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Can Some Children Outgrow Autism?

TUESDAY, March 19, 2019 — Some toddlers thought to have mild autism “outgrow” the diagnosis, but most continue to struggle with language and behavior, new research suggests.

The study is not the first to document cases of autism “recovery.” Doctors have known for decades that a small number of young children diagnosed with an autism spectrum disorder (ASD) seem to outgrow it.

But what does that mean for those kids? The findings suggest that the vast majority continue to face challenges and need support, said lead researcher Dr. Lisa Shulman.

Her team found that of the 38 children who “lost” their autism diagnosis, most were found to have other conditions — including learning disabilities, attention deficit hyperactivity disorder (ADHD) and anxiety disorders.

Why did the picture change for those children?

That’s the “million-dollar question,” said Shulman, a professor of pediatrics at Albert Einstein College of Medicine/Montefiore Health System in New York City.

One possibility is that the initial diagnosis was wrong. But it’s also possible some children responded to early therapy aimed at supporting their development.

Shulman suspects both scenarios are true.

The 569 children in the study were diagnosed before the age of 3. And what looks like an autism in a 2-year-old may start manifesting differently as the child grows, Shulman explained. For example, that 2-year-old may actually have an anxiety disorder, but children that age simply can’t express what they’re feeling. It only becomes clearer when the child is a little older.

On the other hand, early behavioral therapy can help children with autism build their social and language skills, and ease behavior issues. So young kids who respond may no longer meet the criteria for autism at a certain point.

“I do think there is a group of children who were probably never going to have autism,” Shulman said. “And there are some who respond to early intervention.”

James Connell is clinical core director of the A.J. Drexel Autism Institute in Philadelphia. He agreed that in toddlers, it can be “difficult to pin down” whether it’s autism or something else.

“Global developmental delays, language delays and separation anxiety in 18- to 24-month-old children can look like an ASD,” said Connell, who was not involved in the study.

In fact, he said, “I would argue that most, if not all of these kids, did not have an ASD.”

But that’s not to say that kids mistakenly given an autism label did not benefit from therapy. Connell said that early and intensive services can be very helpful not only for children with an ASD, but for those with developmental delays.

And in fact, Connell said, young children with developmental difficulties may specifically be given an ASD diagnosis so that they qualify for such intensive therapy.

“A diagnosis of autism gets services — services these children do need,” he said. “Doctors know that. Parents know that.”

The latest findings, published recently in the Journal of Child Neurology, were based on records for 569 children who were diagnosed with autism at the researchers’ center between 2003 and 2013. Four years later, 38 of those kids no longer met the diagnostic criteria.

They all had one thing in common, according to Shulman. They had what initially appeared to be milder symptoms; they were not on the more severe end of the spectrum.

And nearly all saw their diagnoses evolve. A full 68 percent still had language or learning disabilities. Half were diagnosed with “externalizing” behavior disorders — such as ADHD and oppositional defiant disorder — while one-quarter had “internalizing” mental health conditions, including anxiety disorders and obsessive compulsive disorder. Two children had more severe mental illnesses involving psychosis.

There were three children, the researchers added, who did not “warrant” any alternative diagnosis.

Those kids, Connell said, probably never had autism. “Most researchers would agree that children are never ‘cured’ of autism — it just becomes less apparent,” he said.

More information

The U.S. Centers for Disease Control and Prevention has more on diagnosing autism.

© 2019 HealthDay. All rights reserved.

Posted: March 2019

Drugs.com – Daily MedNews

FDA: Some Claire’s Cosmetics May Contain Asbestos

WEDNESDAY, March 6, 2019 (HealthDay News) — Consumers should avoid certain Claire’s cosmetic products that may contain potentially cancer-causing asbestos because the company has refused to recall the items, the U.S. Food and Drug Administration warned Tuesday.

The agency’s concern dates back two years, when the FDA first became aware of reports of possible asbestos contamination in some cosmetic products sold by Claire’s and Justice retailers. Those initial tests were conducted by third-party laboratories, so the FDA ordered further tests by an independent lab.

