New state health laws are in effect; one to regulate herbal drug kratom is in limbo due to lack of funding, Beshear says

Kentucky Capitol (Wikipedia photo)

By Melissa Patrick
Kentucky Health News

A number of new state health laws took effect July 15, ranging from measures on maternal health to improved access to a commonly used allergy medication.

The General Assembly passed more than 200 bills during its 60-day session. They become law 90 days after adjournment of the legislature unless they have a defined effective date, are general appropriation bills, or are passed with an emergency clause. This year, the effective date was July 15.

Some of the health measures that are now law are:

Health Care Liability: House Bill 159, sponsored by Rep. Patrick Flannery, R-Olive Hill, protects health-care providers from criminal liability when a medical error harms a patient. The bill does not apply to harm resulting from gross negligence or wanton, willful, malicious or intentional misconduct.

Kratom: HB 293, sponsored by Rep. Kim Moser, R-Taylor Mill, aims to regulate kratom, an herbal drug frequently sold online and in convenience stores. The bill prohibits sales to people under 21 and provides guidelines for manufacturing and labeling the product.

This bill was included in a list of 22 laws mentioned in an April letter from Gov. Andy Beshear to legislators saying there is a lack of funding to implement them, so that puts this new law in limbo, Liam Niemeyer reports for the Kentucky Lantern.

Maternal health: Senate Bill 74, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, aims to support maternal and infant health and reduce the high mortality rate for mothers in Kentucky. Several sections of the bill took effect July 15, including one that will provide more information about breastfeeding and safe sleep to at-risk parents. Others establish a state maternal-fatality review team and require Medicaid to cover lactation consulting, breastfeeding equipment, and in-home and telehealth services. The bill also requires state health officials to compile an annual report about the number and types of delivery procedures performed at each hospital. Other sections of the bill will not take effect until 2025. This bill includes the “Momnibus” bill, which was originally filed as HB10 by Moser.

Medical cannabis: HB 829, sponsored by Rep. Jason Nemes, R-Middletown, updates some aspects of Kentucky’s upcoming medical cannabis program. It allows schools to ban medical cannabis from their campuses and allow local governments to apply a small fee to the program, among other changes. Three sections of the bill related to applications for business licenses, state enforcement and patient pamphlets will not take effect until 2025.

Pseudoephedrine: HB 386, sponsored by Rep. Robert Duvall, R-Bowling Green, eases purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their medical needs.

Vaping in schools: HB 142, sponsored by Rep. Mark Hart, R-Falmouth, bans all tobacco, alternative nicotine and vapor products in Kentucky public schools. It also requires school districts to adopt disciplinary procedures for students who violate the bans.

Veteran suicide prevention: Under HB 30, sponsored by Rep. Michael Meredith, R-Oakland, the Kentucky Department of Veterans Affairs will create a suicide prevention program for service members, veterans and their families.

Youth medical records: HB 174, sponsored by Rep. Rebecca Raymer, R-Morgantown, stipulates that parents have access to their child’s medical records. Prior to this law, children ages 13 and older had to sign a waiver for parents to have access.

Alzheimer's education: HB 459, sponsored by Moser, requires advanced practice registered nurses and physician assistants who primarily work with Kentuckians ages 50 years and older to undergo continuing education related to the detection and treatment of Alzheimer’s and other forms of dementia. This language was added from SB 211, sponsored by Sen. Stephen Meredith, R-Leitchfield, in the final days of the session. The bill also involves the APRN national certification exam and Kentucky Board of Nursing appointments.

News releases from the Legislative Research Commission contributed to this story.

Bills to become law on vaping, pharmacy reform, vaccinations, drugs, at-home blood testing, coverage of cancer screening, more

Kentucky State Capitol (Photo via Wikipedia)

By Melissa Patrick
Kentucky Health News

In its 2024 session the Kentucky General Assembly has passed dozens of health-related bills that address a range of topics. With one day left in the session, here are some of them: 

Vaping: House Bill 11 limits legal sale of vaping products to those approved by the U.S. Food and Drug Administration. It also creates a database of retailers that sell the products and sets fines for retailers, manufacturers and wholesalers who violate the law.

HB 142 requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the state Department of Education. Changes in the Senate, accepted by the House, allow schools and their governing bodies to apply for grants related to nicotine usage and remove the mandate that schools suspend students with a third possession violation. 

Pharmacy reform: Senate Bill 188 changes laws governing commercial pharmacy benefit managers, with requirements aimed at saving the state's independent pharmacies from closing.  It provides for dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own.

The bill, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And a PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Reducing barriers to screening

Cancer detection: HB 52 will require health-insurance plans to cover all preventive cancer screenings and tests that are consistent with nationally recognized clinical practice guidelines without requiring patients to pay any cost-sharing requirements, including a deductible charge for the services.

The sponsor, Rep. Deanna Frazier Gordon, a Republican from Richmond, told Kentucky Health News in February that the cost for screenings is often a barrier for people who often don't get screened because they don't have symptoms.

HB 115 will eliminate co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Currently, screening mammograms are covered by insurance, but follow-up exams are often not. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not any more,"  Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

Vaccines and drugs  

Vaccinations: HB 274 will allow Kentucky pharmacists to order and administer vaccinations to children as young as 5. The state's routine vaccination rates for kindergarteners remain below pre-pandemic levels.

Pseudoephedrine: HB 386 will raise the annual purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their needs. The bill changes the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction, said sponsor Robert Duvall, R-Bowling Green.

