Spring forecast

BY Michael Johnsen

Springtime allergy season may be delayed a few weeks this year, kicking into high gear in early April as opposed to late March due to a 2013-2014 winter characterized by extremely low temperatures and heavy snow storms. 

“Theoretically, the colder it is, the more delayed the pollen season may be,” Myron Zitt, past president of the American College of Allergy, Asthma and Immunology told DSN Collaborative Care. “[But] global warming, with higher concentrations of carbon dioxide in the air, predisposes … a longer pollen season and significantly heavier pollination — higher pollen counts.”

That means once the spring allergy season arrives, with tree pollens predominating, incidence may seem heavier than ever. In addition to greater vegetation, there are more allergy sufferers. According to ACAAI, 23.6 million Americans were diagnosed with hay fever in the last year. The prevalence of allergies is surging upward, with as many as 30% of adults and up to 40% of children having at least one allergy.

“A damp season, on the other hand, can cause some earlier mold problems,” Zitt said. “Particularly with a lot of rain, there is a lot of mold in the soil — the mold grows on rotten leaves and rotten tree trunks — and as soon as there is a day that’s nice, dry and breezy, all the molds from all the rains start to blow around.”

According to the Farmer’s Almanac, spring will start late and be exceptionally wet for most sections of the country, with snowfall predicted through late March and early April in many areas.


The American College of Allergy, Asthma and Immunology has identified the following as factors that influence the severity of allergy season, along with some explanations about why more Americans are being diagnosed with allergies.

  • Climate change: Recent studies have shown pollen levels gradually increase every year. Part of the reason is due to climate change. The warmer temperatures and milder winters several regions experienced the last few years can cause plants to begin producing and releasing pollen earlier, making the spring allergy season longer. Rain can promote plant and pollen growth, while wind accompanying rainfall can stir pollen and mold into the air,
    heightening symptoms.
  • Priming effect: When the weather becomes erratic and some regions experience unseasonably warm temperatures, there is an early release of pollen from trees that triggers symptoms. Once allergy sufferers are exposed to this early pollen, their immune system is primed to react to the allergens, meaning there will be little relief even if temperatures cool down before spring is in full bloom. This “priming effect” can mean heightened symptoms and a longer sneezing season for sufferers.
  • Hygiene hypothesis: This theory suggests that exposure to bacterial byproducts from farm animals, and even dogs, in the first few months of life reduces or delays the onset of allergies and asthma. This may, in part, explain the increasing incidence of allergies worldwide in developed countries.


 According to a paper published in the January issue of Annals of Allergy, Asthma and Immunology, in order for treatment to be effective, asthma sufferers need to ask questions and feel as if they have open communication with their allergist.

“When patients do not understand their condition or treatment plan, they may not follow life-saving guidelines, putting them at increased risk for asthma attacks,” stated allergist Stanley Fineman, past-president of the American College of Allergy, Asthma and Immunology and article author. “Changes need to be made by allergists and patients to ensure a treatment plan is in place that will be followed. Proper treatment and adherence to the plan not only improves quality of life, but may save lives.”

While 40% of people with allergic rhinitis express symptoms of asthma, between 90% and 95% of asthmatics suffer from allergy symptoms. And treating allergy symptoms can be important in preventing asthma attacks. “If you can’t control the rhinitis, you don’t have a chance at controlling the asthma,” added Myron Zitt, another past-president of ACAAI, in an interview with DSN Collaborative Care. “It’s very important to control upper airway [symptoms],” he said, in an effort to improve breathing quality in the lungs.

In his paper, Fineman noted that only 8% to 13% of asthma sufferers continue to refill inhaled corticosteroid prescriptions after one year. Taken early and as directed, these inhalers can improve asthma control, normalize lung function and even prevent irreversible injury to airways.

Asthma is responsible for 4,000 deaths annually, according to ACAAI. The number of Americans with asthma grows every year, and currently affects 26 million Americans. 


There is a new allergy remedy on store shelves this spring. For the first time a nasal corticosteroid is available as an over-the-counter remedy. Sanofi and its U.S. consumer healthcare division Chattem in February announced that Nasacort Allergy 24HR Nasal Spray is now available without
a prescription.

