Upper Respiratory Tract Infections Ebook

Avoid / Cure A Cold Fast

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The Common Cold and the

The common cold and the flu (influenza) are both caused by viruses. The viruses that cause colds and the flu are transmitted when an infected person coughs or sneezes into the air and another person inhales the infected droplets. You can also catch a cold or the flu by kissing an infected person or by touching your mouth after touching the other person's hands or an object he or she has touched. Each cold is caused by a different virus, and there are nearly 200 different cold viruses. Adults average about two to four colds per year. The virus that causes the flu changes from year to year that is why a flu immunization is good for only a year. When these viruses enter your body, they multiply rapidly. Your immune system tries to fight them, producing symptoms that include coughing, sneezing, and a runny nose. Many people confuse the common cold with the flu, but there is one easy way to tell the difference the flu usually causes a fever, while a cold does not. Also, a cold causes nasal...

The Hazards of Tobacco

If you smoke, you will notice the gradual onset of a host of long-term problems. Your senses of smell and taste will weaken, you will get more frequent colds than before, facial wrinkling will intensify, and you will develop a nagging smoker's cough, which is actually a symptom of a serious disease called chronic bronchitis (see page 246). You also increase your chances of developing cancers of the lung and other organs, emphysema, high blood pressure, stroke, and heart disease. You also place your family at risk of the same health problems by exposing them to secondhand smoke (see page 31).

Placebos and the Placebo Effect

A well-known study of the placebo effect was reported in 1955 by Dr. Harry Beecher (1). He described the placebo effect in a variety of conditions, including the common cold, pain after surgery, headache, and seasickness. Overall, symptoms were improved in 35 percent of the people who were given the placebo. Subsequent studies of a variety of medical conditions found placebo effects that were frequently in the range of 30 to 40 percent. In some studies, placebos have been 70 percent effective.

Atopic Eczema Dermatitis

Rash From Figs Eaten

In most patients there is a family history of eczema or of other atopic diseases, such as asthma or allergic rhinitis. Atopic eczema usually presents during infancy and, often, may resolve during childhood, whereas in others it may persist into adult life. Atopic eczema usually affects the face, wrists, and the flexural aspects of the elbows and knees (Fig. 2). There may be some involvement of the trunk, and the rash may become generalized. The eczema may be complicated by bacterial infection, and there is evidence to suggest that many exacerbations of atopic eczema may be due to occult infection with Staphylococcus aureus. Eczematous skin is also more prone to infections with wart viruses, molluscum contagiosum, and herpesviruses. Patients with atopic dermatitis may develop a widespread and potentially fatal rash, eczema herpeticum, following the development of herpes simplex or following contact with individuals affected with herpes simplex.

Bordetella bronchiseptica

Bordetella bronchiseptica is a Gram-negative, small rod-shaped bacterium which is a primary pathogen in the rabbit and the guinea pig. In rats, it is an opportunistic pathogen when associated with other primary pathogens such as Mycoplasma or viruses. The respiratory infection is characterized by suppu-rative rhinitis and bronchopneumonia.

Brompheniramine maleate

Action Kinetics Fewer sedative effects. tv2 25 hr. Time to peak effect 3-9 hr. Duration 4-25 hr. Uses Allergic rhinitis (oral). Par-enterally to treat allergic reactions to blood or plasma adjunct to treat anaphylaxis uncomplicated allergic conditions when PO therapy is not possible or is contraindicated. Contraindications Use in neonates.

Action Kinetics Peak serum levels

Uses Otitis media due to Streptococcus pneumoniae, Hemophilus influenzae, Streptococcus pyogenes, and staphylococci. Upper respiratory tract infections (including pharyngitis and tonsillitis) caused by S. pyo-genes. Lower respiratory tract infections (including pneumonia) due to S. pneumoniae, H. influenzae, and S. pyogenes. Skin and skin structure infections due to Staphylococcus aure-us and S. pyogenes. UTIs (including pyelonephritis and cystitis) caused by Escherichia coli, Proteus mirabilis, Klebsiella, and coagulase-negative staphylococci. Extended-release tablets Acute bacterial exacerbations of chronic bronchitis due to non- -lac-tamase-producing strains of H. in-fluenzae, Moraxella catarrhalis (including -lactamase-producing strains), or S. pneumoniae. Secondary bacterial infections of acute bronchitis due to H. influenzae (non- -lactamase-producing strains only), M. catarrhalis (including -lactamase-producing strains), or S. pneumoniae. Pharyngitis or tonsillitis due to S....

Sexually Transmitted Diseases

After colds and the flu, STDs are the most common infectious diseases in the United States, with more than 15 million new cases each year, 3 million of them among teenagers. By age 21, nearly one in five Americans requires treatment for a disease acquired through sexual contact.

