https://www.medscape.com/viewarticle/906135

Megan Brooks

December 2018

More than 40% of Americans have not been vaccinated against influenza this year and don’t plan to get vaccinated, despite repeated warnings about the potential dangers of the flu, as well as last year’s record-high number of deaths from flu, a new survey indicates.

The survey included 1202 interviews with a nationally representative sample of adults aged 18 years and older. It was conducted between November 14 and 19 by the National Opinion Research Center (NORC) at the University of Chicago.

Results showed that 43% of adults had received the flu shot and that 14% had not yet been vaccinated but intended to get vaccinated this season. Yet, 41% of adults surveyed said they had not been vaccinated and did not intend to get vaccinated. About 2% were undecided about getting the flu shot or did not respond to the question.

The highest vaccination rate (62%) was for adults older than 60 years, a group at higher risk for flu-related complications. However, 1 in 4 (24%) people aged 60 years and older did not plan to get vaccinated this year.

Adults younger than 45 were the least likely to report being vaccinated. Roughly half of this group indicated that they did not plan to receive a vaccination this year.

Among adults who have children younger than 18 years living in their home, 39% said they do not vaccinate their children.

Misconceptions Common

The top reasons people cited for not getting vaccinated against the flu were concern about side effects from the vaccine (36%), concern about getting the flu from the vaccine (31%), and because they never get the flu or they do not think the flu vaccine works (31%).

“Unfortunately, many people are still not getting flu shots due to broader misconceptions about the value of receiving a flu shot and concerns about the safety and efficacy of the vaccines,” Caitlin Oppenheimer, MPH, senior vice president of public health research at NORC, said in a news release.

The Centers for Disease Control and Prevention (CDC) recommends routine annual influenza vaccination for all persons aged 6 months or older who do not have contraindications. The CDC estimates that flu vaccination coverage among adults was 37% for the 2017-2018 season and 43% for the 2016-2017 season.

Last year’s flu season was particularly severe, with a record-breaking 900,000 hospitalizations and more than 80,000 deaths in the United States. Although most flu deaths were in adults older than 65, the flu also killed 180 children and teenagers.

Many survey respondents did not know this. About two thirds (63%) incorrectly believed that last year’s season was about the same as usual, was less severe than usual, or they did not know. People who had already received their flu shot for this season were more aware of the severity of last year’s flu season; 43% of people who had already been vaccinated correctly identified last year’s season as being more severe than usual, compared to only 30% of people who do not plan to get vaccinated.

“Flu vaccination helps prevent people from getting sick with the flu and reduces the severity of illness for those who do get sick. Widespread vaccination also helps create ‘herd immunity’ that protects vulnerable groups who are prevented from getting vaccinated,” Caroline Pearson, BA, senior fellow at NORC, said in news release. “Unfortunately, over half of all adults are currently unvaccinated, with four in 10 not intending to get vaccinated, placing themselves and those around them at risk.”

Things you need to know about the flu.  https://acaai.org/asthma/conditions/flu

Overview

Unlike other viral respiratory infections, such as the common cold, the flu can cause severe illness and life-threatening complications. In 2010 the Centers for Disease Control and Prevention reported that from 1976 to 2007, between 3,000 and 49,000 people died annually from flu-related complications, with the variation in the death toll related to the specific flu strain circulating in a particular year. The risk is greater for very young children, people age 65 and older and people with chronic medical conditions, such as asthma.

Because both asthma and the flu are respiratory conditions, people with asthma may experience more frequent and severe asthma attacks if they get the flu. As a result, it is particularly important for people with asthma to take steps to minimize their risk of exposure.

Symptoms
  • Fever
  • Headache
  • Fatigue
  • Dry cough
  • Sore throat
  • Nasal congestion
  • Body aches
Management and Treatment

How does the flu spread?

Influenza is a contagious disease that attacks the respiratory tract, including the nose, throat and lungs. The flu spreads when an infected person coughs or sneezes, spraying droplets into the air and onto people nearby. It can also be spread by touching droplets on another person or object and then touching your own mouth or nose before washing your hands. Infected people are contagious one day before developing symptoms and up to seven days after getting sick.

How can you tell if you have the flu?

Because many flu symptoms are similar to those of other respiratory infections, including the common cold, the only way to be sure it’s the flu is to see your doctor. There are tests that can determine if you have the flu as long as you are tested within the first two or three days after your symptoms begin. In general, if your respiratory symptoms are accompanied by sudden onset of body aches and fever and occur during flu season, suspect the flu.

When is flu season?

Peak flu season months in the U.S. are December, January and February; flu season can last from November through March. Fortunately for people living in most parts of the U.S., flu season doesn’t correspond to periods of peak pollen counts, which can trigger and aggravate asthma in those who are allergic.

