, and emulsifying properties.
There are several allergens present in lanoline, and lanoline-sensitive patients can sometimes tolerate one lanoline preparation but not another.
Cosmetics containing lanoline include:
• Moisturizers, Hand creams, Protective creams
• Sunscreens
• Glossy lipsticks
• Makeup remover, Eye makeup
• Foundations, eye makeup
• Baby oils & diaper lotions
• Hair spray
Cosmetics with herbal ingredients
Virtually all-herbal remedies have been reported to cause either allergic sensitization or photosensitization.
In a recent study in Portland, Oregan, USA, 63% of patients with suspected cosmetics dermatitis that had used a skin product containing botanical extracts were patch test positive to a botanical extract. In New Zealand the true prevalence of contact allergy to botanical extracts in patients with cosmetics dermatitis is unknown, as most people who suffer from skin rashes do not seek medical help unless the rash is persistent.
Common herbal products causing contact dermatitis include plants from the Compositae family:
• Artichoke
• Chamomile (found in numerous shampoos & other hair treatment products)
• Daisy (Chrysanthemum)
• Dandelion (Taraxacum)
• Feverfew
• Marigold
• Pyrethrum
• Ragweed (Ambrosia)
• Thistle
Several plants in the Compositae plant family are regularly included in "natural skin care products" in New Zealand, especially shampoos and aromatherapy solutions. In some cases the reactions to Compositae is worsened by sunlight, often giving the appearance of a light-sensitive rash.
Tea Tree (Melaleuca alternifolia) Oil is increasingly being used in NZ in various cosmetics (soaps, deodorants, toothpaste, gargles & aftershave) and allergic contact dermatitis is being found related to this product throughout the world.
The leaves of the tea tree contain an essential oil, which contains turpentines (limonene, alpha-pinene, phellandrene). In one study in Honolulu limonene was the most common allergen causing allergic contact dermatitis from tea tree oil.
The 'tea tree' oil available in the Netherlands is distilled from the Melaleuca alternifolia and mainly contains eucalyptol. Eucalyptol is probably the most important allergen. The Photoaged Melaleuca is a stronger sensitiser than regular tea tree.
There have been recent reports of topical tea tree oil causing anaphylaxis (Allergy Asthma Proc. 2003 Jan-Feb; 24(1): 73-5)
Propolis
There are reports in the literature describing several individual cases of contact dermatitis in patients using propolis as a component of various cosmetic products, listing the most frequently sensitizing constituents of propolis. There are also reports of the existence of a cross-reaction between the components of Peruvian balsam and propolis constituents.
Henna Allergy
With the vigorous back-to-nature trend in Western countries, henna as a natural hair dye has become increasingly popular. This shift away from chemical dyes is enforced by the relatively high risk of sensitization to chemical dyes, in both hairdresser and their clients.
Henna is derived from a shrub Lawsonia inermis, which is native to the Middle East & North Africa.
There have been several reports in the literature of Immediate Allergic (& Anaphylactic) reaction to using Henna hair dyes. Most cases had sneezing, runny nose, cough, & shortness of breath instead of skin reactions. They were all diagnosed with the help of a positive skin prick test to henna extract. Most of these individuals were hairdressers who became sensitized from their work. It is felt that they became sensitized by inhalation of henna powder dispersed in the air.
Henna also causes allergic contact dermatitis.
Photosensitivity is the term used to describe skin disease caused by the interaction of UV radiation and an exogenously (externally) acquired chemical agent, which may be either a drug or food taken orally, or a substance applied to the skin. It can be divided into photodermatitis, also referred to as photoallergic dermatitis, and photoirritant contact dermatitis.
Plants that cause photodermatitis (Phytophotodermatitis)
Phytophotodermatitis produces reddening and blisters on first exposure followed by persistent hyperpigmentation (darkening of the skin). This darkening of the skin can last for months. The rash is produced via a phototoxic reaction, which simply means that the reaction renders the skin susceptible to damage by UV light, and symptoms include burning pain at the affected site. This is in contrast to the reaction produced by plants such as poison ivy, which is classified as allergic contact dermatitis, and involves symptoms such as intense itching.