Discharge And Home Healthcare Guidelines

GG astroenteritis is an inflammation of the stomach and the small bowel. More than 200,000 pediatric hospitalizations occur each year in the United States, and as many as 10,000 people die each year. Gastroenteritis is a self-limiting disease that is also called intestinal flu, traveler's diarrhea, viral enteritis, or food poisoning. The stomach and small bowel react to any of the causative agents with inflammation and increased gastrointestinal (GI) motility, thus leading to severe diarrhea. Gastroenteritis is a common disease throughout the world, and often outbreaks occur in epidemics, especially among people who are living in crowded conditions. It is also more common in autumn and winter than in the warmer seasons. Although it is a major cause of mortality and morbidity in underdeveloped countries, in the United States, the condition is rarely life threatening. It does rank second to the common cold as a cause of sick days among American workers, however.

Headache see specific sections in Chapter 8 for International Headache Society criteria

Attacks of severe, strictly unilateral pain, orbital, supraorbital, and or temporal, usually lasting 15-180 minutes and occurring from at least once every other day up to eight times per day. Associated with one or more of the following conjunctival injection, lacrimation, nasal congestion, rhinorrhea, forehead and facial sweating, miosis, ptosis, eyelid edema. Attacks occur in series for weeks or months ( cluster periods), separated by remissions of usually months or years.

Clinical Manifestations

Cutaneous Black eschar, dramatic local edema, regional lymphadenopathy. Gastrointestinal (GI) Nausea and vomiting, malaise, bloody diarrhea, abdominal pain, sepsis, case fatality rate (CFR) 50+ Inhalation Upper respiratory illness (URI) prodrome, pneumonia, adult respiratory distress syndrome (ARDS), sepsis, hemorrhagic mediastinitis case fatality rate (CFR) was 70 , now

Classification Antihistamine

Action Kinetics Fexofenadine, a metabolite of terfenadine, is an H1-his-tamine receptor blocker. Low to no sedative or anticholinergic effects. Onset Rapid. Peak plasma levels 2.6 hr. t 2, terminal 14.4 hr. Approximately 90 of the drug is excreted through the feces (80 ) and urine (10 ) unchanged. Uses Seasonal allergic rhinitis in adults and children 12 years of age and older. Special Concerns Use with care during lactation. Safety and efficacy have not been determined in children less than 12 years of age. Side Effects CNS Drowsiness, fatigue. GI Nausea, dyspepsia. Miscellaneous Viral infection (flu, colds), dysmenorrhea, sinusitis, throat irritation.

Qing hao Artemisia annua Asteraceae

Artemisia annua has been used for hundreds of years in traditional medicine in China. The leaves were harvested in the summer, before the flowers appear, and dried for later use. The dried leaves are generally used in the treatment of fever, malaria, colds, diarrhea, as a digestive, and, externally, as a wound remedy. As recently as 1971 a Chinese research group isolated the active principle, the sesquiterpene lactone artemisinin, which proved to be very effective against the malarial parasite Plasmodium falciparum, and particularly towards chloroquine-resistant malaria.

What About Allergy Immunodeficiency And Reflux

By the time a child arrives in the otolaryngologist's office for evaluation of chronic sinusitis, someone in the family will have raised the issue that this is all due to allergy. In many situations, the nature of the rhinorrhea and congestion does resemble that seen in atopic patients. However, microscopic and immunologic analyses of the secretions are not consistent with what is seen in IgE-mediated rhinitis. Rather, the findings are those of acute infectious inflammation. Whereas some reports report a higher incidence of sinusitis in atopic children, concerns about reporting biases and biases in the allergy practices reporting such findings raise concerns about the validity of the reports. The primary risk factors for such disease are primarily related to exposure to other children, as in day care. The prompt response to effective antimicrobials also weighs against allergy being of primary importance. As a child grows beyond 3-5 years of age, the incidence of IgE-mediated disease...

Angioedema and Urticaria

Angioedema Pictures Eyelids

INTRODUCTION Angioedema and urticaria are common transient phenomena that result from mast cell degranulation with the release of mediators that promote vascular permeability, causing proteins and fluids to extravasate into the extracellular space. In urticaria fluid collects within the dermal tissue, whereas in angioedema fluid collects in the deeper subcutaneous space. The causes of mast cell degranulation are varied and include both immunologic and nonimmunologic mechanisms. Systemic involvement may include rhinitis, bronchospasm, or anaphylaxis. Severe reactions may lead to syncope, bronchial asthma, and hypotension. In rare cases both urticaria and angioedema may be triggered by exercise. Acute cases reach a peak in one to three days and usually fade in 7-21 days. In chronic cases the condition waxes and wanes for months or may even persist for years. There may be recurrent attacks separated by months to years. Inciting allergens are numerous and include foods, cosmetics,...