Kratom: HB 293 will regulate kratom, a natural herbal supplement that is not currently regulated. It is often used for anxiety, pain, PTSD and opioid withdrawal. The bill defines kratom, prohibits sales to people under 21, puts it behind the counter and provides guidelines for manufacturing and labeling. It also says federal law supersedes state law on the matter. 

Blood thinners: HB 31 allows Medicaid patients in Kentucky who are on blood thinners to use at-home machines to test their blood. Patients on some blood thinners, like warfarin, now require a weekly trip to the doctor's office for blood work that looks at how fast their blood clots.

Amanda Crabtree, a registered nurse at University of Kentucky Chandler Hospital, told WKYT-TV that she hopes that other states will follow Kentucky's example in this legislation. Crabtree said she expects that Medicaid patients could receive their at-home machines as soon as this summer.

Health-care business issues

Provider liability: HB 159 will protect health-care providers from criminal liability when a medical error harms a patient unless the harm results from gross negligence or wanton, willful, malicious or intentional misconduct. 

This effort was led by the Kentucky Nurses Association, which said the bill "will prevent health-care professionals from being charged criminally for making a medical error; that makes it good for nurses and nursing, and puts Kentucky at the forefront of developing laws to protect health-care workers." 

Workplace violence: HB 194 extends to contract workers, such as travel nurses, the law that makes violence against health-care workers a third-degree assault. It also extends this protection, now limited to hospitals, to contract employees at health clinics, doctor offices, dental offices and long-term care facilities. 

Sepsis: HB 477 establishes diagnostic criteria for sepsis allow hospitals to preserve current rules used for reimbursement of sepsis care, which allow payment when it is detected early, instead of only allowing reimbursement after organ failure occurs. 

"We know that if sepsis is caught early, the likelihood of survival is great," Jim Musser, vice president for policy with the Kentucky Hospital Association, told Kentucky Health News in March. "But for every hour that we wait, the chance of mortality increases by 7 percent." In sepsis, "The body responds improperly to an infection," says the Mayo Clinic. "Sepsis may progress to septic shock . . . When the damage is severe, it can lead to death."

Other health bills that passed

Youth medical records: HB 174 allows parents have access to their child’s medical records until they turn 18. Right now, children 13 and older must sign a waiver for parents to have access to them. HB 174 also updates the state's Medical Orders for Scope of Treatment form, which defines a person's end-of-life wishes.

Veteran suicide prevention: HB 30 calls on the state Department of Veterans Affairs to create a suicide prevention program for service members, veterans and their families.

Stuttering: SB 111 eliminates some insurance coverage limits on speech therapy for stuttering. It was promoted by former UK basketball star Michael Kidd-Gilchrist, who has overcome stuttering.

Medicaid: SB 71 is designed to keep people from coming to Kentucky to establish residence so that they can sign up for drug treatment to be paid for by Medicaid. One challenge resulting from this practice, according to Rep. Shane Baker, R-Somerset, is that when they leave the program, they are often homeless. 

SB 280 will allow Level II trauma centers that partner with a  university to get the university-hospital rate for services delivered as part of that residency program.

Study says allergy to red meat is under-diagnosed, probably due to clinicians' limited knowledge of it, and Ky. is a national hotspot

Map from CDC research report, adapted by Kentucky Health News; click on it to enlarge.

Lone star ticks are the main source. (CDC photo)

Kentucky Health News

Thousands of Kentuckians are likely living with an allergy to red meat, and many of them probably don't know it because it hasn't been diagnosed in them, a new study suggests. Another study says most of the people who do the diagnoses -- health-care providers -- have little or no working knowledge of alpha-gal syndrome.

The studies were published Thursday by the Centers for Disease Control and Prevention. In the first one, scientists reviewed laboratory results of people who had been tested for antibodies that identify the syndrome since 2020. They found 110,000 suspected cases, but that figure is probably a significant underestimate," reports Emily Anthes of The New York Times. 

The second study, also done by CDC disease ecologist and veterinarian Dr. Johanna Salzer, "found that 78 percent of health-care providers who were surveyed had little or no knowledge of the condition, and many clinicians who had heard of the syndrome were not sure how to diagnose it," Anthes reports. "When the researchers factored in this knowledge gap, they estimated that the true toll of the syndrome might be closer to a half-million, although Dr. Salzer acknowledged that the figure was 'a crude estimate'."

Extrapolating the national estimate of 450,000, about 6,000 Kentuckians would have the syndrome if they reflected the estimated national prevalence, but a map with the study shows that Kentucky is one of the states with the highest prevalence of the allergy, based on the available antibody tests.

Anna Buckman of the Adair County Community Voice reported in 2019, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Buckman noted that the syndrome "is relatively new to the allergy world," having been identified in scientific literature about 15 years ago. Anthes reports, "Until August 2021, a single commercial lab did nearly all of this antibody testing in the United States. In one of the new studies, researchers reviewed the results of the antibody tests performed at this lab from 2017 to 2022."

The allergy "takes its name from galactose-alpha-1,3-galactose, a sugar present in beef, pork, lamb and the meat of most other mammals. (It is not present in humans or other apes.) Lone star ticks, which scientists believe are the primary culprits of the disease in the United States, can transmit the sugar to people through a bite. Some people’s immune systems may then label this foreign sugar a threat and overreact to its presence the next time they eat meat," Anthes writes.

The more a person is bitten, the more at risk they are of developing the allergy, Buckman reported.

