Private: Let’s talk! And I’ll share some tales

Does taking PPIs to reduce reflux increase allergies?

New research in Austria suggests that it just might. In an article in Medical News Today, published August 5, 2019, “Could the use of stomach acid drugs raise the risk of allergies?” Catharine Paddock PhD (fact checked by by Jasmin Collier) says that “New research finds a link between PPIs and the risk of allergies. Due to the study’s design, the results do not prove that gastric acid reducers — such as proton pump inhibitors (PPIs) — actually cause allergies.”

In a Nature Communications paper about their work, however, the authors suggest that the findings “infer” an increased risk of allergy.

The data for the study came from health insurance records that cover around 8.2 million people living in Austria. This number represents 97% of the Austrian population.

A team from the Medical University of Vienna (MedUni Vienna) in Austria used the epidemiological data to analyze the use of anti-allergy drugs following the use of prescription medications that reduce stomach acid.

As the data came from insurance claims, the team did not analyze actual incidence of allergies, instead using patterns of prescription anti-allergy medications as stand-ins.

The analysis showed that following prescriptions for stomach acid inhibitors, the use of prescription anti-allergy drugs was higher compared with other types of drug.

According to the findings, it appears that people who took stomach acid medications such as PPIs had a two-to-three times higher chance of later receiving prescriptions for anti-allergy drugs.

Gastric acid and PPIs

Doctors prescribe PPIs to treat various gastric acid conditions, such as gastroesophageal reflux disease. This occurs when acid from the stomach flows backward into the esophagus, or the pipe along which food travels.

Estimates suggest that more than 15 million people received PPI medications in the United States in 2013.

Stomach acid drugs may cause depression

The researchers note that gastric acid is vital for food digestion. The acid contains enzymes that break down proteins before they undergo further processing.

Gastric acid also protects the digestive system from infection by bacteria and other disease causing agents.

Reducing the production of gastric acid could increase opportunities for allergy causing substances to enter the gut unchallenged. Such an influx has the potential to trigger or worsen an allergy.

Do not use PPIs ‘longer than necessary’

Principal investigator Erika Jensen-Jarolim, of the Institute of Pathophysiology and Allergy Research at MedUni Vienna, cautions people not to use gastric acid inhibitors “any longer than necessary.”

“They prevent protein digestion, change the microbiome in the gastrointestinal tract, and increase the risk of allergic reactions,” she adds.

Prof. Saad Shakir, director of the Drug Safety Research Unit in the United Kingdom, describes the research as “hypothesis testing.” He was not involved in the study.

He agrees that PPIs and other stomach acid suppressors can weaken the defense mechanism that normally prevents many substances traveling farther than the stomach.

He suggests that using prescriptions as surrogate markers for allergy diagnoses “is a reasonable approximation.”

Prof. Shakir concludes that although the study does not answer the question for sure, “it strengthens the hypothesis regarding the association between taking acid suppressants and the development of allergic symptoms.”

Scientific American August 2019 How to Prevent Food Allergies

Claudia Wallis is an award-winning science journalist whose
work has appeared in the New York Times, Time, Fortune and the
New Republic. She was science editor at Time and managing editor
of Scientific American Mind.

If You Give a Baby a Peanut

Feeding infants allergenic foods may be
the key to preventing allergies
By Claudia Wallis

Few things are more subject to change and passing fancies than dietary advice. And that can be true even when the advice comes from trusted health authorities. A dozen years ago the standard recommendation to new parents worried about their child developing an allergy to peanuts, eggs or other common dietary allergens was to avoid those items like the plague until the child was two or three years old. But in 2008 the American Academy of Pediatrics (AAP) dropped that guidance, after studies showed it did not help. And in its latest report, issued in April, the AAP completed the reversal—at least where peanuts are concerned. It recommended that high-risk children (those with severe eczema or an allergy to eggs) be systematically fed “infant-safe” peanut products as early as four to six months of age to prevent this common and sometimes life-threatening allergy. Children with mild or moderate eczema should receive them at around six months.

These are not whimsical changes. They match advice from a federal panel of experts and reflect the results of large randomized studies—with the inevitable cute acronyms. One called LEAP (Learning Early About Peanut Allergy), published in 2015, found that feeding peanut products to high-risk infants between four and 11 months old led to an 81 percent lower rate of peanut allergy at age five, compared with similar babies who were not given that early exposure. Another trial, known as EAT (Enquiring About Tolerance), published in 2016, found that after parents carefully followed a protocol to begin feeding peanut protein, eggs and four other allergenic foods to healthy, breastfed infants between three and six months of age, the babies had a 67 percent lower prevalence of food allergies at age three than did a control group. The results were strongest for peanuts, where the allergy rate fell to zero, compared with 2.5 percent in the control group. Egg allergies also fell, but the AAP is waiting for more data on eggs, says Scott Sicherer, a professor of pediatrics, allergy and immunology at the Icahn School of Medicine at Mount Sinai and an author of the April report. “We don’t want to tell people to do something where there isn’t really good evidence.”