Adverse Effects Interactions and Pharmacokinetics

Dosages of up to 30 mg rhDNase I per day were well tolerated in healthy volunteers and CF patients 69,87 . Severe bronchospasms or anaphylactic reactions, as seen after inhalation of bovine DNase I, have never been observed with rhDNase I. The most common adverse effects reported after daily inhalation of 2.5 mg rhDNase I were voice alterations (hoarseness), pharyngitis, rash, laryngitis, and conjunctivitis 74,76,78 . All these events are generally mild and transient. In patients with severe pulmonary disease (FVC 40 ), rhinitis, fever, dyspepsia, dyspnea, and an FVC decrease of 10 have also been reported 76,88 . Facial edema has been reported to an exceptional degree in patients receiving 2.5 or 10 mg rhDNase I twice daily 70 . It has also been shown that rhDNase I may increase airway inflammation by releasing elastase and proinflammatory cytokines that are bound to DNA in the airway secretions 89-91 . However, other studies did not confirm this observation 92-94 . Antibodies against...

Antibiotics for Use in Pediatric Rhinosinusitis

Late-phase reaction after exposure to antigen.71 Accordingly, steroid nasal sprays are especially useful in children with allergic rhinitis or nasal polyps or both. Nasal sprays containing ipatropium bromide have a different mechanism of action, and no studies have been done to validate the efficacy of this drug in rhinosinusitis.

Confirm Clinical Suspicions

HEENT Severe mucosal irritation and edema keratoconjunctivitis can lead to corneal epithelial ulcers ( gas eye ) rhinitis. Cardiovascular Bradycardia, angina. Pulmonary Dyspnea, cyanosis, bronchitis, cough, hemoptysis, pulmonary edema. Gastrointestinal Nonspecific nausea and vomiting.

Otitis Media To Treat or Not to Treat

Otitis media research also has the potential to confuse and confound as much as it contributes to our knowledge. There are three main reasons for this. First, clinical research has to deal with so many coexistent factors (e.g., season, age, child care, upper respiratory tract infections UTI ) that significance tends to be diluted, unless very large numbers are involved. Second, much research deals with surrogate outcomes (effusion resolution for example), while long-term true outcomes (e.g., IQ, employment status) are much harder to come by. Meta-analy-sis is particularly amiss when it comes to grouping subtly disparate studies. Finally, we are overwhelmed by definitions, and what seems very obvious is not always so. For example, Hay-den10 illustrated this nicely when he surveyed 165 pediatricians, who had 147 different definitions for acute otitis media.

Classification Antihistamine ophthalmic

Contraindications Not to be injected. Not to be instilled while the client is wearing contact lenses. Special Concerns Use with caution during lactation. Safety and efficacy have not been determined for children less than 3 years of age. Side Effects Ophthalmic Burning or stinging, dry eye, foreign body sensation, hyperemia, keratitis, lid edema, pruritus. Nose throat Pharyngitis, rhinitis, sinusitis. Oral Taste perversion. Miscellaneous Headache, asthenia, cold syndrome. Drug Interactions None reported. How Supplied Solution 0.1 Solution in a 5-mL drop dispenser

Medical Management Options for Otitis Media Antibiotics

Antimicrobial therapy has continued to be a mainstay of therapy for patients with otitis media. Recently, there has been evidence that over usage of antimicrobial therapy has led to an increased incidence of bacterial resistance in common pathogens related to otitis media. Most notably, St. pneumoniae, H. influenzae, and M. caterrhalis.15 Children frequently presenting to primary physicians with viral upper respiratory tract infections may be treated with antimicrobials, whether or not the patient has simultaneously developed otitis media.4 We know from prior microbiologic studies13,14 that a significant number of middle ear effusion cultures contain predominantly viruses that would not benefit from antimicrobial therapy. It is apparent from these prior studies that many children with otitis media may not benefit from antimicrobial agents, as the cause of otitis media in many cases is nonbacterial, or some cases of bacterial otitis media may resolve without pharmacologic therapy....

Alternative Medical Treatment Options

Other medical modalities recommended for the treatment of otitis include corticosteroids, administered orally or intra nasally 33-36 antihistamines and or decongestants. Although there is evidence that orally administered corticosteroids may help clear chronic middle ear effusion, there is no evidence that this provides a long-term benefit in patients with chronic otitis media with effusion.35 In addition, there is the risk of potential side effects from utilization of cortocosteroids. Intranasal steroids may play a role in patients with chronic middle ear effu-sion.36 However, there is no evidence of efficacy in the treatment of acute otitis media. Antihistamine decongestant preparations have been used in the past for treatment of otitis media with effusion. However, there is no evidence that this accelerates clearance of middle ear effusion and there appears to be no role for these medications in the treatment of acute otitis media.37 In children who have significant symptoms of...