"The symptoms, which often take hours to appear, are wide-ranging, and may include hives, nausea, diarrhea or anaphylactic shock," Anthes reports. "Even patients who have the syndrome may not feel sick every time they eat meat."

Sneezing? Sniffling? Climate change means U.S. allergy seasons last a month longer than in 1990 and have 21% more pollen

Medical News Today photo

By Laurel Swanz
Kentucky Health News

With allergy season in full swing in Kentucky, those suffering from nasal allergies and asthma may feel as though the pollen gets worse every year.

The American College of Allergy, Asthma and Immunology says there is some truth to this – and climate change, which is causing warmer temperatures, longer growing seasons and decreased air quality, is to blame.

Pollen season starts earlier and lasts longer than in previous years, according to research led by William Anderegg of the University of Utah School of Biological Sciences and the National Institute of Food and Agriculture.

Andregg’s research found that pollen seasons “start 20 days earlier, are 10 days longer, and feature 21% more pollen than in 1990.”

Kentucky has had a longer pollen seson this year because it had an unseasonably warm February, putting parts of the state in bloom for months, according to Lexington's WKYT-TV.

“The strong link between warmer weather and pollen seasons provides a crystal-clear example of how climate change is already affecting peoples’ health in the U.S.,” Anderegg said in a report for the National Institute of Food and Agriculture.

According to Anderegg’s research, the warming temperatures confuse plants’ internal timing, or phenology, causing them to start producing pollen earlier in the year.

That means people who suffer from seasonal allergies and asthma and their health-care providers must start preparing sooner, as many treatments take varying amounts of time before becoming effective.

For example, immunotherapies to treat allergies through dissolving tablets or shots can take anywhere from 12 weeks to years to become effective, so knowing when allergy season is coming is essential to the timing and effectiveness of these treatments.

The Mayo Clinic offers several strategies to relieve seasonal allergies before resorting to allergy shots, including staying indoors when pollen counts are high to reduce exposure and using over-the-counter remedies such as antihistamines, decongestants and nasal irrigation.

The American College of Allergy, Asthma and Immunology reports that allergies and asthma often go hand in hand. And because climate change leads to heightened symptoms of both conditions, people need to know what they’re dealing with and how to treat it.

“What many people don’t realize is that the same things that trigger your seasonal ‘hay fever’ symptoms – things like pollen, dust mites, mold and pet dander – can also cause asthma symptoms,” allergist Kathleen May said in an ACAAI news release. “If you have allergies, and you are wheezing or coughing, an allergist can determine if you also have asthma. Allergists are specialists at treating asthma and can put together a treatment plan to help you deal with both conditions.”

Anderegg’s research found that climate change’s contribution to increasing pollen counts is only rising.

“Climate change isn’t something far away and in the future. It’s already here in every spring breath we, and increasing human misery,” Anderegg said in the report. “The biggest question is — are we up to the challenge of tackling it?”

Even if you have a history of severe allergic reactions to vaccines, Pfizer and Covid shots are still a good idea, big study says

Image from CNBC.com

The Pfizer and Moderna coronavirus vaccines using messenger RNA are shown to be safe for people with a history of severe allergic reactions to vaccines, medications, or allergens, according to a study of more than 52,000 employees in the Mass General Brigham health-care system in Massachusetts.

In the study, published in JAMA Network Open, 474 participants reported a history of such allergic reactions, and significantly more suffered from allergic reactions following the mRNA vaccine than those who did not report a history of allergic reactions, 11.6% to 4.7%. The most common reaction was swelling in the skin. Despite these symptoms, 97.6% of the employees received two doses of an mRNA vaccine.

Lily Li, the study's lead author, said, "The results of this study can help guide expectations for patients with high-risk allergy histories. Symptoms such as hives and swelling may occur, particularly with the first vaccine dose, but most reported allergic symptoms did not impede completion of the two-dose mRNA vaccine series."

Allergy season can cause symptoms that also occur with Covid-19, but watch for other symptoms and a quick onset of them

Covid-19 has made allergy season confusing for people with runny noses and nasal congestion. Telling the difference between Covid-19 and a common cold can be hard, but according to Dr. Jessica Grayson of the University of Alabama-Birmingham, "knowing when to get tested and when to see a physician" are important.

Rhinitis is inflammation of the nasal airway that can be caused by viruses, allergens or other irritants, and Grayson said it "can be seen in Covid-19, as well as nasal congestion and a runny nose." Rhinitis can be treated with over-the-counter steroid nasal sprays, antihistamines if allergies are the cause, and potentially allergy immunotherapy.

Covid-19 symptoms include congestion and runny nose, but also loss of smell loss, fever and cough, and the symptoms appear more quickly. If you have one of those symptoms or another possible Covid symptom, such as headache or gastrointestinal problems, Grayson says you should consider the possibility that it is Covid-19 and get tested.

Receiving the Covid-19 vaccine is the best way to reduce the risk of hospitalization, Grayson says.

Rural weekly reports on increasing tick-borne allergy to red meat

Map shows cases entered by site users and is not verified. For a larger version of the map, click on it.

A tick-borne allergy to red meat is becoming more common, the Adair County Community Voice reported Oct. 31, in a pair of front-page stories: one on the main front and the other leading its occasional Health and Wellness section.

The allergy is caused by a sugar molecule called alpha-gal. Anna Buckman writes, "Dr. Kourtney Gentry Gardner, an allergist-immunologist in Bowling Green, diagnoses about five people a month with the alpha-gal allergy, and it’s becoming increasingly more common, she says."

Close-up of the Lone Star tick, which
is much larger when it is full of blood.