How food allergies develop and why they have become so commonplace remain dynamic areas of research. Both the allergies and eczema (a major risk factor) have been on the rise. A 2010 study by Sicherer and his colleagues found that the prevalence of childhood allergies more than tripled between 1997 and 2008, jumping from 0.6 to 2.1 percent.

A leading theory about how these allergies develop and the role of eczema has been proposed by Gideon Lack, a professor of pediatric allergy at King’s College London and senior author of both LEAP and EAT. The “dual allergen exposure hypothesis” holds that we become tolerant to foods by introducing them orally to the gut immune system. In contrast, if a child’s first exposure is through food molecules that enter through eczema-damaged skin, those molecules can instigate an allergic response. Research with mice strongly supports this idea, whereas in humans the evidence
is more circumstantial. Lack points out that peanut allergy is more prevalent in countries where peanuts or peanut butter is popular and widespread in the environment, mustard seed allergy is common in mustard-loving France and buckwheat allergy occurs in soba-loving Japan. “Parents are eating these foods, then touching or kissing their babies,” Lack suggests, “and the molecules penetrate through the skin.”

A modern emphasis on hygiene may also contribute, Lack notes: “We bathe infants and shower young children all the time, very often once a day or more, which you could argue breaks down the skin barrier.” Researchers are examining whether applying barrier creams such as CeraVe can help stave off food allergies.

Eight foods account for 90 percent of food allergies: cow’s milk, eggs, fish, shellfish, tree nuts, peanuts, wheat and soybeans. Some scientists believe this is so because these foods contain proteins that are unusually stable to digestion, heating and changes in pH and are therefore more likely to cause an immune response.

Early dietary exposure is now the confirmed preventive strategy for peanuts and, pending more research, perhaps the other foods, although this is more easily said than done. In EAT, parents had to get their babies to swallow at least four grams per week of each of the allergenic edibles, and many found it to be challenging. As Lack observes, “It’s just not part of our culture to feed solids to very young babies.”

Let’s Talk about Fragrances – UPDATE!

WE WON! All it took was starting to have an asthma attack while talking to the acting manager of my apartment complex in the office Friday afternoon, after being exposed for about 1 minute. As we talked about the problem (I hadn’t complained about the previous system – but I explained that whatever that scent was had been a fairly routine trigger, whereas this was much more aggressive) I began wheezing noticeably, and had to sit down. Within about two minutes, the wheezing was serious enough to interfere with my ability to speak, and I was using my rescue inhaler for the second time.

I told her I had to get upstairs to use my nebulizer and take some medication. She emailed me a few minutes later saying she had been unable to dismantle the box mounted on the wall, so beat it to death with the handle of a mop, and had them put the pieces into several bags and place it outdoors.

This afternoon she said they held a meeting at the management’s central office and decided to have them removed permanently from all the buildings they manage.

VICTORY FOR THE LUNGS!!!

I still think there needs to be a class-action lawsuit to force the companies (this one was Aire-Master) to STOP!

Hooray!!

Has anyone else noticed how we have been swamped with “scents” in the past few years? I thought it was bad when I had to hyperventilate and then

Bamboo garden — Photo by James Lee on Unsplash

rush past the cosmetic departments in department stores, but now I can’t even find garbage bags without “scents” that make me sneeze and cough! Not one brand!

Now buildings, from hotels and office buildings to apartment buildings (including mine – we are currently having a tussle over it) are falling for slick sales people telling them what they really need to put their ultimate brand on something is a particular “scent.” (At first I thought it was just the chi-chi hotels and resort-type condos around town. I was wrong.)

[Every time I go in or out of the single accessible entrance to my building (and also the only one to the mailboxes), I have to use my rescue inhaler twice and get through it as quickly as possible. This also means I can’t use the gym any longer. Can you tell I’m pissed??]

The lung rebellion

I’ve been on a campaign in recent years to persuade drivers for Uber and Lyft around DC to STOP with the damn chemical “air fresheners.”

I have explained to them patiently that the chemicals are:

1. not safe to be inhaled, especially in enclosed areas and when those enclosed areas get heated up by the sun during the day;

2. have never been tested for safety on humans -and aren’t required to be because of the lackadaisical approach our country takes to commerce (laissez-faire capitalism at its umm … best?); and

3. inhalation of “air fresheners” and similar products have been linked to cancer, heart disease, and can trigger asthma attacks virtually immediately in those who are particularly sensitive (like me).

So why do it? Why spend upwards of $10 a month on chemicals which don’t really “remove” unpleasant odors, but merely deaden your ability to smell them temporarily? And do so while causing you serious potential harm?

Because they are afraid to repel a rider with the smells left by a previous passenger’s leaky shopping bag, or cooked cabbage and other smells from his leftover dinner last night that he forgot to take into the kitchen.