Compounds related to furocouramins (psoralens) usually cause plant-related photosensitivity. Two requisites for initiation of phytophotodermatitis are contact with a sensitizing plant (e.g. furocouramin) and exposure to ultraviolet light (wavelength greater than 320 nm), usually sunlight. Therefore, this dermatitis is usually seasonal.
Common plants causing photodermatitis:
Common Name
Botanical Name
Family
Angelica
Angelica archangelica
Umbelliferae
Bergamot
Citrus bergamia
Rutaceae
Celery
Apium aurantium
Umbelliferae
Citron
Citrus medica
Dill
Anethum graveolens
Umbelliferae
Fennel
Foeniculum vulgare
Umbelliferae
Fig
Ficus carica
Moraceae
Lemon
Citrus lemon
Rutaceae
Lime
Citrus aurantifolia
Rutaceae
Parsnip
Pastinaca sativa
Umbelliferae
Wild Carrot
Dacus carota
Umbelliferae
In New Zealand many of these plants are also being added to "natural skin care products".
Contact urticaria is a hives-like reaction occurring at the site of contact of the skin product and usually occurring within 15 minutes of the product touching the skin.
Diagnosis of skin rashes caused by cosmetics
Contact Urticaria is diagnosed by applying the product to the skin for 15 – 20 minutes and observing the skin for redness, swelling and itching or doing a skin prick test (applying the suspected allergen/s to the forearm and pricking the skin with a lancet & waiting 15 minutes for a bump like a mosquito bite at the site of the prick)
Contact Dermatitis is diagnosed by doing a patch test. The only way to obtain proof of allergic contact dermatitis is by patch testing. Patch testing is the universally accepted method for the detection of the causative contact allergens. The positive patch test reproduces an experimental contact dermatitis on a limited area of the skin. This is different from skin prick testing (which gives a positive response in 15 minutes) in that it is a delayed hypersensitivity response (it gives a positive response in about 48 hours).
The most frequently encountered contact allergens have been selected by various international contact dermatitis groups and included in standard patch test series. The chemicals are taped to the back in small chambers. The skin is not broken. The patches stay in place for 48 hours. You cannot shower or do any work or exercise that will wet or loosen the patches.
After 2 days, the patches are removed, and a reading is done. The patch sites are marked, and you may be asked to return for a final reading on another day. An experienced doctor can differentiate between allergic contact dermatitis and an irritant reaction on patch testing.
Repeated Open Application Test (ROAT) or Use Test
This is a simple test for new skin care products or products suspected of causing skin reactions. A small amount of the product is applied twice daily to a small area of normal skin, usually on the front of the elbow for 1 week. If no rash appears after 1 week the product is considered safe for that individual. This test simulates the everyday use of cosmetic products and can be used to define the clinical relevance of doubtful or positive diagnostic patch tests.
Photo-patch testing is patch testing with the addition of radiation to induce the formation of photoantigens. All photosensitive patients should be photo-patch tested.
Cosmetic Allergy & The Future
A recent Patch test study done in Austria (published in Paediatrics Dermatology 2003 Mar-Apr; 20(2): 119-23) showed that the overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily to be lowest among patients more than 70 years old. This coupled with the fact that appearance is so important to adolescents as they are bombarded with numerous cosmetic advertisements; they are significant consumers of toiletry & skin care products. Therefore we would expect the prevalence of cosmetic allergy to continue to increase.