Asthma The Role of Atopy Risk Factors and Maternal Exposures

People with atopy are genetically predisposed to produce IgE antibodies in response to common household allergens and have at least one atopic disease (i.e., asthma, allergic rhinitis, or atopic eczema) (Kay 2001). Most patients with asthma are atopic, although a minority have intrinsic, nonatopic asthma that often has a later onset and a more protracted course than atopic asthma. Recent studies indicate that there are more similarities than differences in the airway abnormalities of atopic and nonatopic asthma (Humbert et al. 1999). A large body of evidence shows that allergen exposure influences the atopic phenotype, and many studies indicate that allergen or toxicant exposure during critical windows of immune system development (in utero and early infancy) may influence a sensitization process that can lead to childhood asthma (reviewed in Landrigan 1998). Epidemiological data support the findings from these studies and highlight the role of maternal factors (Donovan and Finn 1999...

Clinical manifestation

Spread by nasal droplet infection incubation period of 14-19 days, with onset of rash usually on the 15th day disease contagious from a few days before to 5-7 days after the appearance of the exanthem most contagious when rash is erupting may have no prodrome in children, with rash being first manifestation in adults, fever, sore throat, and rhinitis may occur discrete macules on the face that spread to the neck, trunk, and extremities, with coalescence into plaques exanthem lasts 1-3 days, first leaving the face nonspecific enanthem (Forscheimer's spots) of pinpoint red macules and petechiae visible over the soft palate and uvula just before or with the exanthem

Phenylephrine hydrochloride

Uses Systemic Vascular failure in shock, shock-like states, drug-induced hypotension or hypersensitiv-ity. To maintain BP during spinal and inhalation anesthesia to prolong spinal anesthesia. As a vasoconstrictor in regional analgesia. Paroxysmal SVT. Nasal Nasal congestion due to allergies, sinusitis, common cold, or hay fever. Ophthal-mologic 0.12 Temporary relief of redness of the eye associated with colds, hay fever, wind, dust, sun, smog, smoke, contact lens. 2.5 and 10 Decongestant and vasoconstrictor, treatment of uveitis with posterior synechiae, open-angle glaucoma, refraction without cyclople-gia, ophthalmoscopic examination, funduscopy, prior to surgery. Contraindications Severe hypertension, ventricular tachycardia. Special Concerns Use with extreme caution in geriatric clients, severe arteriosclerosis, bradycardia, partial heart block, myocardial disease, hyperthyroidism and during pregnancy and lactation. Nasal and ophthalmic use of phenylephrine may be systemically...

CoQ To Avoid Infections In Athletes

In the last few years, our knowledge about immune systems has increased greatly. There is a hypothesis that regular training enhances immunocompetence, while intensive, exhaustive physical exercise may weaken the cellular immune system and may increase susceptibility to infections.52 It is also proposed that a single, strenuous, and long-lasting performance increases the incidence of upper respiratory tract infections endurance runners had a 2.1-fold increase in the incidence of upper respiratory tract infections compared to nonrunner controls in a two week period after a 56-km race.53 Similarly, the incidence of upper respiratory tract infections in endurance runners were five-times higher during the week following a marathon run when compared to trained controls who did not participate in the race.54 One possible contributor to increased susceptibility to infections during exhaustive exercise may be free radicals generated during exercise. Therefore, it has been suggested that the...

Inflammation of the Larynx Laryngitis

Whether acute or chronic, laryngitis presents with hoarseness and generalized hyperemia of the laryngeal mucous membrane. Acute laryngitis commonly follows an upper respiratory tract infection, or is traumatic following vocal abuse. Voice rest is the most effective treatment.

Stepwise Summary of Assessment Management and Management of Uncomplicated Chronic Pediatric Rhinosinusitis

Cardinal symptoms 18 chronic nasal congestion purulent nasal discharge, head, pain, cough, fetid breath, postnasal drainage, behavioral changes Boggy edematous turbinates with obstruction polyposis posterior pharyngeal cobbling postnasal discharge tender cervical adenopathy Symptom duration of 12 weeks or more 1. Gwaltney J, Philips C, Miller R, et al. Computed tomographic study of the common cold. N Engl J Med 1994 330 25-30 3. Wald E. Rhinitis and acute and chronic sinusitis. In Bluestone C, Stool S, Kenna M, eds. Pediatric Otolaryngology. 3rd Ed. WB Saunders Philadelphia 1996 843-858 13. Wald E, Gurerra N, Byers C. Upper respiratory tract infection in young children, duration of and frequency of complications. Pediatrics 1991 87 129-133 71. Pipkorn U, Proud D, Lichtenstein L, et al. Inhibition of mediator release in allergic rhinitis by pretreatment with topical glu-cocorticosteroids. N Engl J Med 1987 316 1506-1510 73. Yaniv E, Oppenheim D, Fuchs C. Chronic rhinitis in children....

