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Antihistamines Linked to Delayed Care for Severe Allergic Reaction: Study

MONDAY, Oct. 28, 2019 — Giving antihistamines to a child suffering a potentially fatal allergic reaction may do more harm than good if it causes a delay in emergency treatment, a new study warns.

Researchers reviewed the medical records of young patients, aged 8 months to 20 years, who were admitted to a pediatric intensive care unit for treatment of anaphylaxis between July 2015 and January 2019.

The investigators found that 72% of patients who took antihistamines at home delayed seeking medical care, compared to 25% who didn’t take antihistamines.

“Anyone experiencing symptoms of anaphylaxis, which can constrict airways and circulation, should seek medical care immediately and use an epinephrine auto-injector if they have been prescribed one,” said lead author Dr. Evan Wiley, a pediatric resident at Jacobi Medical Center in New York City.

But many families first turn to antihistamines and wait to see if they might ease the allergic reaction, he said. That can be a risky mistake.

The findings were to be presented Sunday at the American Academy of Pediatrics (AAP) annual meeting, in New Orleans. Research presented at meetings is typically considered preliminary until published in a peer-reviewed journal.

“While the use of antihistamines might help some allergic symptoms such as rash or itching, those medications will not prevent death from anaphylaxis,” Wiley said in an AAP news release. “It is important for patients with anaphylaxis to seek immediate medical care, since the only proven lifesaving treatment is epinephrine, and any delay in receiving appropriate treatment can be fatal.”

The most common trigger for anaphylaxis is food allergies, which are on the rise in children, according to the U.S. Centers for Disease Control and Prevention.

More information

The Mayo Clinic has more on symptoms and causes of anaphylaxis.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

Some May Be Vulnerable to Severe Skin Reaction While Using Gout Drug

TUESDAY, Oct. 1, 2019 — Some gout patients with heart or kidney disease might be more susceptible to severe skin reactions while taking the gout medication allopurinol, researchers report.

“Our findings suggest that heart disease, like chronic kidney disease, is a risk factor for allopurinol-associated severe cutaneous adverse reactions that warrants adoption of precautionary measures against these reactions,” said researcher Dr. Hyon Choi, from the Department of Rheumatology, Allergy and Immunology at Massachusetts General Hospital in Boston.

Gout is form of inflammatory arthritis that develops in people who have high levels of uric acid in their blood. The acid can form needle-like crystals in joints and cause sudden, severe episodes of pain, tenderness, redness, warmth and swelling.

An earlier study found a link between heart disease and an increased risk of hospitalization for people who had a severe skin reaction to allopurinol.

For the latest study, Canadian and U.S. researchers used data from nearly 5 million people in British Columbia. More than 130,000 of these people were on allopurinol. Of these patients, those with heart disease and chronic kidney disease had a higher risk of severe skin reactions than those without such conditions.

People with the genetic marker HLA-B*5801, which is more common in Asian and black people, have a significantly higher risk of this adverse reaction than people without the mutation.

The report was published Sept. 30 in the CMAJ.

The U.S. Food and Drug Administration recently warned patients about the risk of cardiovascular events from the gout medication febuxostat, so the number of prescriptions for allopurinol will probably increase, the researchers noted.

But severe skin reactions are rare, and allopurinol plays an important role in managing gout, they added.

“Physicians who prescribe allopurinol should look for these risk factors so that they may consider initiating lower-dosage allopurinol and other precautions, which may prevent this rare but serious adverse reaction,” Choi and his co-authors concluded in a journal news release.

More information

For more on gout, see the Arthritis Foundation.

© 2019 HealthDay. All rights reserved.

Posted: October 2019

Drugs.com – Daily MedNews

CDC Clarifies Opioid Guidelines for Severe Pain

By Amy Norton

HealthDay Reporter

TUESDAY, April 9, 2019 (HealthDay News) — People with severe pain from cancer or sickle cell anemia should not be denied coverage for opioid painkillers, a new clarification on federal guidelines states.

In the wake of the national opioid epidemic, various medical societies had encouraged doctors to rein in prescriptions for the powerful painkillers.

In 2016, the U.S. Centers for Disease Control and Prevention published guidelines that said for most patients seen by primary care doctors, opioids should be a last resort.

But there has been an unintended consequence: Some insurers have refused to pay for prescriptions for patients with cancer or sickle cell anemia, or for cancer survivors with complicated chronic pain conditions.

The new clarification was issued in a letter from the CDC to three medical societies who’d brought the insurance problem to the agency’s attention — the American Society of Hematology, the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network.

The letter, released Tuesday, stresses that the guidelines weren’t intended for patients undergoing cancer treatment.

Beyond that, the letter says, the guidelines weren’t designed to “deny any patients who suffer with chronic pain” the option of opioid medications.

Dr. Deepika Darbari, who is with the hematology society, treats young patients with sickle cell anemia at Children’s National, in Washington, D.C. She said she’s come up against the insurance barrier herself — namely, plans that refused to pay for IV opioids for patients hospitalized with severe pain episodes.

And they’ve cited the CDC guidelines as the reason, Darbari said.

Sickle cell anemia is an inherited disease that causes red blood cells to be crescent-shaped, rather than disc-shaped. The cells also become “sticky” and prone to clotting. Because of poor blood circulation, patients can suffer periodic pain “crises.”

Over time, Darbari explained, sickle cell anemia can cause chronic pain by damaging organs and joints throughout the body.

Patients can first try other pain relievers, like acetaminophen (Tylenol) and ibuprofen (Motrin, Advil), along with nondrug therapies, according to Darbari.

But, she said, some need oral opioids, like Vicodin or OxyContin. And for severe pain episodes, patients may need to be hospitalized and given IV opioids.

