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Choosing an Insect Repellent

insect-repellantMosquitoes are a concern any summer, but this summer in particular, the focus is on protecting against mosquitoes that carry the Zika virus.

The Zika virus is transmitted to people by a mosquito bite from an infected Aedesspecies mosquito. The Aedesmosquito is an aggressive daytime biter, but it also bites at night.The Zika virus can cause symptoms such as fever, rash, joint pain, and conjunctivitis (pink eye) lasting several days to weeks.

Insect repellents can help protect against mosquito bites. Ann Slattery, managing director of the Regional Poison Control Center at Children’s of Alabama, offers some tips on safelyapplying insect repellent:

  • Do not allow young children to apply insect repellent themselves.
  • Do not apply to young children’s hands or around eyes and mouth. Adults should spray the repellent into hands and then apply on child’s face.
  • Cover up with long pants and long sleeves when possible, especially if you need protection form both sun and mosquitoes.
  • Spray the outside of your child’s clothes, including hats, with insect repellent.
  • Wash your hands after applying repellent. Wash repellent-coated skin at the end of the day.

Types of Insect Repellent
Two commonly used repellents are DEET(chemical name: N,N-diethyl-meta-toluamide) and picaridin. DEET is considered the “gold standard” for repelling mosquitoes, and both products have been deemed safe for use on children two months of age and older.

Read the product label to determine the concentration of DEET or picaridin.Higher concentrations mean longer periods that the product will offer protection.With either ingredient, choose the lowest concentration that will provide the required length of coverage.

A concentration of 10 percent to 30 percent DEET is recommended for children. For example, 10 percent DEET product provides protection for about two hours, and 30 percent DEET protects for about five hours.Products containinga picaridinconcentration of 20 percent protect up to seven hours against mosquitoes.

Slattery said she does not recommend products that are a combination of sunscreen and insect repellent. “Sunscreen needs to be reapplied based on the SPF, but too much insect repellent could lead to toxicity,” she said.

Preventing Repellent Poisoning
If your child experiences any skin redness or irritation from an insect repellent, immediately wash the skin with mild soap and water. If there is a more serious reaction, including welts or a sever rash, contact his or her pediatrician.

If the repellent gets in your child’s eye, irrigate the eye with water for about 10 to 15 minutes. “Bring the child to a faucet and position him so that the spigot is over the bridge of the nose and the affected eye is closest to the drain. Have the child blink occasionally while the water is running over the eye,” Slattery said. The eye may look puffy initially after flushing, because water does not have the same composition as our natural tears. Then place a cool compress over the eye for about 30 minutes.

If any repellent gets in to your child’s mouth, have him rinse it out with about an ounce of water. After any exposure, Slattery said parents should call Poison Control at 1-800-222-1222 with any questions or concerns.

Swimmer’s Ear

Swimmer’s ear is common during the summer months when children are more likely to swim in the pool, lake or ocean. But you don’t have to swim to get swimmer’s ear. The infection is caused by too much moisture in the ear which can allow bacteria or fungi to grow.

Swimmer’s ear or otitis externa (outer ear infection) is not to be confused with a regular (middle) ear infection.  Dr. Joe Jolly, a pediatrician at Greenvale Pediatrics in Alabaster explains, “Swimmer’s ear takes place in the outside of the ear in the ear canal itself, whereas an ear infection occurs behind the ear drum.”

Dr. Jolly says it’s easy for parents to identify whether their child has swimmer’s ear or a regular ear infection. When a child has swimmer’s ear, the outside of their ear is a lot more painful, especially when pulled or pressed upon. Symptoms include:

Symptoms of swimmer’s ear

Pain on the outside of the ear

Swelling which causes child to feel like ear is “full”

Discharge

Redness

There are ways to prevent swimmer’s ear without having to give up swimming.

Prevention of swimmer’s ear

Make sure ears are thoroughly dry after swimming

Consider using over the counter drying drops (though not for children who have ear tubes or a hole in the ear drum).

Dr. Jolly says drying the ears thoroughly is especially important when a child has been swimming in a natural water source such as a lake or river where bacteria are more likely to be found. And as much as parents may be tempted to use cotton swabs to clean a child’s ear, Dr. Jolly says using swabs can do more harm than good. Having wax in the ear offers a natural protective shield to bacteria.

If you think your child might have Swimmer’s ear, it’s extremely important to see their pediatrician as soon as possible. Swimmer’s ear is very painful and can lead to secondary infections if untreated.

