New Allergy Guidelines for People Over 12 Years Old

If you or your kids suffer from allergies, I'm sure you want to know how to best manage them. In addition to limiting exposure, medications can be a big benefit. 

The American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology (AAAAI and ACAAI) have published new guidelines in the Annals of Internal Medicine for the initial medical treatment of seasonal allergies in people 12 years and older.

The recommendations essentially state:

• Use steroid nasal sprays first without an oral or nasal antihistamine. Many intranasal steroids are available over the counter without a prescription. A great list is included on the AAAAI website. (Be careful to not to confuse them with the nasal antihistamines, which are in the same chart but identified in the column titled "Class".) 
• In those over 15 years, the nasal steroid is preferred over a leukotriene receptor antagonist (ie Singulair or montelukast). For those with asthma, the leukotriene receptor antagonist might offer an additional benefit for asthma, but it is not the preferred treatment in either allergies or asthma. (I think the age change is simply due to the ages studied but it was not specified.)
• In moderate to severe allergic conditions, a combination of nasal steroid and nasal antihistamine can be considered. 

These recommendations are based on a review of many studies to show what treatments worked and what didn't. They also took into consideration the fact that oral antihistamines can cause sedation and the nasal antihistamines do not. In general the nasal steroids worked better than other treatments. They did note that for people who do not tolerate nasal sprays, alternates would be oral antihistamines or leukotriene receptor agonists.

Flu Vaccine Recommendations for 2016-2017 Season

Flu vaccine recommendations change from year to year. Here's this year's summary:

• Everyone over 6 months should get a flu vaccine. This includes children, teens, adults, pregnant women, the elderly, and most people with chronic diseases.
• The vaccine can be used as soon as it is available. (Note: the elderly might benefit from waiting until October due to potentially shorter duration of protection.) Preferably vaccination will happen by November, but vaccination can be done any time the vaccine is available. Illness from influenza can occur at any time in the year, but is most common in the winter and early spring, so vaccinating throughout the season is appropriate if it has not already been done.
• The nasal spray is not recommended this year.
• People with egg allergies can get the flu vaccine and don't have to be monitored for 30 minutes afterwards unless they have a history of severe reactions to egg (not just hives). The amounts of egg protein in the flu vaccines are so low that an allergic reaction is not likely.
• Kids under 9 years of age who have previously received two or more total doses of any influenza vaccine only need one dose of flu vaccine this season. The big difference from previous recommendations is that the two doses don't need to have been given during the same season or even in consecutive seasons - any two flu vaccines count.
• Different brands of flu vaccine are approved for use in various age groups, but they all include the same strains of viruses. This year’s strains are:

o A/California/7/2009 (H1N1)pdm09-like virus
o A/Hong Kong/4801/2014 (H3N2)-like virus
o B/Brisbane/60/2008-like virus (B/Victoria lineage)
o B/Phuket/3073/2013-like virus (B/Yamagata lineage) (quadrivalent vaccines only)

The flu shot is not going to give you the flu. 

I got mine! 

It might cause a sore arm, low grade fever, and headache, but that is brief and doesn't limit activities. I have heard many times that people were sick after getting the shot, but most often they were sick with whatever virus was going around town, not the flu. If they did get the flu that season, they were generally not as sick as those who got the flu without previously being vaccinated. (People who had the FluMist at times did get very sick with the flu, which is one of the reasons it is not being used this year.)

Influenza disease causes significant illness that usually improves within 2 weeks, but can lead to severe complications (including death). The majority of people who get the flu do not develop the severe complications, but they do miss a significant amount of work or school. Save yourself (and your family) and get the shot!

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