The Pediatric Group Newsletter Spring 1998

The Pediatric Group, P.A.

66 Mount Lucas Road, Princeton, NJ 08540-2733, USA

tel 609-924-4892, fax 609-921-9380

Spring 1998 Newsletter

(text copy)

Norman S. Katz, M.D., F.A.A.P.

Mark B. Levin, M.D., F.A.A.P.

John M. Cotton, M.D., F.A.A.P.

Timothy J. Patrick-Miller, M.D., F.A.A.P

Louis J. Tesoro, M.D., F.A.A.P.

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Dr. Katz: katz@pedgroup.com
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Dr. Cotton: cotton@pedgroup.com
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Dr. Tesoro: tesoro@pedgroup.com
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Information: information@pedgroup.com

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Well, Winter is over! And even though it wasn't a bad one, it's still nice to be welcoming Spring again. This year's Newsletter has information you might find useful about warm weather issues, especially regarding the change in our Chicken Pox Vaccine policy.

CHICKEN POX VACCINE: We're Now Recommending It
Recently, a varicella vaccine became available to prevent chicken pox. The vaccine can be used in normal children twelve months of age and older who have not had chicken pox. Like the measles-mumps-rubella vaccine, varicella vaccine is a live attenuated virus vaccine. Clinical trials, thus far, have shown the vaccine to be both safe and effective, and long term studies are ongoing. Following a single dose of vaccine in children less than thirteen years, or a pair of injections one month apart in older patients, protection against the severest form of disease is about 95%. Against mild and moderate chicken pox, protection approximates 80%.
Side effects are usually minor and include local inflammation (20 to 30%, zero to two days after vaccination), rash resembling mild chicken pox (1-5%, 5-26 days after vaccination averaging about five lesions), and fever 10-15%). A small number of close contacts of recipients of the vaccine (< 1 %) may contract a very mild case of chicken pox.
The vaccine can not be given to individuals with a severe allergy to gelatin or neomycin. Nor should it be used in patients who are pregnant or lactating, immune compromised, have malignancies or certain blood diseases, or who have an illness with fever. Vaccine recipients should avoid pregnancy and exposure to high risk individuals for three months, and salicylates (i.e., aspirin, Pepto-Bismol) for six weeks. Reye Syndrome, a severe neurologic condition that can follow chicken pox when salicylates are used, has not been reported after varicella vaccine.
Until recently, our policy has been to recommend varicella vaccine only for those children who reached the age of ten years and have not contracted chicken pox. We reasoned that, thereafter, the disease would be more severe though the likelihood of acquiring it diminished. We also worried that waning vaccine immunity would create an adult population susceptible to chicken pox. Recently, data about vaccination against varicella suggests that protection is unlikely to wane over time. Furthermore, since more children are being immunized, there is less chance of acquiring the infection before adolescence and thus acquiring natural immunity.

We have, therefore, revised our policy to recommend that all susceptible children receive vaccination against chicken pox at twelve months or older. Because this vaccine is not required for school attendance, some parents may elect not to immunize their children. While this is not our new policy, we will support both decisions--to vaccinate or to withhold vaccination in young children. Nevertheless, patients ten years and older who have not yet had chicken pox should certainly be vaccinated.
As always, we are happy to answer any questions you have. Please call our office to find out more about this vaccine or to schedule a visit.

WARM WEATHER SAFETY TIPS
Bicycle Safety: Bike riding can be both enjoyable and a good form of exercise. However, It can also be dangerous if not safeguarded. Be sure that your children do not ride bikes not suited for them (i.e. too big). Their feet should be flat on the ground when seated, and their legs should be straight. If they ride after dark, be sure they wear light clothing and/or reflectors to make them clearly visible to motorists. ALL CHILDREN RIDING TWO WHEELERS MUST WEAR BICYCLE HELMETS!!!!!

Water Safety: Be sure that all young children are supervised when swimming or near a body of water. Toddlers, especially in the second and third years of life, tend to wander off on their own, so be careful. Swimming programs for infants do not teach infants to swim, so don't he lulled into a false sense of security. All children three and older should be taught to swim. To prevent swimmer's ear, place several drops of a 50:50 solution containing white vinegar and rubbing alcohol in the ears after swimming.