People who are bitten by the Lone Star tick, especially those bitten repeatedly, are at risk of "having allergic reactions to the molecule, which is found in most mammalian or red meat," Buckman notes. "It is relatively new to the allergy world," having been identified in scientific literature only 10 years ago.

Buckman deals with the science but brings the story home by writing about some local victims, illustrating the varying manifestations of the allergy:

"Tiffany Bean can no longer hang out at summer gatherings where friends grill burgers because, following a tick bite, she developed a food allergy so severe that she even has reaction being around the fumes of cooked beef. . . . Rick Wilson is also allergic to red meat but can eat dairy products. He only had occasional reactions when he was still consuming red meat."

Joshua Wethington (Adair Co. Community Voice photo)

"Five-year-old Joshua Wethington doesn’t like dairy-free pizza, but that’s the only kind he can have. Because of a tick bite at some point in his short life, he is so allergic to red meat that allergists recommended removing dairy from his diet because it is a byproduct of cows." Joshua’s mom, Dana Wethington, told Buckman, “I’m having a hard time getting him to eat things because it doesn’t taste the same to him.”

Other differences: "Bean went from just having an itchy tick bite to having a stomach illness for hours or breaking out into a rash if she consumed anything with alpha-gal. She has lost 40 pounds due to the allergy," Buckman reports. "Joshua got hives all over his body every day that he consumed red meat. Wilson experienced severe itching and nearly passed out during one of his few reactions. Speak to three people with alpha-gal and you’ll discover one thing is certain: it’s complicated. The only similar experiences that Bean, Wilson and the Wethingtons have are the difficulty of living with the allergy and dealing with its affects when they go out publicly."

Bean told Buckman, “People don’t seem to take it seriously. You tell people that you have it and that you could die from it, and people are like, ‘Oh no, you can’t die from eating a hamburger or bacon.’ Well, yeah, you can.”

Alpha-gal victims use technology to help each other, including a smartphone app ("Is it Vegan?"), a Facebook groups (“The AlphaGal Kitchen” and “Alpha-Gal Support Kentucky”) and an interactive map that locates cases (above).

"Recommended by a member on a Facebook support group, the Munfordville Pool Hall and Grill is a relief to alpha-gal sufferers and also sets a great example for other restaurants for being allergy-friendly in general," Buckman writes. "The pool hall has designated one fryer where no red meat or cheese is prepared. They have designated skillets to cook foods for separate consumption because people with alpha-gal allergy can have a negative reaction from even the residue from a mammal product.

Pool-hall employee Justin Minton told Buckman that employees acted after notiing that several people in the community have the allergy. “Speaking from experience, going to Subway is pretty much the only place my grandpa can go,” Minton told Buckman.

Even though "people with alpha-gal are helping one another with useful information, Kandace Webster, an advance-practice registered nurse at T.J. Health Columbia Primary Care, "urges sufferers to seek professional guidance," Buckman reports.

Study: Infants are not as susceptible as older children to food allergens, and if exposed early, less likely to develop allergies

Med Shadow image

If you're wary of exposing an infant to food that might be allergic, think again. New medical guidelines say that infants should be exposed to potentially allergic foods because that makes them less likely to develop allergies.

A study done in conjunction with the new guidance  found that food-induced, multiple-symptom allergic reactions that can cause death in older children and toddlers have a much milder effect in infants.

The study published in Annals of Allergy, Asthma and Immunology out of Ann & Robert H. Lurie Children’s Hospital of Chicago shows that infants under the age of 1 are much less susceptible to the severe side effects of food-induced allergic reactions, such as death, than their older peers.

The study was a reaction to new guidelines from the National Institute of Allergy and Infectious Diseases that encourage parents to introduce their children to foods with peanuts between four and six months. This new recommendation contrasts with previous advice to avoid introducing young children to peanut products. Now, the institute claims that if introduced early on to potential allergens, children are less likely to develop food allergies.

Waheeda Samady, a doctor at Lurie Children's Hospital, said in a press release that with the new guidelines, "It is understandable that parents might be fearful of triggering a serious reaction", but said the new research should be "reassuring."

The researchers examined 357 cases of children with food-induced allergies i 2015-17. Of these, 47 were infants (under the age of 1), 43 were toddlers between 1 and 2; 96 were 2 to 6; and 171 were school-aged children over 6. They found that 83 percent of the infants in the study experienced vomiting due to exposure, but none died. Still, the researchers warned that anytime an infant has a negative reaction to trying a new food, the child's primary doctor should be consulted or 911 should be called.

Study indicates fast food contains industrial chemicals linked to health problems such as infertility, diabetes and allergies

People who eat a lot of fast food have higher levels of chemicals that "have been linked to a number of adverse health outcomes, including higher rates of infertility," especially among men, Roberto Ferdman reports for The Washington Post.

Researchers at George Washington University in Washington, D.C., say the connection could have "great public health significance," Ferdman writes. "Specifically, the team found that people who eat fast food tend to have significantly higher levels of certain phthalates, which are commonly used in consumer products such as soap and makeup to make them less brittle. . . . The danger, the researchers believe, isn't necessarily a result of the food itself, but rather the process by which the food is prepared."

Here's how the study was done: Researchers analyzed diet and urinalysis data for nearly 9,000 people, collected as part of federal nutrition surveys in 2003-2010. "Food eaten at or from restaurants without waiters or waitresses was considered fast food. Everything else — food eaten at sit-down restaurants and bars or purchased from vending machines — was not," Ferdman writes. "The first thing the researchers found was that roughly one-third of the participants said they had eaten some form of fast food over the course of the day leading up to the urine sample collection," which fits with government estimates.