References
(1) Allergic contact dermatitis to topical minoxidil solution: Etiology and treatment. J Am Acad Dermatol 2002; 46:309-12
(2) Dooms-Goossens A et al., Cosmetic products and their allergens. Eur J Dermatol 1992; 2: 465-8
(3) Kohl, et al, Allergic contact dermatitis from cosmetics. Retrospective analysis of 819 patch-tested patients. Dermatology. 2002; 204(4): 334-7
(4) Wolfgang Uter et al. Epidemiology of contact dermatitis. The information network of Departments of Dermatology. European Journal of Dermatology. Vol 8. Number 1. 36-40 Jan – Feb 1998
(5) Maya Krasteva et al. Contact Sensitivity to hair dyes can be detected by consumer open test. European Journal of derm. Vol. 12. Number 4, 322-6
(6) Joseph F. Fowler Jr et al. Allergy to Cocamidopropyl Betaine and Amidoamine in North America. Dermatitis, Vil 15, No 1 March, 2004: pp5-6
(7) Adams et al. A five year study of cosmetic reactions, J Am Acad Dermatol 13: 1062-1069, 1985
Contact & Occupational Dermatology by James G. Marks & Vincent A. DeLeo
Contact dermatitis is produced through one of two major pathways: irritant or allergic.
Irritant contact dermatitis (ICD) and allergic contact dermatitis (ACD) are two of the most common dermatologic conditions in industrialized societies, with a prevalence of up to 10%. The two conditions are clinically indistinguishable and often both conditions co-exist. Many of the allergens causing ACD are also irritants.
Irritant contact dermatitis predominates, accounting for 80% of all cases of contact dermatitis. ICD is a non-immunologic skin reaction that does not involve immune system sensitization (previous exposure to the allergen). It can occur in all members of the population depending on the "irritancy" of the chemical, the duration of contact and individual susceptibility. Atopics (who invariably have dry skin) are more prone to irritant dermatitis. Water is one of the most common irritants; therefore atopics who do a lot of wet work will often get irritant hand dermatitis. Another reason atopics get irritant dermatitis is that the skin gets injured from chronic scratching, allowing the otherwise harmless chemicals in cosmetics to enter the skin. The most common skin irritants include acids, alkalis, detergents, and solvents that disrupt the barrier function of the skin. Common cosmetics / skin care products causing skin irritation include:
• Bath soaps & shampoos
• Eye shadow & mascara
• Make-up removers,
• Antiperspirants,
• Permanent hair-waving solutions.
• Water present in cosmetics and skin care products is the most common irritant to very dry skin.
Irritant contact dermatitis is a risk factor for allergic contact dermatitis, as the penetration of contact allergens is enhanced when the skin barrier function is disturbed.
Allergic contact dermatitis (ACD), on the other hand, is an immunologic skin reaction that occurs in a genetically predisposed individual. The allergic response occurs only when a person’s immune system is sensitized to the allergen. The more contact the individual has with the allergen the greater the risk of sensitization. In sensitized individuals, allergic contact dermatitis appears or is exacerbated 24 to 96 hours after contact with the causative allergen. ACD is usually accompanied by intense itching. The edges of the lesions are usually well demarcated, but unlike irritant dermatitis it may propagate beyond the site of contact. This reaction is also known as delayed hypersensitivity reaction, since the rash usually develops more than 12 hours after contact with the allergen. The reaction usually peaks about 48 hours after exposure. The number of chemicals known to be capable of causing ACD is said to be near 3000 and constantly increasing.
Site of the skin reaction is usually the face especially around the eyes. In one study allergic contact dermatitis was found to be the cause in 74% of patients with eyelid dermatitis. In Saudi Arabia it is well known that men with dermatitis in the beard have an allergy to permanent hair dyes.
Common allergens in cosmetics and skin care products that cause contact dermatitis
Current reviews demonstrate that the most frequent allergenic groups causing cosmetic allergy are fragrances, preservatives, and paraphenylenediamine (PPD) found in permanent hair dyes.