Unlike many allergy remedies that relieve symptoms after they start occurring, Nasacort Allergy 24HR Nasal Spray should be used two to three weeks prior to allergy season for best control of symptoms, noted Myron Zitt, past-president of the American College of Allergy, Asthma and Immunology.

“Even though some of these patients with severe pollen allergy or a history of severe pollen allergy may not be having symptoms yet because it’s so cold, they should be starting an intranasal steroid, something that’s anti-inflammatory,” he said. “Don’t let those [allergy] symptoms to take hold; treat it before it hits, and it’s going to be a lot easier to control it.”


  • Nasal allergies are estimated to affect approximately 50 million people in the United States, including as many as 30% of adults and up to 40% of children.
  • 16.9 million adults and 6.7 million children have been diagnosed with hay fever in the last year.
  • More than 13.4 million visits to physician offices, hospital outpatient departments and emergency departments were due to allergic rhinitis.
  • Allergic rhinitis can be seasonal or perennial. Symptoms of seasonal allergic rhinitis occur in spring, summer and/or early fall. They are usually caused by allergic sensitivity to pollens from trees, grasses or weeds, or to airborne mold spores. People with perennial allergic rhinitis experience symptoms year-round. It is generally caused by sensitivity to house dust mites, animal dander, cockroaches and/or mold spores. Underlying or hidden food allergies rarely cause perennial nasal symptoms.
  • Once diagnosed, allergic rhinitis treatment options are: avoidance, eliminating or decreasing exposure to the irritants or allergens that trigger symptoms; medication; and immunotherapy.
  • Immunotherapy (allergy shots) helps reduce hay fever symptoms in about 85% of people with allergic rhinitis.
  • Allergic diseases, which include asthma, are the fifth-most prevalent chronic diseases in all ages, and the third-most common in children.
  • 8.3 million American children have respiratory allergies.
  • An estimated 9.5 million American children have skin allergies.
  • Food allergies in children are on the rise, affecting nearly 6 million, or 8%, of children.


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Sally Hansen looks to jazz up manicures with new Big Top Coats

BY Antoinette Alexander

NEW YORK — Coty’s Sally Hansen brand has unveiled its new bold Big Top Coats. From the glittery to the cracked, these new finishes help take manicures to the next level with a one-step alternative to nail art.

The collection includes:

  • Big Glitter Top Coat;
  • Big Smoky Top Coat;
  • Big Shimmer Top Coat; and
  • Big Crackle Top Coat.

The top coats are priced at $5.99 each.



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Appropriate antibiotic prescribing in bronchitis

BY Susan M. Cooley

Antibiotics are often inappropriately prescribed for adults with acute bronchitis. Clinical guidelines for treating adults with no co-morbidity do not indicate treatment with antibiotics. 

Acute bronchitis consistently ranks among the top 10 conditions diagnosed in the retail health setting. Most cases of bronchitis have a viral etiology — respiratory syncytial virus, adenovirus, influenza and parainfluenza being most common.  

Despite the fact that the vast majority of acute bronchitis cases (i.e., more than 90%) have a nonbacterial cause, antibiotics are prescribed 65% to 85% of the time. Inappropriate antibiotic treatment of adults with acute bronchitis is of clinical concern, especially since misuse and overuse of antibiotics lead to antibiotic drug resistance. Because so many of our patients come to us with symptoms related to bronchitis and other upper respiratory complaints, it is imperative that the retail clinician review and understand the Centers for Disease Control and Prevention guidelines on antibiotic use in upper
respiratory illnesses.

The evaluation of adults with an acute cough illness or with presumptive diagnosis of uncomplicated acute bronchitis should focus on ruling out pneumonia. In the healthy, non-elderly adult, pneumonia is uncommon in the absence of vital sign abnormalities or asymmetrical lung sounds. Routine antibiotic treatment of uncomplicated bronchitis is not recommended, regardless of duration of cough. Chronic bronchitis (i.e., cough with mucus most days for at least three months a year for at least two years) is more common among smokers.   

Patient education, while it sometimes presents difficulty, is of utmost importance. While patients are often eager for a quick fix, and clinicians are stressed for time in patient encounters, it is important to take a moment to explain to each patient the expected course of the illness (i.e., two to eight weeks) and provide empathy around the fact that although the patient is likely feeling quite ill, antibiotics will not alter the course of
the illness.



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