People who said they had eaten fast food in the previous 24 hours "tended to have much higher levels of two separate phthalates," Ferdman reports. Those who said they ate only a little fast food had levels 15 and 25 percent higher than those who said they had eaten none. "For people who reported eating a sizable amount, the increase was 24 percent and 39 percent, respectively. And the connection held true even after the researchers adjusted for various factors about the participants' habits and backgrounds that might have contributed to the association between fast-food consumption and phthalate levels."

The study was reported in Environmental Health Perspectives, a peer-reviewed journal funded by the National Institutes of Health.

"There is little consensus on the harms of phthalates, which are widely used in commerce and give materials such as food packaging added flexibility, except that exposure to them is widespread," Ferdman writes, citing the federal Centers for Disease Control and Prevention. "But there is growing concern that the chemicals could pose a variety of risks, particularly when observed in the sort of levels seen in the study."

Noting several other studies, such as those linking the chemicals to diabetes and allergies, Ferdman reports, "Many governments have moved to limit exposure to the industrial chemicals. Japan disallowed the use of vinyl gloves in food preparation for fear that their use was compromising health. The European Union, which limits the use of the chemical, has been nudging manufacturers to replace it. And the United States restricted its use in toys."

So, why do people who eat fast food seem to have much higher levels of these chemicals? That is unclear, Ferdman writes, "but it's easy enough to guess: the sheer amount of processing that goes into food served at quick-service restaurants. The more machinery, plastic, conveyor belts, and various forms of processing equipment that food touches, the more likely the food is to contain higher levels of phthalates. And fast food tends to touch a good deal more of these things than, say, the food one purchases at a local farmers' market."

Ferdman concludes, "It certainly seems as though eating fast food is more toxic than avoiding it, and not for the obvious reasons." He quotes Marion Nestle, the Paulette Goddard professor of nutrition and food studies at New York University: "Traditional fast food was never meant to be daily fare, and it shouldn’t be," said  "It’s too high in calories and salt and, as we now know, the chemicals that get into our food supply through industrial food production."

Spring fever: If over-the-counter medicines don't quell your allergies, it's a good time to see an allergist

By Ann Blackford
University of Kentucky

The beauty of spring is upon us, but as lovely as it may be to look at, it can wreak havoc in your nose, throat and eyes. The higher the pollen count, the greater the misery.

Seasonal allergies are the result of a chain reaction that starts in your nose. If you are allergic to pollen, the immune system will overreact by producing allergic antibodies. The antibodies attach cells in your airway and cause release of chemicals, causing an allergic reaction.

Many people find relief in some very effective over-the-counter medications. If OTC medications don't provide relief, or cause significant side effects, this is a good time to visit an allergist. An allergist/immunologist is a pediatrician or internist who has spent an additional two to three years of training specifically in this field.

Allergists will discuss treatment options: typically allergy avoidance, followed by medical management, and lastly allergy injections.

Allergy shots are the only known cure to date for allergic rhinitis (nasal allergies). The concept behind allergy shots — allergy immunotherapy — is that the immune system can be desensitized to specific allergens that trigger allergy symptoms, thereby building up resistance or tolerance to the allergens.

Allergy shots generally work in two phases. The buildup phase can last from three to six months and involves receiving injections in increasing amounts of the allergen and are taken once or twice a week.

The maintenance phase begins when the most effective dose is reached. The dose can be different for each person, depending on how allergic you are and your response to the build-up injections. Once the maintenance dose is reached, there are longer periods of time between injections, typically two to four weeks.

Some people will experience relief of their symptoms during the build-up phase, but for others, it may take as long as 12 months on the maintenance dose. If there is no improvement after a year, your allergist may discuss other treatment options.

Allergy shots are a good option for people with allergic rhinitis (hay fever), allergic asthma, conjunctivitis (eye allergy) or stinging insect allergy. Shots can be given to children as young as four to five years old.

Shots are not recommended for food allergies, but can help in patients with oral allergy syndrome. This syndrome occurs in patients highly allergic to pollens; the body reacts to cross-reacting foods, and causes itching of the mouth and tongue. Allergy shots are not started on pregnant women but can be continued on patients who become pregnant while on shots.

Recently the Food and Drug Admimistration approved allergy drops or sublingual immunotherapy for grass and ragweed allergy. However, most patients have many confounding allergens (i.e. trees, molds, mites, animal danders), which can be included in allergy shots, thus making shots much more effective.

How to avoid and treat poison ivy, oak and sumac

Now that school is out and summer is here, more people will be venturing into the woods to enjoy hiking, camping and other outdoor activities. Poison ivy, poison oak and poison sumac cause more allergic reactions than any other source, said Renee Miller, R.N., a certified specialist in poison information at the Tennessee Poison Center at Vanderbilt University Medical Center.

The leaves, vines and roots all contain the oils that cause the reaction. "Only about 15 percent of people are resistant to these plants, and sensitivity tends to decrease with age," Miller said.

The most effective way to avoid an itchy reaction is to avoid coming into contact with the plant. Wearing long pants, long sleeves, gloves and boots will help. If a person is exposed to poison ivy, he or she should wash the area with soap and lukewarm water. "If you wash within the first 15 minutes of exposure, 100 percent of the oils can be washed away," Miller said. "If you wait an hour, zero percent can be washed away." Pets and clothes can also carry the oils.