Fragrance
The commonest allergen causing ACD is fragrance. More than 5000 different fragrances are used in cosmetics and skin care products. Seventy to eighty percent of fragrance allergy can be picked up by patch testing with Balsam of Peru and Fragrance Mix (which contains 8 common fragrances). Fragrance can also cause increased pigmentation of the affected skin, photodermatitis, or contact urticaria.
It is important to know that "unscented" does not mean "fragrance-free". Some unscented products might contain a fragrance to mask other chemical odours. To indicate that no fragrance is added to a product it must be marked "fragrance-free" or "without perfume".
In 1989, less than 10% of the patients patch tested in a multicentre project in Germany reacted to the fragrance mix (a mixture of 8 important fragrances). Between 1990 and 1994, a steady increase in the percentage of sensitizations diagnosed to more than 13% was noted (4).
Screening for Fragrance Allergy:
These are the fragrances tested in a standard patch test battery:
• Balsam of Peru
• Fragrance Mix:
1. Oak Moss
2. Cinnamic aldehyde
3. Cinnamic alcohol
4. Alpha amyl cinnamic alcohol
5. Geraniol
6. Hydroxycitronellal
7. Isoeugenol &
8. Eugenol
• Musk Ambrette and Moskene
In a worldwide multicenter investigation on fragrance contact dermatitis, reaction to fragrance mix occurred in 78% of patients patch tested
Balsam of Peru
Balsam of Peru (BP) is usually included in the standard screening patch-test series as an indicator of fragrance sensitivity. It is positive in 50% of cases of fragrance allergy. BP is a naturally occurring substance, obtained from fir trees. It is composed of many allergens including benzyl acetate, benzoyl alcohol, cinnamic acid, cinnamic alcohol, cinnamic aldehyde, eugenol, and isoeugenol.
Paraphenylenediamine (PPD) Hair dye Allergy
This is the most important dye used for permanent (oxidation) hair colouring and is the third most common ingredient after fragrances & preservatives that cause contact dermatitis from cosmetics. Permanent hair dyes are more sensitizing compared to other types of hair dye.
In most cases the reaction to the dye is itching of the scalp and some redness, but nothing more. These individuals might just think they have a bit of dandruff. In more severe cases the hair dye may trigger scaly skin & pain. The distribution of the affected skin can vary and may not match the exact area to which the dye was applied. In more severe cases there can be swelling around the eyes and scaly skin on the ears, face & neck. Sensitization to hair dye may gradually develop with repeated exposure.
In some European countries, PPD was banned because it was thought to be too hazardous. The regulations of the EEC, however, have allowed up to 6% PPD in hair dyes.
In the consumer, PPD produces acute dermatitis that involves the scalp, eyelids, face, and hairline and may extend to include the neck & upper portion of the trunk, but may spread to involve the whole body. In the hairdresser the most common region affected is the hand, but other exposed areas like the arms & face may be affected. Once the dye becomes fully oxidized it is no longer allergenic; thus dyed hair does not cause dermatitis.
Other damage to the scalp skin can make one more sensitive than normal to hair dye and other chemicals.
Substances related to PPD which should be avoided in PPD-sensitized people
• Benzocaine (found in some haemorrhoid preparations) & procaine – local anaesthetics.
• Azo dyes: used in temporary & semi-permanent hair dyes, pen inks,
• Textiles dyes – especially dark clothing & clothing made of synthetic fiber like polyester or nylon
• Some foods & pharmaceuticals coloured with azo dyes
• Sulfa drugs
• Para-aminobenzoic acid (PABA) – found in sunscreens
Hair dye open skin sensitivity Test (“Dab test”) or Open Patch Test
In many countries there is legislation that requires hair dye products to carry a warning about conducting patch test prior to using the dye. This is a precaution to make sure the individual is not sensitized to the dye.
Allergies to PPD can develop, even though there was no reaction during previous use. For this reason, it is important to take the allergy test 48 hours ahead of every use.