Maculopapular Exanthemas

Macular drug eruptions and viral exanthemas may be morphologically indistinguishable except for the clear predilection of SLE exanthemas for light-exposed areas. Also, SLE exanthemas lack the characteristic symptoms associated with some viral eruptions (such as lymphadenopathy, catarrhalic rhinitis and conjunctivitis in rubella, Koplik spots in measles). Constitutional symptoms (fever, malaise, and arthralgias) are little contributory for differential diagnosis because they may occur in all moreover, episodes of SLE may be precipitated by viral infections, and the respective symptoms may occur simultaneously or in short succession.

Classification Oral antidiabetic

Diabetic ketoacidosis, with or without coma. Type 1 diabetes. Special Concerns Use with caution in impaired hepatic function. Safety and efficacy have not been determined in children. Side Effects CV Chest pain, angina, ischemia. GI Nausea, diarrhea, constipation, vomiting, dyspepsia. Respiratory URI, sinusitis, rhinitis, bronchitis. Musculoskeletal Arthralgia, back pain. Miscellaneous Hypoglyce-mia, headache, paresthesia, chest pain, urinary tract infection, tooth disorder, allergy.

Psychiatric Disorders Related To Trauma And Disaster

PTSD has been widely studied following both natural and human-made disasters (for review, see 51). PTSD is not uncommon following many traumatic events, from terrorism to motor vehicle accidents to industrial explosions. In its acute form, PTSD may be more like the common cold, experienced at some time in one's life by nearly all. If it persists, it can be debilitating and require psychotherapeutic and or pharmacological intervention.

Preparation And Routes Of Administration

The bioavailability of intranasal cocaine is about 60 . Peak plasma levels occur over a range of 30-120 minutes (Barnett, Hawks, & Resnick, 1981). Cocaine is a topical anesthetic and causes numbness of the nose during snorting. Nasal congestion, with stuffiness and sneezing, may occur after snorting cocaine due to both vasoconstrictive properties and contaminants in the preparation. Users may flush out the inside of the nose with a saltwater mixture after a round of snorting, and they commonly employ decongestants and antihista-mines to relieve symptoms.

Immunological Contact Urticaria

Immunological contact urticaria (ICU) is an immediate type 1 allergic reaction (52). The molecules of a contact urticant react with specific IgE molecules attached to mast-cell membranes. The cutaneous symptoms are elicited by vaso-active substances, mainly histamine, released from mast cells. Other mediators of inflammation may influence the degree of response. Immunological contact urticaria reaction can extend beyond the contact site and generalized urticaria may be accompanied by other symptoms, such as rhinitis, conjunctivitis, asthma, and even anaphylactic shock. The term ''contact urticaria syndrome'' was therefore suggested by Maibach and Johnson (55). Fortunately, the appearance of systemic symptoms is rare, but it may be seen in cases of strong hypersensitivity or in a widespread exposure and abundant percutaneous absorption of an allergen.

Neurotoxic Shellfish Poisoning

Larization (opposite of saxitoxin and tetrodo-toxin TTX ). Vectors Clams oysters. Incubation 15 minutes to 3 hours. Symptoms Mild ciguatera-like symptoms with perioral paresthesias and temperature reversal rarely nausea and diarrhea unique conjunctivitis, rhinitis, and or asthmatic bronchitis from aerosolized brevetoxins in breaking surf. Diagnosis By history, TLC or HPLC. Treatment Supportive only. Prognosis Full recovery in 48 hours. Prevention Monitor shellfish bed dinoflagel-late counts adhere to shellfish consumption advisories.

The Cigarette Century

The EPA report officially categorized ETS as a known human carcinogen, placing ETS in the Class A (most dangerous) category reserved for only a few toxic substances, including radon, benzene, and asbestos (Carlson, 1997). The report also identified ETS as a cause of serious respiratory illness in children,

Acquired Immune Deficiency Syndrome AIDS The Common Cold A cure for the common cold is still illusive, but there are moderately effective treatments that attack the problem indirectly. The rhinovirus responsible for the common cold is the heart of the problem in the majority of cases. Currently, there are more than 75 structures of rhinovirus in the PDB. The structure of the virus itself, HRV1A (1R1A),48 complexed with various antiviral ligands,49'50 and ligand binding in drug-resistant mutants51 have been published. For a review of this work, see the article by Bella and Rossmann.52 While we now understand the basic structure of the protein viral capsid, we have been unable to find a lasting cure, since the virus continues to evolve. The basic action of the rhinovirus is similar to that of HIV, but less deadly for most. The virus attaches itself to the cell surface, and its RNA enters the human cell, which then directs the cell to replicate the virus. Unlike HIV, which focuses on the immune system, rhinoviruses...