How can you prevent the flu?

The best way to prevent the flu is to get vaccinated each fall. This is particularly important for those who have chronic respiratory conditions, such as asthma. The vaccine triggers the development of antibodies that fight the flu virus when the body is exposed to it. There are two types of flu vaccines: injection (the flu shot) and nasal spray.

Those who have asthma or other chronic medical conditions should get the flu shot, which is an inactivated vaccine (meaning that it contains killed virus). The best time to get it is in October or November, as it typically takes about two weeks for sufficient antibodies to develop.

The flu shot is approved for use in very young children, including those with chronic medical conditions, such as asthma.

Allergists urge everyone who has asthma to get the flu vaccination as part of his or her routine care. Flu viruses change from year to year, so being vaccinated one year will not necessarily protect you from different flu viruses in subsequent years.

The second type of flu vaccine, administered through a nasal spray, contains attenuated (weakened) live viruses. It is approved for use only by healthy people ages 5 to 49. Because it contains live viruses, the nasal-spray flu vaccine should not be used in people with asthma, as it can provoke or aggravate symptoms.

Most varieties of the flu vaccine contain small amounts of egg protein. An updated guideline from the Joint Task Force on Practice Parameters stresses that no special precautions are needed or recommended for those with egg allergy when it comes to the flu vaccine. There is no longer a need to:

  • See an allergy specialist for the flu shot.
  • Give special flu shots that don’t contain traces of egg.
  • Require longer-than-normal observation periods after the shot, or
  • Even ask about egg allergy before giving the vaccine.

If the vaccine is age-appropriate, it can be used for anyone with or without egg allergy.

What should you do if you get the flu?

The best strategy for recovering from the flu is to rest, drink plenty of fluids and avoid using alcohol and tobacco. Over-the-counter medications can relieve the symptoms of the flu, but never give aspirin to children or teenagers who have symptoms of the flu — particularly fever — without consulting a doctor first. Aspirin use in children and teenagers with flu-like symptoms has been linked to Reye’s syndrome, a serious condition that causes swelling in the liver and brain.

Your doctor also may prescribe an antiviral medication, such as Tamiflu (oseltamivir phosphate) or Relenza (zanamivir), to treat the flu, but these are effective only if started within the first two days of experiencing symptoms.

Citation:  acaai.org/asthma/conditions

Based on our research, this is the latest summary of currently available versions of injectable epinephrine in the United States as of December 2018.

Auvi-Q (Kaleo) $700

EpiPen (Mylan) $600

generic EpiPen (Mylan) $300

generic EpiPen (Teva) $300

generic Adrenaclick (Impax) $110

Prices reflect the LIST PRICE for a 2-pack and do not include coupons or other special discounts.

Hives – https://acaai.org/allergies/types-allergies/hives-urticaria

“Hives, also known as urticaria, affects about 20 percent of people at some time during their lives. It can be triggered by many substances or situations and usually starts as an itchy patch of skin that turns into swollen red welts. — ACAAI News https://acaai.org/news/

Overview

If you’ve had red or skin-colored bumps that appeared and disappeared quickly, then it’s unlikely to be simple bug bites. The skin rash could be hives, and the itching from hives may range from mild to severe. Scratching, alcoholic beverages, exercise and emotional stress may worsen the itching. If you think you might have hives, then it’s best to speak with an allergist.

Symptoms

Symptoms can last anywhere from minutes to months – or even years.

While they resemble bug bites, hives (also known as urticaria) are different in several ways:

  • Hives can appear on any area of the body; they may change shape, move around, disappear and reappear over short periods of time.
  • The bumps – red or skin-colored “wheals” with clear edges – usually appear suddenly and go away just as quickly.
  • Pressing the center of a red hive makes it turn white – a process called “blanching.”

There are two types of hives – short-lived (acute) and long-term (chronic). Neither is typically life-threatening, though any swelling in the throat or any other symptom that restricts breathing requires immediate emergency care.