The test area used is either behind the ear or inside the arm at the elbow. A small amount of the “colour base” (or some companies recommend mixing the base with the developer first) is applied to the test area. Do not wash the test area. Wait 48 hours unless there is reddening, burning or other irritation. If there is no reaction on the unwashed patch test site after 48 hours, then one can proceed to the full application.
Three dermatological departments in Italy, Great Britain & Poland, have validated this test. They considered it an effective method to detect delayed hypersensitivity (contact allergy) to hair dyes, and as such are useful in the secondary prevention of hair dye allergy. (5)
Preservatives
Preservatives in cosmetics and skin care products are the second most common cause of skin reactions. Cosmetics that contain water must contain some preservative to prevent bacterial or fungal growth. Examples of cosmetics preservatives that cause allergy include:
• Parabens are the most commonly used preservatives in cosmetics
• Formaldehyde is an important sensitiser & is released by a number of biocides, it is mainly found in shampoos
• Imidazolidinyl urea (Germall 115)
• Quaternium-15 (Dowcill 200) is a formaldehyde releasing preservative found in many cosmetics including, eye makeup, foundations, shampoos, moisturizing lotions, sunscreens, body powders, and skin cleansers.
• Phenoxyethanol
• DMDM hydantoin (Glydant)
Cocamidopropyl Betaine (CAPB) was voted Contact Allergen of the year for 2004 by a committee of international experts. It is a non-ionic surfactant found primarily in rinse off cosmetics (shampoos, soaps, and bath gels). It is less irritating to the skin than older surfactants. For this reason patients may think that a less irritating product such as a baby shampoo is safer for the skin when it is more likely to cause allergic contact dermatitis.
A case was presented in the American Journal of Dermatology (Vol 15, No 1 (March), 2004: pp3-4) of a 37-year-old woman who presented with eyelid dermatitis that had been present for 5 months. She was instructed by her family doctor to apply baby shampoo to the eyelids daily (similar advice given in NZ as well). Patch testing revealed a + reaction to CAPB. CAPB was present in the baby shampoo she applied. Discontinuation of this product resulted in clearing of her allergic contact dermatitis.
CAPB is found in over 600 personal care products (according to FDA). The case of CAPB illustrates an important point regarding allergy to cosmetics. Because CAPB is “less irritating” than other surfactants, it may be preferred by consumers, manufacturers, and doctors. The fact that it is more allergenic came to light only after its widespread use.
The reported prevalence of allergic contact dermatitis (ACD) secondary to CAPB exposure ranges from 3.0 to 7.2% (6).
Lanoline or Wools alcohol
In North America lanoline was the fourth commonest cosmetic allergen (after fragrance, preservatives and PPD) causing contact dermatitis (7). It is felt that the prevalence of ACD to lanoline is decreasing because knowledge of its allergenicity has been known for a very long time.
It is a natural material obtained from the sebum of sheep. It is recovered from raw wool by solvent extraction. It is used in cosmetics because of its emollient, moisturizing, and emulsifying properties.
There are several allergens present in lanoline, and lanoline-sensitive patients can sometimes tolerate one lanoline preparation but not another.
Cosmetics containing lanoline include:
• Moisturizers, Hand creams, Protective creams
• Sunscreens
• Glossy lipsticks
• Makeup remover, Eye makeup
• Foundations, eye makeup
• Baby oils & diaper lotions
• Hair spray
Cosmetics with herbal ingredients
Virtually all-herbal remedies have been reported to cause either allergic sensitization or photosensitization.
In a recent study in Portland, Oregan, USA, 63% of patients with suspected cosmetics dermatitis that had used a skin product containing botanical extracts were patch test positive to a botanical extract. In New Zealand the true prevalence of contact allergy to botanical extracts in patients with cosmetics dermatitis is unknown, as most people who suffer from skin rashes do not seek medical help unless the rash is persistent.