In a statement, the agency said that further testing confirmed the presence of asbestos in samples of three cosmetic products from Claire’s and one product sample from Justice. The Justice product has been recalled by the company, but Claire’s has refused to recall the three products that tested positive for asbestos.

Those products are: Claire’s Eye Shadows, Batch No/Lot No: 08/17; Claire’s Compact Powder, Batch No/Lot No: 07/15; and Claire’s Contour Palette, Batch No/Lot No: 04/17.

The FDA said it doesn’t have the authority to force Claire’s to recall the products, which is why it is warning consumers not to use them. The agency also said that consumers and health care providers should report any cosmetic-related problems to the FDA’s MedWatch reporting system.

Cosmetics are not required to be approved by the FDA, the agency noted. However, it does have some tools to protect consumers.

For example: “Cosmetics must not be ‘adulterated’ or ‘misbranded,’ meaning they must be safe for consumers when used according to directions on the label, or in the customary or expected way, and they must be properly labeled,” explained FDA Commissioner Dr. Scott Gottlieb.

The FDA also announced new measures, including “working with cosmetics manufacturers and requesting information about what procedures they use to ensure their cosmetics are safe.” Specifically, the agency said it will ask manufacturers how “they ensure that talc used in any cosmetic product is free from asbestos.”

The FDA stressed that the vast majority of cosmetics that contain talc are not thought to contain asbestos.

“In 2010, we surveyed 34 cosmetic products including body powders, face powders, foundation, eye shadow, blush and samples from four major talc suppliers and found no traces of asbestos contamination using the most sensitive techniques available,” Gottlieb noted.

But stepped-up inquiries with cosmetics maker should “help us better identify specific cosmetic products and raw ingredient suppliers that may be more likely to be contaminated,” he added.

The FDA is also asking cosmetics companies to register their products and list ingredients, including talc, used in their products.

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Why Do Some Kids With Eczema Get Food Allergies?

By Robert Preidt

HealthDay Reporter

WEDNESDAY, Feb. 27, 2019 (HealthDay News) — Researchers have added to a growing body of evidence that skin plays a major role in food allergies.

Their study of 62 children with eczema found that those with food allergies had skin irregularities not present on others.

Those irregularities included a lack of structural proteins needed to retain moisture and produce an effective skin barrier; increases in certain keratin proteins indicative of an immature skin barrier; and increased activation of type 2 immune genes, which are associated with allergic diseases.

The findings suggest that individualized treatment might help protect some patients with eczema (atopic dermatitis) from food allergies, according to the study authors.

“The skin of atopic dermatitis patients with food allergies show clear markers of a predisposition to allergic diseases and a faulty skin barrier,” said lead author Dr. Donald Leung. “They suggest that personalized treatment of these children may reduce the risk of developing both atopic dermatitis and food allergies.”

Leung is head of pediatric allergy and immunology at National Jewish Health in Denver.

Eczema affects up to 20 percent of children, causing dry, itchy and cracked skin. About 30 percent of kids with eczema develop food allergies.

“The skin of atopic dermatitis patients loses water and dries out,” Leung said in a news release. “It can crack like potato chips. Increasing evidence indicates that when food particles enter those cracks, they can promote the development of food allergies.”

The findings suggest eczema patients who develop food allergies are a “distinct subset,” Leung said.

“The first weeks after birth, when an infant goes from the watery environment of the womb to the dry air of the outside world, is particularly traumatic for an infant’s skin. We believe early treatment to maintain moist skin and a healthy skin barrier is especially important for these patients,” he said.

The skin-testing technique used in this study may help identify infants who are at risk for food allergies and allow for preventive steps, Leung said.

The study was recently published in the journal Science Translational Medicine.

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Sources

SOURCE: National Jewish Health, news release, Feb. 20, 2019

Copyright © 2013-2018 HealthDay. All rights reserved.