Car Safety: Don't forget to use car seats for infants and boosters for older children less than four or five years. Remember, children are, in general, safer in the back of the car than in front seat, particularly if the car has a passenger side air bag. Use the car seat even for very short trips. Most accidents occur very close to home!!

ALLERGIES: What You Should Know
An allergy is a common condition in which people suffer unpleasant symptoms when exposed to certain substances. The tendency to have allergies is inherited. Allergy symptoms can start at any age. The symptoms begin after repeated exposure to an allergen, a substance that can trigger an allergy. Some examples of common allergens are dust, pollens, mold spores, feathers, fabrics, animal dander, foods, and medicines or other chemicals.
The symptoms an allergic person experiences are related to where the allergen enters the body Inhaled allergens can cause sinus headaches, nasal congestion, dry or sore throat, cough from post-nasal drip, tingling of the mouth, puffy itching eyelids, hoarseness and wheezing. Swallowed allergens can cause nausea, vomiting, abdominal aches and diarrhea. Skin exposure can cause welts (hives), peeling, blisters or other rashes. Hives, headaches, crankiness, sleepiness, pallor or over activity can all be signs of allergy when exposure is excessive by any route.

The treatment of allergy consists of several approaches. The hereditary predisposition to allergies cannot be changed. Allergy proneness can change with age to become milder or more severe. Symptoms may change with age, too. The most effective, least costly, least dangerous way to control allergies is simply to avoid your allergens. Since allergens may differ for different people, we can help an individual discover what to avoid. Sometimes, skin and/or blood testing is necessary. Since allergic reactions are often mediated by the body's production of histamine, we often prescribe antihistamines to attempt to block allergic reactions or ameliorate symptoms. Alternatively, we can try to decrease histamine release in response to exposure to allergens using medicines known as mast cell stabilizers. A third class of medications known as corticosteroids can be used to shut down the entire inflammatory process ignited by allergies. Which antihistamine, mast cell stabilizer, corticosteroid, or combination to use varies from person to person. We can help you decide the safest, most effective approach.
The final mode of treatment is allergy shots. Shots do not cure allergies. They simply modify the body's response to allergens for a period of time. For severe allergies, shots may be necessary. Again, this requires individual discussion.

Allergy sufferers often make excessive mucus. This can be such a sensitive response that even non-allergic irritants (respiratory infections, smoke, odors, extreme temperature change, ambient dryness) can elicit prolonged and uncomfortable allergic symptoms. So allergic individuals often have prolonged cold symptoms as well as a higher incidence of bronchitis, sinusitis, and otitis media. Avoidance of these irritants (by not smoking cigarettes, for example, or by staying in an air conditioned room on extremely hot, humid days) may help alleviate unpleasant symptoms caused by excessive mucus production.
Please call us if you have any questions about allergies.
Rave a nice and safe spring!

PREVENTING SKIN CANCER

One out of seven Americans develops some form of skin cancer. It is the most common form of cancer in America, but most could and should be prevented.
The two most common forms, basal cell and squamous cell, are caused by the cumulative exposure of the sun. Even if you never burn, the more sun exposure, the more likely are these cancers. Melanoma, the worst form, is rare, but often is fatal. Although more common in fair skinned people, melanoma can occur in anyone, anywhere. Sun burning markedly increases the risk of developing melanoma. Therefore, one should be cautiously respectful of the sun's damaging radiation.
To help prevent skin cancer, avoid unnecessary exposure when the sun is strongest--during the summer, especially between ten a.m. and two p.m., and especially when closer to the equator or higher in altitude. Wear protective clothing, including, for infants, a light cotton hat, and use an effective sun screen on exposed areas of the skin. An SPF of fifteen to twenty is usually sufficient. Sun screens can be safely applied on infants as early as six months of age.
If ever you notice a mole changing quickly in size, shape, color or texture, especially if it is larger than ¼ of an inch, the mole should be checked. Remember, with appropriate precautions, you can enjoy the outdoors! Call us if you have any questions.

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