Common herbal products causing contact dermatitis include plants from the Compositae family:
• Artichoke
• Chamomile (found in numerous shampoos & other hair treatment products)
• Daisy (Chrysanthemum)
• Dandelion (Taraxacum)
• Feverfew
• Marigold
• Pyrethrum
• Ragweed (Ambrosia)
• Thistle
Several plants in the Compositae plant family are regularly included in "natural skin care products" in New Zealand, especially shampoos and aromatherapy solutions. In some cases the reactions to Compositae is worsened by sunlight, often giving the appearance of a light-sensitive rash.
Tea Tree (Melaleuca alternifolia) Oil is increasingly being used in NZ in various cosmetics (soaps, deodorants, toothpaste, gargles & aftershave) and allergic contact dermatitis is being found related to this product throughout the world.
The leaves of the tea tree contain an essential oil, which contains turpentines (limonene, alpha-pinene, phellandrene). In one study in Honolulu limonene was the most common allergen causing allergic contact dermatitis from tea tree oil.
The 'tea tree' oil available in the Netherlands is distilled from the Melaleuca alternifolia and mainly contains eucalyptol. Eucalyptol is probably the most important allergen. The Photoaged Melaleuca is a stronger sensitiser than regular tea tree.
There have been recent reports of topical tea tree oil causing anaphylaxis (Allergy Asthma Proc. 2003 Jan-Feb; 24(1): 73-5)
Propolis
There are reports in the literature describing several individual cases of contact dermatitis in patients using propolis as a component of various cosmetic products, listing the most frequently sensitizing constituents of propolis. There are also reports of the existence of a cross-reaction between the components of Peruvian balsam and propolis constituents.
Henna Allergy
With the vigorous back-to-nature trend in Western countries, henna as a natural hair dye has become increasingly popular. This shift away from chemical dyes is enforced by the relatively high risk of sensitization to chemical dyes, in both hairdresser and their clients.
Henna is derived from a shrub Lawsonia inermis, which is native to the Middle East & North Africa.
There have been several reports in the literature of Immediate Allergic (& Anaphylactic) reaction to using Henna hair dyes. Most cases had sneezing, runny nose, cough, & shortness of breath instead of skin reactions. They were all diagnosed with the help of a positive skin prick test to henna extract. Most of these individuals were hairdressers who became sensitized from their work. It is felt that they became sensitized by inhalation of henna powder dispersed in the air.
Henna also causes allergic contact dermatitis.
Photosensitivity is the term used to describe skin disease caused by the interaction of UV radiation and an exogenously (externally) acquired chemical agent, which may be either a drug or food taken orally, or a substance applied to the skin. It can be divided into photodermatitis, also referred to as photoallergic dermatitis, and photoirritant contact dermatitis.
Plants that cause photodermatitis (Phytophotodermatitis)
Phytophotodermatitis produces reddening and blisters on first exposure followed by persistent hyperpigmentation (darkening of the skin). This darkening of the skin can last for months. The rash is produced via a phototoxic reaction, which simply means that the reaction renders the skin susceptible to damage by UV light, and symptoms include burning pain at the affected site. This is in contrast to the reaction produced by plants such as poison ivy, which is classified as allergic contact dermatitis, and involves symptoms such as intense itching.
Compounds related to furocouramins (psoralens) usually cause plant-related photosensitivity. Two requisites for initiation of phytophotodermatitis are contact with a sensitizing plant (e.g. furocouramin) and exposure to ultraviolet light (wavelength greater than 320 nm), usually sunlight. Therefore, this dermatitis is usually seasonal.
Common plants causing photodermatitis:
Common Name
Botanical Name
Family
Angelica
Angelica archangelica
Umbelliferae
Bergamot
Citrus bergamia
Rutaceae
Celery
Apium aurantium
Umbelliferae
Citron
Citrus medica
Dill
Anethum graveolens
Umbelliferae
Fennel
Foeniculum vulgare
Umbelliferae
Fig
Ficus carica
Moraceae
Lemon
Citrus lemon
Rutaceae
Lime
Citrus aurantifolia
Rutaceae
Parsnip
Pastinaca sativa
Umbelliferae
Wild Carrot
Dacus carota
Umbelliferae
In New Zealand many of these plants are also being added to "natural skin care products".