Hives Triggers

  • Some food (especially peanuts, eggs, nuts and shellfish)
  • Medications, such as antibiotics (especially penicillin and sulfa), aspirin and ibuprofen
  • Insect stings or bites
  • Physical stimuli, such as pressure, cold, heat, exercise or sun exposure
  • Latex
  • Blood transfusions
  • Bacterial infections, including urinary tract infections and strep throat
  • Viral infections, including the common cold, infectious mononucleosis and hepatitis
  • Pet dander
  • Pollen
  • Some plants, such as poison oak and poison ivy

Management and Treatment

Researchers have identified many – but not all – of the factors that can cause hives. These include food and other substances you take, such as medications. Some people develop hives just by touching certain items. Some illnesses also cause hives. Here are a few of the most common causes:

  • Some food (especially peanuts, eggs, nuts and shellfish)
  • Medications, such as antibiotics (especially penicillin and sulfa), aspirin and ibuprofen
  • Insect stings or bites
  • Physical stimuli such as pressure, cold, heat, exercise or sun exposure
  • Latex
  • Blood transfusions
  • Bacterial infections, including urinary tract infections and strep throat
  • Viral infections, including the common cold, infectious mononucleosis and hepatitis
  • Pet dander
  • Pollen
  • Some plants, such as poison oak and poison ivy

Antihistamines – available either over the counter or by prescription – are a frequently recommended treatment for hives. They work by blocking the effect of histamine, a chemical in the skin that can cause allergy symptoms, including welts. Low-sedating or nonsedating antihistamines are preferred. They are effective and long-lasting (may be taken once a day) and have few side effects. Your allergist may recommend a combination of two or three antihistamines to treat your hives, along with cold compresses or anti-itch salves to ease the symptoms.

Severe episodes of urticaria may require temporary treatment with prednisone, a similar corticosteroid medication or an immune modulator, which can reduce the severity of the symptoms.

If your reaction involves swelling of your tongue or lips, or you have trouble breathing, your allergist may prescribe an epinephrine (adrenaline) auto-injector for you to keep on hand at all times. These can be early symptoms of anaphylaxis, a potentially fatal allergic reaction that impairs breathing and can send the body into shock. The only treatment for anaphylaxis is epinephrine. If you develop hives and your injector is not nearby – or if using the auto-injector doesn’t cause the symptoms to immediately improve – go to an emergency room immediately. You should also go to the emergency room after using an auto-injector.

If the cause of hives can be identified, the best treatment is to avoid the trigger or eliminate it:

  • Foods: Don’t eat foods that have been identified to cause your symptoms.
  • Rubbing or scratching: Avoid harsh soaps. Frequent baths may reduce itching and scratching – beneficial because itching and scratching can make the hives feel worse.
  • Constant pressure: Avoid tight clothing. Pressure hives can be relieved by wearing loose-fitting clothes.
  • Temperature: If you develop hives when exposed to cold, do not swim alone in cold water and always carry an epinephrine auto-injector. Avoid exposure to cold air and use a scarf around your nose and mouth in cold weather. If you must be out in the cold, wear warm clothing. 
  • Sun exposure: Wear protective clothing; apply sunblock.
  • Medications: Notify your physician or pharmacist immediately if you suspect that a specific medication is causing your hives.

Citation: ACAAI News https://acaai.org/news/

Christmas Trees and Allergies – https://acaai.org/allergies/types-allergies/pine-tree-allergy

“While pine tree allergy is relatively uncommon, there are two main allergens of concern that come from pine trees: pine nuts and pine pollen. Pine nuts (pignoli) are the edible seeds of certain species of pine trees, and are used in a variety of foods, including Italian pesto. Pine nut consumption has increased due to its use in the Mediterranean Diet. Pine pollen is produced when the trees reproduce in the springtime. It is possible for pollen to travel very long distances in the air.” — ACAAI News https://acaai.org/news/

Symptoms

Symptoms of pine pollen allergies are much like “hay fever” and typically include:

  • Itchy tearing red eyes
  • Bags under the eyes
  • Runny nose with or without sneezing and congestion
  • Coughing

In some cases pollen may aggravate asthma.

Pine nut allergies are much like other tree nut allergies in that they can cause anaphylactic reactions. Symptoms may vary from mild to severe and include:

  • Tightness in the chest and difficulty breathing
  • Swelling of the tongue, throat, nose and lips
  • Hives or rash
  • Abdominal pain, diarrhoea, and/or vomiting
  • Dizziness and fainting or loss of consciousness
  • Shock and heart failure

If you have an anaphylactic reaction, even if it is mild, consult your allergist as these symptoms won’t go away. Symptoms include those listed above and:

  • Itchy throat
  • Sneezing
  • Abdominal discomfort

Citation: ACAAI News https://acaai.org/news/

Allergy injections and eczema – https://acaai.org/news/your-severe-eczema-may-best-be-treated-allergy-shots

“SEATTLE (November 16, 2018) – If you’ve suffered with severe atopic dermatitis (eczema) for a long time and have tried what you think is every available option for relief, you may want to consider allergy shots. A medically-challenging case being presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting found that allergy shots provided significant benefits to the eczema symptoms suffered by a 48-year-old man.” — ACAAI News https://acaai.org/news/