Treatment for swimmer’s ear is relatively easy. The child’s doctor may prescribe ear drops that contain antibiotics to fight the infection. Sometimes a small cotton wick is inserted into the ear to enable the medicine to target the infection. The drops are usually given several times a day for seven to 10 days. It’s important to keep water out of your child’s ear during the course of treatment.

Swimmer’s ear can put a damper on any child’s summer fun. But with prevention and prompt treatment when identified, they’ll be back in the water in no time.

 

Potentially Life-Changing Changes Afoot for Children with Food Allergies

Prescott AtkinsonDr. Prescott Atkinson is Director of Pediatric Allergy and Immunology at Children’s of Alabama and a Professor of Pediatrics at UAB. He is board certified in pediatrics, as well as allergy and immunology. He received his MD/PhD from Emory University in 1987, completed his pediatric residency at Georgetown University and completed a fellowship in allergy and immunology in 1992 at the National Institutes of Health. He joined the UAB faculty in 1992.

New medical research is ushering in big changes in how doctors think about food allergies and the way they will be treated in the near future.

The turning point came last year with the LEAP (Learning Early About Peanut) Study published in the New England Journal of Medicine. This five-year study showed that avoidance of food allergens by children at risk for food allergy is often the wrong strategy, which, of course, is contrary to something doctors had been advising for decades.

Data in the study were so powerful that doctors have already changed the advice they are giving to parents with children pre-disposed to food allergies. Meanwhile, the American Academy of Allergy and Immunology together with the American College of Allergy and Immunology are working with the National Institutes of Health to firm up a position paper to formalize these new recommendations.

Researchers with the Immune Tolerance Network conducted the LEAP Study by enrolling hundreds of infants from 4 to 11 months old who were predisposed toward peanut allergy. Children in the study were not yet sensitized to peanuts, but they had the family history plus a strong sign of developing food allergies—severe eczema. It is likely that eczema is associated with food allergies because breaks in the skin allow allergens to sensitize children.

Children in the study were divided into two groups. One group was fed peanuts daily, and the other group strictly avoided peanuts. After five years, researchers looked at which children had become allergic to peanuts and which had not. Only about 2 percent in the group that was exposed repeatedly to peanuts developed a peanut allergy. By contrast, nearly 14 percent of the children in the peanut avoidance group developed allergies. We seldom see differences like that in human studies. It was striking and statistically significant.

So there’s a new recommendation for infants at risk for food allergies. We can do testing, of course, and if they are not already allergic and are able to tolerate the food allergen, we are recommending that they should be fed the food frequently. That is the opposite of the previous recommendation, which warned parents to avoid exposing children to potentially allergenic foods for as long as possible.

For children who have already developed food allergies, some hopeful trials are underway that may offer protocols for desensitization. This approach would be similar to how allergists desensitize people who are allergic to pollen. Pollen desensitization is usually done with injections, but that’s dangerous for people with food allergies. With food allergies, the desensitization would be attempted with a graded, oral protocol. These are being developed for egg, nut and peanut allergens.

Patients would be challenged in clinic to see how much of an allergen they can tolerate. Then, a patient will consume that amount daily, possibly increasing that amount according to how they fared in subsequent challenges. Researchers have found that food tolerance gradually increases in most patients. In about a third of cases, patients can become completely desensitized, even those who had severe allergic reactions. A majority of patients are desensitized to the point that they can tolerate a small amount of allergens safely. That substantially lowers risks for severe, life-threatening allergic reactions.

Obviously, there is great interest in these protocols since about 5 percent of children have food allergies. We expect to have the new protocols available in general clinical use in the not-too-distant future.

This changing paradigm about food allergies is making doctors take a second look at why food allergies have been increasing. Most likely doctors have been contributing to this pattern by giving new mothers the wrong advice. Until the LEAP Study, we just didn’t have the data to make a good scientific recommendation, so we depended upon logic and common sense. We turned out to be wrong.

I strongly suspect that the incidence of food allergies in children will begin to subside after new recommendations take effect.

It’s also worth mentioning that there are some new biologic drugs in the pipeline that are promising for children with severe allergic asthma. We’ve been using one of these injection drugs, Xolair (omalizumab), for about a decade. Now, new ones will be available soon and some are effective at controlling severe asthma and even severe hives.

These new drugs will be expensive, but for people who are often hospitalized with severe asthma, they may be cost-effective and could certainly improve their quality of life.