Physiology and Pathophysiology

Once the sinus ostia become obstructed, ventilation is impaired and there is a transient increase in intrasinal pressure, followed by a negative intrasinal pressure.8 The negative pressure within the sinus relative to the atmospheric pressure may allow nasal flora to flow against the mucosal ciliary beat patterns and enter the typically sterile sinus cavity. Sniffing, sneezing, and nose-blowing, associated with altered intranasal pressure, may also facilitate entry of bacteria into the sinus from a colonized nasal chamber.3 As nasal congestion increases, nasal breathing decreases decreased gas exchange produces a decreased partial pressure of oxygen intrasinally, which favors multiplication of certain bacterial species. An acidic pH may also develop, promoting anaerobic conditions. As the immune system responds to the bacterial invasion, tissue congestion worsens secondary to the inflammatory response, further perpetuating the cycle of obstruction. Perhaps critical to our further...

Stress Management

Many connections between stress and chronic conditions are known. Stress increases blood levels of adrenaline and cortisol, two so-called stress hormones. Cortisol can suppress the immune system, making people more susceptible to infectious diseases such as colds and flu. The effects of stress on the circulatory system (a quicker pulse, narrowed blood vessels, and thickened blood) can make people more susceptible to heart rhythm irregularities, angina (chest pain), high blood pressure, and stroke.


Wheezing does not always represent asthma. Wheezing may persist for weeks after an acute bronchitis episode. Patients with chronic obstructive pulmonary disease may have a reversible component superimposed on their fixed obstruction. Etiologic clues include a personal history of allergic disease, such as rhinitis or atopic dermatitis, and a family history of allergic disease.

Reyes Syndrome

Reye Syndrome Rash

Reyes syndrome is an entity of unknown etiology affecting children, in which an upper respiratory tract infection, chicken pox, and, rarely, gastroenteritis are followed by vomiting, convulsion, coma, hypoglycemia, elevated blood ammonia, and abnormal serum transaminase values. Individuals dying of the entity show fatty metamorphosis of the liver, with multiple small fatty cyto-plasmic vesicles in the hepatocytes, myocardial fibers, and tubular cells of the kidneys. These are extremely fine vesicles compared with the coarse deposit seen in alcoholic fatty metamorphosis of the liver. Reyes syndrome can be confused with inborn errors of metabolism with which it may share many of the same clinical characteristics. The only way to be absolutely sure of the diagnosis is to demonstrate specific mitochondrial changes in liver tissue.

CAMs in the Skin

ICAM-1 is an 85- to 110-kDa transmembrane glycoprotein mapped to human chromosome 19 and constitutively expressed by a variety of cells. Binding of ICAM-1 to its ligand, lymphocyte function-associated antigen 1, is the major pathway for kera-tinocytes and Langerhans' cells to interact with leukocytes and mediates both antigen-independent and antigen-dependent adhesion (Trefzer and Krutmann 1995). In addition, ICAM-1 has been shown to function as a receptor for human rhinoviruses ( common cold ) (Greve et al. 1989, Staunton et al. 1989) and as an endothelial cell receptor for Plasmodium falciparum in malaria (Behrendt et al. 1989).


Over the past 25 years, more than 1,000 studies have evaluated the possible therapeutic effects of garlic. Suggestive, but not conclusive, results have been obtained in studies of the effectiveness of garlic in treating high cholesterol levels, high blood pressure, and cancer. On the basis of limited scientific studies, garlic sometimes is recommended as a treatment for the common cold.


Many scientific and clinical studies have evaluated echinacea. Some, but not all, studies indicate that echinacea limits the duration and severity of infections, especially the common cold. What about other measures to prevent or treat the common cold or other minor infections Goldenseal and garlic (see subsequent sections) have not been shown to have definite effects on infections, and the scientific basis for their use is unclear. Also, vitamin C and zinc, which are discussed in detail elsewhere in this book, sometimes are used for infections. However, both of these compounds also have unclear effects on infections and may activate the immune system. People with MS may take several safe measures to prevent and treat viral infections such as the flu and common cold. First, the flu vaccine is readily available, appears to be safe for people with MS, and helps prevent the flu. Recently developed prescription medications (oseltamivir Tamiflu , zanamivir Relenza ) also decrease the...


Type I (anaphylactic) due to preformed IgE antibodies, which cause release of vasoactive amines (e.g., histamine, leukotrienes) from mast cells and basophils. Examples are anaphylaxis (bee stings, food allergy especially peanuts and shellfish , medications especially penicillin and sulfa drugs , rubber glove allergy), atopy, hay fever, urticaria, allergic rhinitis, and some forms of asthma. With chronic type I hypersensitivity (atopy, some asthma, allergic rhinitis), look for eosinophilia, elevated IgE levels, family history, and seasonal exacerbations. Patients also may have allergic shiners (bilateral infraorbital edema) and a transverse nasal crease (from frequent nose rubbing), Pale, bluish, edematous nasal turbinates with many eosinophils in clear, watery nasal secretions also are classic.