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Primatene Mist Coming Back; Some Docs Concerned

Feb. 1, 2019 — Primatene Mist, an over-the-counter inhaler for asthma, is now back on drugstore shelves after an 8-year absence. Pulled from the market in 2011 due to its ozone-depleting propellant, the new inhaler has a more environmentally friendly propellant.

The FDA approved the new version for use in people ages 12 years and older for the temporary relief of mild symptoms of intermittent asthma, such as wheezing, tightness of the chest, and shortness of breath.

But not everyone is happy about its return or convinced it is safe to use unsupervised. Some doctors worry that patients, despite the drugmaker’s warnings, will self-treat their asthma long-term, a risky practice.

The active ingredient in Primatene Mist is epinephrine, and none of the national guidelines on asthma treatment recommend the use of inhaled epinephrine.

Others agree that the inhaler should not be as freely available. In late January, 12 organizations, including doctor groups and nonprofits devoted to respiratory issues, asked major pharmacy chains carrying Primatene Mist to make it a ”behind-the-counter” medicine. When medicines are behind the counter, customers have to ask for them, and thus have contact with pharmacy personnel who could steer them to medical help if needed.

Amphastar Pharmaceuticals, the drug’s maker, says that leaving the drug just as it is, over-the-counter with no pharmacist interaction needed, is safe and that the company has worked with the FDA to ensure that safety.

In the U.S., nearly 19 million adults, or 1 in 12, and 7 million children, or 1 in 11, have asthma, the CDC says. Asthma causes nine deaths a day.

Primatene Mist: Old vs. New

The FDA approved the new version of Primatene Mist in November 2018, saying the medicine is meant ”to provide temporary relief for symptoms of mild, intermittent asthma.” In its statement, it says that it is approved only for those who have been diagnosed with asthma by a health care provider and urges ongoing follow up with a health care

professional.

The metered dose inhaler allows 0.125 milligrams per spray of epinephrine, a bronchodilator, or drug that relaxes the bronchial muscle so that air passages can expand. It contains160 doses.

Deliveries began in December, says Jason Shandell, Amphastar’s president, and the inhaler is now available nationwide in CVS and Walgreens. It’s also sold online, retailing for about $ 30.

The older version was approved for ages 4 years and up, but the FDA allows the new inhaler only for people ages 12 years and older. The FDA is requiring the company to do a pediatric study in children ages 4-11.

Who Should Use Primatene Mist?

Instructions on the Primatene site are specific about Primatene’s use. It’s meant only for temporary relief of mild symptoms, the drugmaker says. Users are cautioned to see a doctor if they are not better in 20 minutes, if the asthma gets worse, if they need more than eight inhalations in 24 hours, or if they have more than two asthma attacks a week.

There’s a lengthy list of other cautions. Those who have not been told by a doctor they have asthma should not use it. Anyone ever hospitalized for asthma needs to ask a doctor before using the inhaler, Amphastar says. Those with other health issues, including heart disease, high blood pressure, and diabetes, are also warned to get a doctor’s go-ahead first.

What’s the Issue?

National guidelines for managing asthma recommend against the use of inhaled epinephrine for quick or rescue relief, says Michael Blaiss, MD, executive medical director of the American College of Allergy, Asthma, and Immunology. Too much heart stimulation, especially in high doses, is one reason.

The issue of self-medicating is another concern. “Asthma to me is not a disease that can be treated without a health care provider’s supervision,” says Blaiss, who’s also a clinical professor at the Medical College of Georgia, Augusta. “This is a rescue medicine, so it doesn’t treat the underlying disease,” he says. “If someone is needing this medicine, they are having an asthma attack.”

Rescue medicines open the airways and provide short-term relief of symptoms. People who have asthma also receive long-term “controller” medications that manage airway inflammation and treat symptoms.

The rescue medicines, says Blaiss, are “like gargling for a strep throat. It might get rid of some of the pain, but it doesn’t help the infection. We have rescue inhalers like albuterol [Proventil, ProAir] that are safe and last longer. There are already superior medicines [available] with a prescription.”