Usually the rash shows up in 24 to 48 hours, but it can take longer or appear more quickly. "Once an exposure has occurred, topical steroids and antihistamines are the mainstay for treatment," Miller said. "Prescription cortisone can halt the reaction if used early." But once the reaction has progressed to the vesicular stage including small fluid-filled blisters, treatment with systemic steroids is the only effective option.

Crittenden County Elementary School is latest school in area to restrict nuts to protect the health of those with nut allergies

This story has been updated to include information about other Western Kentucky schools with nut restrictions.

Peanut butter and jelly sandwiches are a lunchbox staple for many American children, but they can also pose a serious health risk to those with peanut and tree-nut allergies, especially in the young. The risk has prompted the Crittenden County school district to become the latest in the area to restrict the use of nuts at the Crittenden County Elementary School in Marion.

"Peanut and tree nut allergies plague an estimated 19 million Americans and the number of children with peanut allergies in the U.S. has nearly doubled in just over a decade," The Crittenden Press noted.

After researching the issue and how other schools have dealt with it, the school's parent-teacher council and wellness committee created a policy that restricts but doesn't ban nuts, the Press reports.

The policy asks everyone to be aware that nut products are dangerous to some of the students and asks them to not send those products to school, Principal Melissa Tabor told the Press. She said at least five students have proven nut allergies.

Several other Western Kentucky schools have peanut restrictions,Genevieve Postlethwait reports for The Paducah Sun, including Carlisle County and Fulton County schools, with Paducah and Hickman County schools having restricted peanuts for varying periods of time in the past. (Story is behind a pay wall.)

"We do it on a case-by-case, year-by-year basis," Penny Holt,the district's nutrition director, told Postlethwait of Paducah schools' approach to restricting peanuts and other allergens. "If a child has an allergy that is that serious, we're not going to risk it," she said, noting that they are seeing an increase in all kinds of food allergies.

Another school, Heath Elementary, has a child with an airborne peanut allergy so the school does not serve any peanut products or cook with any peanut products, Sara Jane Hedges, food services director for McCracken County schools. told Postlethwait. Students are still allowed to bring peanut butter products, but " "It's just taken care of very carefully," Hedges said.

Crittenden County Elementary school's policy does not require school personnel to check backpacks or lunchboxes for nut-containing products, but if they see children have one of these products, they ask them to sit at a designated table for that day, where they can ask a friend to join them.

The school sent home a list of nut-free snacks, including safe name brands that do not contain peanut oil, to help parents re-think what to pack in their child's lunch or to send for school snacks or for school parties.

So far, the principal said, parents have been receptive to the policy, and one parent told her that they had successfully switched to a soy butter that tastes like peanut butter because their child wants peanut-butter sandwiches for lunch.

The policy states that those with severe allergies to peanuts or nut products may be at great risk of anaphylactic shock, "an allergic reaction causing swelling, difficulty breathing, itching, unconsciousness, circulatory collapse and sometimes death," if they ingest or are exposed to these products.

"Because of the possibility of cross-contamination, a campus-wide, comprehensive avoidance of foods containing nuts was deemed to be the best solution to reduce the health risks to students with allergens," Tabor told the Press.

Crittenden County School Supt. Vince Clark told the weekly newspaper that he supports the school's policy, despite the argument that it creates a burden to parents of students who love peanut butter.

“There are valid points on each side of the issue,” he told the Press. “Ultimately, we have to support efforts to offer a safer learning environment for the children.” (Read more)

Midwest pollen count indicates that seasonal allergies are expected to be worse than usual this year

Seasonal allergy sufferers beware. Allergy season is officially here and is predicted to be worse than usual, says a news release from Chicago's Loyola University Health System.

image from healthguru.com

After weeks of evaluation, the Gottlieb Allergy Count, which is the official daily allergy count for the Midwest, has detected moderate pollen in the air at a time that is typically low.

Dr. Joseph Leija,  retired allergist who continues to conduct the official daily allergy count, said in the release that the long cold winter with heavy snow is likely to cause "a bad allergy season."

“The prolonged, fierce winter may mean that tree, grass and mold spores appear simultaneously early in the season, causing a triple threat," he said in the release. "Heavy snow means lots of moisture to nourish budding trees and plant life. The continued dampness also fosters the growth of mold."

Here are some allergy relief tips from WebMD :

• Take your shoes off at the door.
• Wipe down your dog's coat before it comes in the house.
• Wash your hair before bed.
• Close the windows and doors, especially on high-pollen days.
• Use the "recirculate" option in the car.
• Service the filters in your furnace and air conditioner.
• Use a dehumidifier to maintain a humidity level of less than 60 percent in your home.
• Check the daily pollen count and plan accordingly.
• If possible, have someone else mow the lawn.
• Avoid sitting outside around freshly cut grass.
• Dry your clothes in a clothes dryer, not on an outdoor line. 

“People with allergies or breathing difficulties should be proactive now to preserve health," Leija said in the release. "Consult your allergist, have the ducts cleaned on your air conditioning system and start taking your allergy medicine so that when things really heat up, you are protected."

Click here to get the daily pollen count in your county from pollen.com.

Lots of research has established that children with egg allergies can still get a flu shot; those with asthma especially should

Flu season can start as early as October, and  children with egg allergies are now encouraged to get a flu shot, especially if they have asthma, according to a news release from the American College of Allergy, Asthma and Immunology.

Children with egg allergies may have been told in the past to not get a flu shot because of a possible reaction to trace amounts of eggs in which the vaccine is produced, but recent research now says that the vaccine is safe for these kids.