Contact urticaria is a hives-like reaction occurring at the site of contact of the skin product and usually occurring within 15 minutes of the product touching the skin.
Diagnosis of skin rashes caused by cosmetics
Contact Urticaria is diagnosed by applying the product to the skin for 15 – 20 minutes and observing the skin for redness, swelling and itching or doing a skin prick test (applying the suspected allergen/s to the forearm and pricking the skin with a lancet & waiting 15 minutes for a bump like a mosquito bite at the site of the prick)
Contact Dermatitis is diagnosed by doing a patch test. The only way to obtain proof of allergic contact dermatitis is by patch testing. Patch testing is the universally accepted method for the detection of the causative contact allergens. The positive patch test reproduces an experimental contact dermatitis on a limited area of the skin. This is different from skin prick testing (which gives a positive response in 15 minutes) in that it is a delayed hypersensitivity response (it gives a positive response in about 48 hours).
The most frequently encountered contact allergens have been selected by various international contact dermatitis groups and included in standard patch test series. The chemicals are taped to the back in small chambers. The skin is not broken. The patches stay in place for 48 hours. You cannot shower or do any work or exercise that will wet or loosen the patches.
After 2 days, the patches are removed, and a reading is done. The patch sites are marked, and you may be asked to return for a final reading on another day. An experienced doctor can differentiate between allergic contact dermatitis and an irritant reaction on patch testing.
Repeated Open Application Test (ROAT) or Use Test
This is a simple test for new skin care products or products suspected of causing skin reactions. A small amount of the product is applied twice daily to a small area of normal skin, usually on the front of the elbow for 1 week. If no rash appears after 1 week the product is considered safe for that individual. This test simulates the everyday use of cosmetic products and can be used to define the clinical relevance of doubtful or positive diagnostic patch tests.
Photo-patch testing is patch testing with the addition of radiation to induce the formation of photoantigens. All photosensitive patients should be photo-patch tested.
Cosmetic Allergy & The Future
A recent Patch test study done in Austria (published in Paediatrics Dermatology 2003 Mar-Apr; 20(2): 119-23) showed that the overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily to be lowest among patients more than 70 years old. This coupled with the fact that appearance is so important to adolescents as they are bombarded with numerous cosmetic advertisements; they are significant consumers of toiletry & skin care products. Therefore we would expect the prevalence of cosmetic allergy to continue to increase.
References
(1) Allergic contact dermatitis to topical minoxidil solution: Etiology and treatment. J Am Acad Dermatol 2002; 46:309-12
(2) Dooms-Goossens A et al., Cosmetic products and their allergens. Eur J Dermatol 1992; 2: 465-8
(3) Kohl, et al, Allergic contact dermatitis from cosmetics. Retrospective analysis of 819 patch-tested patients. Dermatology. 2002; 204(4): 334-7
(4) Wolfgang Uter et al. Epidemiology of contact dermatitis. The information network of Departments of Dermatology. European Journal of Dermatology. Vol 8. Number 1. 36-40 Jan – Feb 1998
(5) Maya Krasteva et al. Contact Sensitivity to hair dyes can be detected by consumer open test. European Journal of derm. Vol. 12. Number 4, 322-6
(6) Joseph F. Fowler Jr et al. Allergy to Cocamidopropyl Betaine and Amidoamine in North America. Dermatitis, Vil 15, No 1 March, 2004: pp5-6
(7) Adams et al. A five year study of cosmetic reactions, J Am Acad Dermatol 13: 1062-1069, 1985
Contact & Occupational Dermatology by James G. Marks & Vincent A. DeLeo
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