Allergic Rhinitis An allergic disorder of humans caused by pollen, house dust, animal dander, or spores of fungi characterized by wheezing, sneezing, coughing, copious flow of watery discharges, itching nose, mouth, excessive flow of tears, headache, and insomnia (also called hay fever and pollenosis).


Goldenseal has been used medicinally for at least 200 years. This herb is taken alone or in combination with echinacea for a variety of infections, including the common cold. Unlike echinacea, which has been investigated extensively, little recent information is available about the biological effects or possible clinical benefits of goldenseal or its chemical constituents, berberine and hydrastine. Because of the limited information about goldenseal, it is difficult to make any definite conclusions about this herb. The clinical studies to date do not support its use for infections. Notably, goldenseal may produce sedation. Therefore, it may worsen MS fatigue or increase the sedating effects of alcohol and some prescription medications.


Uses Relief of nasal and nonnasal symptoms of seasonal allergic rhinitis, including runny nose, itchy and watery eyes, itchy palate, and sneezing. Treatment of chronic idiopathic urticaria. Special Concerns Use with caution, if at all, during lactation. Give a lower initial dose in liver impairment. Safety and efficacy have not been determined in children less than 2 years of age. Side Effects Most commonly, headache, somnolence, fatigue, and dry mouth. GI Altered salivation, gastritis, dyspepsia, stomatitis, tooth ache, thirst, altered taste, flatulence. CNS Hypoesthesia, hyperkinesia, migraine, anxiety, depression, agitation, paroniria, amnesia, impaired concentration. Ophthalmologic Altered lacrimation, conjunctivitis, blurred vision, eye pain, blepharo-spasm. Respiratory Upper respiratory infection, epistaxis, pharyngitis, dyspnea, coughing, rhinitis, sinusitis, sneezing, bronchitis, bronchospasm, hemoptysis, laryngitis. Body as a whole Asthenia, increased sweating, flushing,...


Identification of the allergic child is important in patient evaluation, and a complete medical and family history is the most critical aspect of this process. Symptoms suggestive of allergy include nasal congestion, pruritic nasal and ocular mucous membranes, clear rhinorrhea, paroxysmal sneezing (often exacerbated by inhaled dust or animal exposure), and rhinosinusitis during allergy season.17,27 The history may also include infantile eczema, asthma, food allergy, or a previous good response to antihista-mines or intranasal anti-inflammatory agents.17 Family history is important because children of two allergic parents have a 65 to 75 incidence of significant atopy, and children with one atopic parent have a 35 incidence of allergy.54 The likelihood of allergies is also increased in children with an atopic sibling.54


Release from mast cells, as well as priming these cells for IgE-induced degranulation (Columbo et al., 1992) and sensitizing their responsiveness to eosino-phil-derived granular major basic protein (Furuta et al., 1998). Among the factors released by activated mast cells are IL-5, granulocyte-macrophage colony-stimulating factor (GM-CSF), and tumor necrosis factor-a (TNF-a), which influence eosinophilic protein secretion (Okayama et al., 1997, 1998). In addition to inducing histamine release from mast cells (Luckacs et al., 1996 Hogaboam et al., 1998), SCF promotes the mast cell production of the eosinophilic chemotactic factor eotaxin (Hogaboam et al., 1998) and eosinophilic infiltration (Luckacs et al., 1996). SCF also directly influences the adhesion of both mast cells (Dastych and Metcalfe, 1994 Kinashi and Springer, 1994) and eosinophils (Yuan et al., 1997), which in turn regulates tissue infiltration. Thus, SCF can influence the primary cells involved in allergy and asthma...

Vitamin C

It is sometimes claimed that vitamin C prevents or decreases the severity of the common cold. This is potentially important to people with MS, because viral infections may trigger MS attacks. However, the effects of vitamin C on the common cold are unclear. Also, because vitamin C stimulates the immune system, high doses of vitamin C supplements are theoretically risky for people with MS. Because of its unclear effects on treating the common cold, and its theoretical risks for worsening MS, it is reasonable for people with MS to be cautious about vitamin C use. If vitamin C is used, orange juice (50 milligrams of vitamin C per half cup of orange juice) or supplements in low doses (90 to 120 milligrams or less daily) may be reasonable.


There were no significant findings or between-group differences in the variety of standard clinical lab studies. Adverse events occurred at similar frequencies in both control and placebo patients, and the most common adverse events were upper respiratory tract infection, rash, and injection site reaction. The most common adverse reactions requiring intervention were infusion-related reactions, particularly flushing. Clinically significant infusion reactions were observed in some patients that were manageable with premedica-tions and infusion slowing. One patient with severe respiratory insufficiency and airway compromise needed an emergency tracheostomy due to an airway problem during a reaction. This event in one patient did end up in the label for Aldurazyme. Antibodies to rhIDU developed in 20 out of 22 patients (91 ), and the mean time to conversion was 52.6 d. By the end of the study, many antibody titers were declining.