“We now know administration is safe, and children with egg allergies should be vaccinated,” Michael Foggs, president of the American College of Allergy, Asthma and Immunology, said in the news release. “We recommend that, as with any vaccine, all personnel and facilities administering flu shots have procedures in place for the rare instance of anaphylaxis, a life-threatening allergic reaction.”

The release says "a large number of research studies published over the last several years have shown that thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine as a single dose without a reaction."

More than 21,100 children under the age of five are hospitalized annually because of the flu, with only 55 percent of children ages 5-17 getting a flu shot, according to the Centers for Disease Control and Prevention, says the release.

Foggs especially recommended that children with asthma get the vaccine, because even though they are not more likely to get the flu, it can be more serious for those with asthma, says the release.

"Children with asthma really need to get the flu vaccine," Foggs said in the release. “Asthma sufferers are among the most vulnerable because the flu compromises their airways even further than they already are.”

Prevention and preparation is the key to a productive year at school for kids with asthma (and that's 1 in 10 students)

By Melissa Patrick
Kentucky Health News

As the beginning of a new school year approaches, parents of children with asthma and allergies need to make sure that not only does their child recognize what triggers their symptoms and how to treat a flare-up, but also that their school knows what to do.

One of every 10 school-aged children in Kentucky has asthma, and these students miss an average of four school days each year, according to the Cabinet for Health and Family Services. Kentucky has one of the highest rates of asthma in the United States.

Nationally, more than 10 million kids under age 18 have asthma, 11 percent have respiratory allergies and about six percent have food allergies, according to according to the American College of Allergy, Asthma and Immunology. And on any given day, more than 10,000 kids miss school due to asthma.

Preventative care and avoiding triggers will help children miss fewer days in the classroom and will also allow them to be more productive in all of their activities, the college said in a news release.

“Parents need to be advocates for their kids, to help ensure they’re breathing well with clear minds and able to navigate the triggers that sometimes stand in their way,” Michael Foggs, president of the college. “If kids are having difficulty breathing, are sneezing, have runny noses and itchy eyes, and haven’t slept well the night before, they won’t perform at their best.”

Here are some tips to help with symptom-free days in the classroom and outdoors:

• Create an action plan with your allergist specific to your child's needs. Include medications, doses, triggers, early symptoms of flare-up and what to do if there is a flare up.&

• Share your child’s action plan with your child's teacher and whoever else might come into contact with your child every day. Discuss how independently your child is able to deal with their asthma, give them contact numbers for you and your child's doctor and be sure your child and school staff knows how to work the peak flow meter and how to administer medications, especially if your child needs assistance.

• Assess any triggers for your child at school: mold, dust mites, cockroaches, chalk dust, perfumes, cleaning products or other chemicals, animal dander, saliva or urine. Work on a plan to minimize these triggers.

• Discuss how to handle emergencies. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) also should have epinephrine to use. Be sure your child and school staff know how to use emergency medications.

• If your child has food allergies, send a bagged lunch to school every day and instruct your child to not share foods, napkins or utensils.

• Make sure you have a plan for recess and sports activities. The American College of Allergy, Asthma, Asthma and Immunology says in the release that "asthma symptoms during exercise may indicate poorly-controlled medications."

• Pay attention to the pollen counts if your child is allergic to pollen; it is suggested to start medications two weeks prior to when the levels are at their worst.

Proper asthma control helps kids sleep better at night, spend more time in the classroom, experience less anxiety about their condition and fully participate in all school activities, according to kidshealth.org.

Here are spring-cleaning tips to help allergy sufferers

Spring cleaning often stirs up dust and pet dander, and can leave a strong scent of cleaning supplies in the air. All can cause those with allergies to reach for a tissue and dread the task. But stirring up a little dust and dander is worth a few extra sneezes, the American College of Allergy, Asthma and Immunology says in a news release, because a thorough spring cleaning will ultimately help you avoid allergy symptoms.

“Thoroughly cleaning your home can help eliminate allergens and keep new ones from easily entering,” James Sublett, president-elect of the ACAAI, said in Newswise, a research-reporting service.  “Allergy season can last all year for those sensitive to indoor allergens, but it can worsen in the spring months when pollen becomes an issue. It’s important to remove allergens from the home so you can lead a healthy and active lifestyle.”

The ACAAI  offers tips to remove allergens from your home as well as ways to prevent more from entering.

The best way to prevent allergens from building up in your home is to stay on top of certain chores, such as vacuuming regularly to get rid of dust mites using a cyclonic vacuum or HEPA filter, changing air filters every three months using filters with a MERV rating of 11 or 12, and washing bedding and stuffed animals weekly.

It is also important to resist the urge to open the windows as the weather gets warmer, because this lets unwanted pollen into the house.Those with allergies also have to be careful to avoid air fresheners and candles because chemicals in these items can spur asthma attacks.

A top allergen target in spring cleaning is mold, paying special attention to mold-prone areas like bathrooms, basements and tiled areas, says the release. Make sure bathroom fans are functioning and usable, and always make sure not to leave any standing water in these areas. Use detergent and water to remove any visible mold, and to prevent further mold from growing, keep the humidity in your house below 60 percent.

Because pets spend so much more time indoors over the winter, chances are there is an increased amount of fur, saliva and dander in your house. Remove these allergens by vacuuming frequently and washing upholstery, including your pet's bed, the release says. Also, don't allow your pet in your bedroom.