Continued

The CDC agreed that managing sickle cell pain is complicated. The agency stated in its letter that treatment decisions — and reimbursement — should be based on medical guidelines created specifically for the disease.

Then there is the issue of cancer survivors who suffer lasting pain related to their treatment.

The CDC guidelines specifically said they do not apply to cancer patients undergoing “active treatment.”

“But where does that leave cancer survivors?” said Judith Paice, the lead author of ASCO’s guidelines on treating survivors’ pain.

More and more people are surviving cancer, Paice said — and that means more people living with aftereffects of treatment, which can include chronic pain. Some cancer treatments damage the nerves, for example, leaving people with a form of pain called neuropathy.

Another example, Paice said, relates to the aromatase inhibitors that breast cancer survivors may take for years to cut the risk of recurrence. They can cause chronic joint and muscle pain.

“We have many different options for addressing pain in cancer survivors, and opioids are one,” Paice said.

The CDC guidelines, she noted, were aimed at primary care doctors treating more common problems like lower back pain. Complex pain conditions, like those in cancer survivors, are different, Paice said.

In its letter, the CDC acknowledged that pain in cancer survivors is “unique,” and that guidelines from groups like ASCO offer “useful guidance” on treatment.

Commenting on the letter, the trade group America’s Health Insurance Plans (AHIP) said that health insurance policies have “always” recognized that patients under active cancer treatment do not fall under the CDC guidelines.

Beyond that, the AHIP said, “health insurance providers cover comprehensive, effective approaches to pain management that include evidence-based treatments, more cautious opioid prescribing, and careful patient monitoring.”

The CDC’s letter will be publicly available online, and Darbari said that doctors and patients can cite it if they run into problems with insurance coverage.

Paice called the letter “a beginning.” But she also said the problem is broader: Even when patients are not denied coverage, insurers put up cumbersome prior authorization requirements for opioids — even for refills.

Continued

“That can leave chronic pain patients without any medicine,” she said.

Paice said she reminds patients not to wait until their pills are almost gone to get a refill — since they may face delays.

WebMD News from HealthDay

Sources

SOURCES: Deepika Darbari, M.D., hematologist, Children’s National Health System, and member, American Society of Hematology, Washington, D.C.; Judith Paice, Ph.D., R.N., research professor and director, cancer pain program, Northwestern University Feinberg School of Medicine, Chicago, and lead author,Management of Chronic Pain in Survivors of Adult Cancers Guideline, American Society of Clinical Oncology; Cathryn Donaldson, director, communications, America’s Health Insurance Plans, Washington, D.C.; April 9, 2019, letter from the U.S. Centers for Disease Control and Prevention

Copyright © 2013-2018 HealthDay. All rights reserved.

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Severe ‘Mono’ Infection May Raise Risk for Chronic Fatigue Syndrome

TUESDAY, April 2, 2019 — As if having the exhausting “kissing disease” — also known as mononucleosis, or “mono” — isn’t bad enough, about 1 in 10 people with this infection will develop chronic fatigue syndrome in six months, researchers report.

To better predict which people with mono might end up with debilitating chronic fatigue syndrome, investigators at Lurie Children’s Hospital of Chicago developed a new scale to rate how severe a mononucleosis infection is. They then tested it in 126 college students diagnosed with mono.

“We looked at what factors correlated with bad outcomes and then tried to validate these measures,” said Dr. Ben Katz, an attending pediatric infectious diseases specialist.

People with the most severe mononucleosis infections based on the new scale were more than three times as likely to meet the diagnostic criteria for chronic fatigue syndrome, Katz explained.

And three factors in particular often showed up in people with more severe mono. These included:

  • Being unable to leave home when symptoms were worst.
  • Having trouble breathing.
  • Experiencing digestive symptoms, such as nausea and vomiting.

Mononucleosis is a contagious infection, commonly caused by the Epstein-Barr virus, according to the U.S. Centers for Disease Control and Prevention. It often occurs in younger people — especially those in high school and college. Symptoms include extreme fatigue, fever and sore throat. Between 1% and 5% of college students are diagnosed with mono, according to the study authors.

Chronic fatigue syndrome (CFS) is also called myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The CDC says it causes extreme fatigue, sleep problems, thinking and memory issues, dizziness and pain. Symptoms can get worse after exercise. The exact cause is unknown, and it’s difficult to diagnose, the CDC noted.

Unfortunately, there are no good treatments that get to the root of either mono or CFS, according to Katz. There are supportive treatments that may make people feel better, he said, but no cures for either illness.

“This is a big problem on college campuses, and it could help to have a tool to predict who might have trouble,” Katz said.

Dr. Jane Swedler, chief of adolescent medicine at NYU Winthrop Hospital in Mineola, N.Y., reviewed the findings.

“We know there is an association with CFS and a certain history of specific infections, like mononucleosis,” she said.

Swedler said the new, validated measure should be helpful for guidance and planning. “There’s a predictive value to it, and it may be used to standardize care and possibly for earlier treatment of CFS,” she said.

So what can you do to ensure you don’t get mono, and then possibly CFS?

There’s no vaccine for mononucleosis. To help prevent it, the CDC recommends that you do not share certain items, such as: drinks and food; eating utensils; and personal items, like toothbrushes.

And, if you think someone might have an infection, don’t kiss them, because the disease can be transmitted through kissing, the CDC warns.

The study was recently published in The Journal of Pediatrics.

More information

Learn more about chronic fatigue syndrome from the U.S. Centers for Disease Control and Prevention.

© 2019 HealthDay. All rights reserved.

Posted: April 2019

Drugs.com – Daily MedNews

More Severe Strain of Flu Starting to Spread Widely: CDC