Atopic Eczema

Atopic eczema is a recurrent inflammatory skin condition that produces redness, itching, and scaly patches. People who have atopic eczema also often have other allergic conditions, such as allergic rhinitis (see page 379) or asthma (see page 245), or are allergic to penicillin or sulfa. Atopic eczema is a very common condition that affects about 3 percent of Americans. The disorder can occur at any age but typically appears between infancy and young adulthood. The condition often improves on its own before puberty but also can persist throughout life.

CAM Therapies

Despite some claims, no magic CAM cure is available for colds and flu. No CAM therapy for the flu has been shown to be as effective as the medications currently available. As a result, people with MS who have flu symptoms should first consider these medications before CAM therapy.

Cefuroxime Axetil

Cefuroxime axetil is a p-lactamase-stable, second-generation, oral cephalosporine, which in vivo is rapidly hydrolysed to the active compound cefuroxime. It has a broad spectrum of antibacterial activities that encompasses methicillin-sensitive staphylococci, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella (Branhamella) catarrhalis, group A p-hemolytic streptococci, and several other bacteria. Major indications for cefuroxime are lower and upper respiratory tract infections and bacterial skin diseases. Moreover, this drug also seems to exert some immunomodulating activities. In one study, cefuroxime axetil was used to treat three patients with SCLE (Rud-nicka et al. 2000). With a dose of 500 mg daily, skin lesions cleared almost completely within 30-40 days. Moreover, in one patient, leukopenia, the erythrocyte sedimentation rate, and arthralgia improved. None of the patients experienced severe side effects. A not yet fully understood immunomodulating mechanism seems to be...


Note Terfenadine has been withdrawn from the market. Uses Seasonal allergic rhinitis. Non-FDA Approved Uses Histamine-in-duced bronchoconstriction in asthmatics exercise and hyperventila-tion-induced bronchospasm. Contraindications Significant hepatic dysfunction. Use with drugs that prolong the QT interval, such as disopyramide, procainamide, quini-dine, most antidepressants, and most neuroleptics. Consumption of grapefruit juice.

Salivary Glands

Parotid Glands Swollen

Fig. 5.3 Tonsillary lymph node enlargement. A tonsillar lymph node enlargement (arrow) may be similar to an enlarged submandibular gland. This node is frequently palpable in children, being more conspicuous at times of tonsillar or upper respiratory tract infection, and may become very obvious, as in this case. The node is soft and tender. Fig. 5.3 Tonsillary lymph node enlargement. A tonsillar lymph node enlargement (arrow) may be similar to an enlarged submandibular gland. This node is frequently palpable in children, being more conspicuous at times of tonsillar or upper respiratory tract infection, and may become very obvious, as in this case. The node is soft and tender.

Chronic Drainage

Probably 80 of acutely draining PE tubes clear with initial treatment, and another 80 of chronically draining tubes clear with anti-Pseudomonas treatment with or without tube removal. The remaining few patients, probably less than 5 of all patients with chronic draining PE tubes, have underlying localized mucosal or temporal bone disease, or upper respiratory immunologic, allergic, or bacterial disease that perpetuates tube drainage. A careful history and examination at the first office visit usually identifies these patients. Does the patient have allergy or sinus disease, especially inhalant allergy with rhinitis and sinusitis Does the patient have frequent bronchitis or pneumonia, perhaps associated with sinusitis and recurrent otitis Consider immunoglobulin G (IgG) subclass deficiency, immotile cilia syndrome, iatrogenic immuno-suppression, human immunodeficiency virus (HIV) infection, tuberculosis, and Wegener's granulomatosis. Does chronic ear pain suggest neoplasm, particularly...

Fetal IgE

Several studies indicate that increased cord blood levels of IgE are associated with an increased risk of atopy or asthma (Croner and Kjellman 1990 Edenharter et al. 1998 Halonen et al. 1992 Hansen et al. 1992 Hide et al. 1991 Kjellman and Croner 1984 Michel et al. 1980 Ruiz et al. 1991). Other studies do not bear out this association (Hide et al. 1991 Martinez et al. 1995). However, a general belief is that an early and inappropriate immune response can develop toward allergens and that young children with asthma or allergic rhinitis have higher than normal levels of antibodies to inhaled allergens (Okahata et al. 1990). The evidence that fetal B cells are capable of isotype switching supports this idea (Punnonen et al. 1993 Punnonen and de Vries 1994). Furthermore, production of IgM, IgG subclasses, and IgE response to CD40 ligation and cytokines from T cells is similar in neonatal B cells and antigenically na ve adult B cells (Briere et al. 1994 Servet-Delprat et al. 1996),...