Those with allergies should avoid being outdoors in noonday and afternoon, because pollen counts are highest then. Wear gloves and a N95 pollen mask when mowing or gardening, and make sure to wash your hands, hair and clothing when finished. Also, make sure to take your medication before going outside.

Itchy, watery eyes? Some tips to relieve spring allergy symptoms

The sunshine and bright colors of spring are here, but so are seasonal allergies from pollen, dander, smog or mold that can often lead to itchy, watery eyes. Eye irritation is the body's immune response to allergens, so when pollen comes in contact with eyes, for example, the body releases histamine, causing eye redness, burning and itching.

The Kentucky Optometric Association says discomfort from itchy, swollen or water eyes can be reduced with simple steps, such as maintaining a healthy diet full of anti-oxidants like spinach, broccoli, carrot discomfort that boost the immune system in addition to taking fish oil supplements that help reduce redness and irritation.

Other tips from the KOA include using preservative-free lubricating eye drops or re-wetting eyes with contact solution if you wear contact lenses. Applying a cold compress to eyes can also relieve itching and redness by constricting the histamine-releasing blood vessels. And remember: Do not touch or rub eyes, and be sure to wash hands with soap and water.

A local eye doctor can examine eye allergy symptoms to ensure the cause is properly identified, said Dr. Max Downey, an optometrist in Campbellsville. Optometrists' treatment could range from eye drops to prescription medicines, said Downey.

In addition to discussing allergy relief with your optometrist, the KOA recommends adults have yearly eye exams at the minimum, depending on the severity of allergies.

Bill encouraging schools to stock EpiPens to stop deadly allergic reactions will become law

A bill encouraging Kentucky schools to stock EpiPens, or epinephrine auto-injectors, to stop anaphylaxis, a life-threatening allergic reaction, has passed will soon be signed into law by Gov. Steve Beshear.

When someone has anaphylaxis, the sooner you use an EpiPen, the better the outcome can be, said Thomas Sternberg, an allergist at Graves-Gilbert Clinic in Bowling Green, told Alyssa Harvey of the Daily News.

Under House Bill 172, schools could keep at least two EpiPens in case of emergency, and school boards would develop and approve policies and procedures for managing a student’s life-threatening allergic reaction, reports Harvey.

The bill also helps schools receive or buy the auto-injectors through local health departments and directs the state Department for Public Health to develop clinical protocols for using the auto-injectors in schools. Harvey reports that EpiPens can be donated to schools, and the EpiPens for Schools Program will provide up to four free auto-injectors per school year; if more are needed, they can be purchased at a discounted rate.

"You don’t know when someone could have an anaphylactic reaction,” Rep. Addia Wuchner, R-Florence, who sponsored the bill, told the Daily News. She alluded to an incident in Virginia, where a 7-year-old student died last year after an anaphylactic reaction, and no medications were available at the school to treat her. "There could be a hero in the school who was able to reach for that epinephrine pen and save a child’s life and not a tragedy like in Virginia,” Wuchner said. She filed the bill late in the 2012 session, but the language has been revised for this year's session to encourage rather than mandate schools to stock EpiPens.

Amy Wallace, treasurer and former president of the Bowling Green area's Food Education Allergy Support Team, told Harvey she was disappointed schools will not be required to make necessary provisions, but said advocates of the bill are happy to see that the problem is being addressed. (Read more)

Childhood obesity is linked to more immediate health problems than doctors formerly realized

While a plethora of research on childhood obesity has linked it to long-term health problems, a new UCLA study focuses on the condition's more proximate consequences, showing that obese children are at a greater risk for immediate health problems than previously thought. That's important for Kentucky, which ranks poorly in many health measures and is third highest in child obesity. (Photo by Tara Kaprowy)

"This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity," said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA.

Compared to kids who are not overweight, the study found that obese children have nearly twice the risk of having three or more reported medical, mental or developmental conditions. Specific medical conditions included bone, joint and muscle problems; asthma; allergies; headaches; and ear infections. Obese children also reported a greater tendency toward emotional and behavioral problems, higher rates of grade repetition, missed school days and other school problems, ADHD, conduct disorder, depression, learning disabilities, and developmental delays.

The study provides the first comprehensive national profile of associations between weight status and a broad set of associated health conditions, a UCLA release said. Halfon said these findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for health conditions associated with childhood obesity. (Read more)

Use of pacifiers could lead to very sick babies, study finds

Oklahoma State University researchers report that they have found a wide range of disease-causing bacteria, fungus and mold on pacifiers that young children had been using.

In research presented at the American Society for Clinical Pathology, scientists have shown that pacifiers can also grow a slimy coating of bacterial film that alters the normal bacteria in a baby or toddler's mouth, increasing the likelihood of colic and ear infections. It gets worse, according to study author Tom Glass, a professor of forensic science, pathology and dental medicine: The same types of bacteria found on a common pacifier have been linked to cardiovascular disease, metabolic syndrome, allergies, asthma and autoimmune diseases.

HealthDay reporters Barbara Bronson Gray writes that Glass said the problems associated with pacificers are also applicable to any removable orthodontic appliance like retainers, mouth guards and dentures. Glass said his researchers were particular concerned about their findings when they discovered that "many of the bacteria growing from the used pacifiers were resistant to commonly used antibiotics such as penicillin and methicillin. The development of such resistance to certain antibiotics does not cause the organism to be more infectious than other strains that have no antibiotic resistance, but it can make the infection more difficult to treat." Glass told Gray that he does not recommend that pacifier use. use. "After doing the study, I say why take a risk?" (Read more)