Blaiss sees a very limited role for over-the-counter (OTC) Primatene Mist. For instance, he says, “if someone was out of town, forgot the inhaler, could not get in touch with their doctor, and have a problem, OK.”

But in general, he says ”the concern is, if Primatene mist is out there, patients will think, ‘I can just take this. I will just keep using this when I need it.’ That’s where we get concerned, because asthma is a chronic disease.”

James Li, MD, PhD, an allergist and immunologist, and a professor of medicine at the Mayo Clinic in Rochester, MN, agrees. “The concern is that if a patient is in the midst of a serious asthma attack, instead of going to the ER or calling their doctor or getting the proper treatment, the concern is they will go to the drugstore, grab the inhaler, and use it repeatedly until it’s almost too late,” says Li, a former president of the American Academy of Allergy, Asthma & Immunology.

“It is a concern,” he says, “but it is unclear how often that actually happens.” Li says he is not aware of any study tracking that. Li has served as a consultant for GlaxoSmithKline’s asthma and COPD medications.

Should Access to Primatene Be Controlled?

“I think at a minimum, it should be behind the counter,” says Blaiss. His organization was one of the 12 signing the letter asking CVS Health and Walgreens to keep Primatene Mist behind the counter “to help reduce inappropriate use of this medication and to protect patients from adverse events.”

If Primatene is placed behind the counter, Blaiss reasons, “maybe the pharmacist will send them to the ER, or tell them to call the doctor if it is not better.”

Officials at the American Thoracic Society, made up of doctors and others involved in lung disease care and research, initiated the letter. As of Jan. 31, the organization has not received a response from either CVS or Walgreens, says Dacia Morris, a spokeswoman.

A tablet form of Primatene, containing ephedrine to open airways and an expectorant, guaifenesin, has remained on the market. On the Primatene Tablets site, Pfizer Consumer HealthCare, which distributes it, says they are kept behind the counter at pharmacies. The tablets are also sold online.

More on ‘Behind the Counter’

“Behind the counter” can happen in different ways, says Sandy Walsh, an FDA spokeswoman. For instance, legislation on methamphetamine control requires some drugs, such as Sudafed, to be behind the counter. It contains pseudoephedrine, which can be used to illegally make methamphetamine, or meth.

When Plan B, the emergency contraception, was approved for over-the-counter sales in 2006, the FDA required it be sold only in pharmacies or stores staffed with a licensed pharmacist, Walsh says, and that it be behind the counter.

Company Responds

Amphastar’s Shandell does not think misuse of the new inhaler will be a problem. “Amphastar worked closely with the FDA to ensure that the labeling is clear and that consumers can safely and effectively use Primatene Mist,” he says. “It is very important that asthma sufferers understand that Primatene Mist is only for mild symptoms of intermittent asthma.”

He adds that the original version “was available directly to and used safely by consumers” for more than 40 years. The removal from the market, he says, was not due to safety or effectiveness issues, but only to phase out its ozone-depleting propellant.

Sources

Jason Shandell, president, Amphastar Pharmaceuticals Inc., Rancho Cucamonga, CA.

Sandy Walsh, spokeswoman, FDA.

FDA: “CDER Conversation: Safely Using the Newly Available OTC Asthma Inhaler Primatene Mist.”

James Li, MD, PhD, professor of medicine, Mayo Clinic, Rochester, MN; former president, American Academy of Allergy, Asthma & Immunology.

Dacia Morris, spokeswoman, American Thoracic Society, New York City.

Michael Blaiss, MD, executive medical director, American College of Allergy, Asthma, and Immunology; clinical professor, Medical College of Georgia, Augusta.

American Academy of Allergy, Asthma & Immunology: “Asthma Triggers and Management.”

CDC: “Asthma’s Impact on the Nation.” 

National Asthma Education & Prevention Program: “Guidelines for the Diagnosis and Management of Asthma.” Summary Report 2007.

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Could Neck-Strengthening Prevent Some Concussions?