True fresheners

Is there an alternative? Absolutely. Would I bring it up if there weren’t?

Single best air freshener is – fresh air. Open the windows. Drive with them open for a bit. (Thoroughly clean that air conditioner, replace the filter and clean and disinfect the vents to remove any mold -if you don’t normally do that in your car. Huge source of smells.)

Next best, something my grandmother and mom did – so I do, too: Use baking soda. Take a plastic take-out food container with a tight-fitting lid, put a generous amount of baking soda in the bottom, add a few drops of whichever oil you like the best. (Oils will last the longest.) Punch a few holes in the lid, fasten it on and keep it in the car. Refresh it periodically with more oil. After a particularly odoriferous trip, pop the lid off and leave it on the front seat overnight. In the morning the odors should be gone.

Food-grade flavoring oil (not perfume, not massage oil, not incense). FOOD! ALL-NATURAL! This means real cinnamon oil, lemon oil, vanilla extract.

For some more ideas, check out this article in Scientific American.

Alves’ Hierarchy of Need (at least today)

I have put a great deal of thought into this, but it is subject to change. Let me know if you have anything to add … (Note that hierarchies of need go from the greatest need – top – to the lowest need. And people are not included – this is about inanimate things and senses.)

1. Breathing without constant struggle and constriction

2. Manageable pain

3. Sight

4. Sunshine and natural light

5. Air-conditioning

6. Fresh fruit and vegetables that are truly ripe, and really juicy limes

7 . De-humidification

8. Shelter without carpeting

9. Chocolate

10. Sparkling wine and great tequila

11. Hearing

12. Taste

What order would you put things in?

João Gilberto’s music taught my soul to dance

Obituary for the composer from the Washington Post, July 7, 2019, by Chris Roberts, Post pop music critic. Introduction by Debbie Alves.

João Gilberto gave us more than the bossa nova — he gave voice to the language souls speak in whispers. If you don’t know his music, find some — I promise at some point in your life you will realize his incredible gift. Descanse com os anjos agora, você fala a língua deles há tanto tempo que não pode ser estranho.

(Yes, I know this has nothing whatsoever to do with asthma or my health odyssey. Or maybe it does, if we think about it as one of the things that can help us get through tough times. Or celebrate just being alive, or a beautiful day.)

The Washington Post’s beautiful obituary, written by Chris Richards, the Post’s pop music critic, João Gilberto sang lullabies to the future

João Gilberto sang lullabies to the future

João Gilberto died Saturday at age 88. (Hulton Archive/Getty Images)

By Chris Richards
Pop music critic
July 7, 2019 at 12:10 PM

There’s no such thing as perfect music. We’re reminded of that fact whenever someone gets close. João Gilberto, the bossa nova mapmaker who died on Saturday in Rio de Janeiro at 88, spent the greatest years of his musical life right there, singing softly to the edge.

His voice was one of the most intimate sounds of the 20th century — more melodic than a sigh, more rhythmic than chitchat, only just barely. Every syllable that appeared on his lips carried an air of effortlessness, but Gilberto had worked hard to locate that sacred place where a human breath becomes music. It gave his ballads their focus, their circumspection, their secret rigor. Were it not for Gilberto’s mindfulness, the big-time sensuality of bossa nova probably would have hit this planet like a satin pillow. Instead, the sound went off like a noiseless bomb in Brazil, changing the nation’s musical identity in an overnight kind of way. Over here in the United States, bossa nova became a full-blown phenomenon with the runaway success of Gilberto’s 1962 album with jazz saxophonist Stan Getz.

But in the years that followed, Gilberto’s bossa nova cooled from a craze into a mystery. How could such clean, legible music feel so utterly unknowable? Fellow bossa nova architect Antônio Carlos Jobim once reportedly explained that the fundamental grace of a João Gilberto performance exists in the tension between mouth and fingertips. “He was pulling the guitar in one way and singing the other way,” Jobim said. “It created a third thing that was profound.”

Go back and listen to Gilberto sing his signature lullaby “Chega de Saudade” — in 1959, in 2000, or anytime in between — and that profound third force has the quiet power of nature itself. It’s as if this music is bound by the same tiny, subatomic force that prevents our material reality from floating apart.

Gilberto’s most astonishing album landed during that cooling period, a self-titled thing from 1973 that found him gently singing the songs of his most extroverted followers, including Caetano Veloso and Gilberto Gil. Even better were Gilberto’s original compositions, largely constructed from nonverbal hums and mumbles that seemed to be expounding the meaning of life. With these songs, the maestro figured out how to freight the breeze with an impossible amount of information. Instead of sweet nothings, sweet everything.

Here in the 21st century, we’re plugging little ear buds into our heads, inviting our music to shake the air inside of us. Intimacy feels like music’s most exciting frontier. Gilberto has already been there. The music he leaves behind becomes a prophecy, a map, a guiding force that we’re still only beginning to understand.