Direct-acting antivirals (DAAs) are a suitable options to treat 

 (HCV) infections for hepatocellular carcinoma (HCC) patients.

, MD, PhD, Department of Gastroenterology, Mitsui Memorial Hospital, examined recurrence rates for HCC patients treated with DAAs.

Direct acting antiviral agents have transformed HCV care by altering liver function and reducing the recurrence rate following curative treatment in naïve hepatocellular carcinoma patients. However, it remains unknown whether this treatment class had a favorable effect on this patient group with multiple courses of recurrence.

“Direct acting antiviral agents (DAAs) improve HCV infection outcomes, even in patients with advanced liver disease, with a good safety profile and a sustained virological response (SVR) rate exceeding 90% in clinical practice,” the authors wrote.

The concerns over HCC recurrence became prominent in 2016, but subsequent trials found the risk is similar or possibly lower than what was observed in interferon-treated or DAA-unexposed controls.

In the study, the researchers retrospectively extracted 146 HCV-related HCC patients who received curative treatment using radiofrequency ablation (RFA) after eradication treatment with DAA between 2015-2017 and 184 patients who were curatively treated using RFA without hepatitis C eradication treatment between 2009-2014 as controls. The study and control groups did not differ significantly based on background demographics.

The team used propensity score matching method, which was adjusted based on age, sex, liver function, number of recurrence times, tumor diameter, and tumor numbers between the 2 groups.

The final analysis included 47 hepatitis C HCC patients with eradication of HCV and 47 control group patients, with a median age of 74,8 years old. In addition, 63.8% (n = 60) patients were male and 86.2% (n = 81) were Child-Pugh class A.

The median tumor number was 1, tumor diameter was 20 mm, and the frequency of recurrence was 3 times.

The investigators sought primary endpoints of the time to curative treatment failure, defined as the interval from curative treatment initiation to premature discontinuation of this type of therapy.

The researchers compared clinical data, time to curative treatment failure, and overall survival and assessed the prognostic values of time to curative treatment failure and overall survival using multivariate Cox proportional hazard models.

The cumulative time to curative treatment failure rates of patients who received DAA were 93.6% and 73.2% at 1 and 3 years, respectively, compared to 72.5% and 37.1% for the control group (

The researchers did identify some independent factors that contributed to the time to curative treatment failure in eradication with DAAs (HR, 0.23; 95% CI, 0.12-0.43, 

 < 0.01), and DCP > 50 mAU/ml (HR, 2.62; 95% CI, 1.45-4.74; 

 < 0.01), after the conducted the multivariate analysis.

“Eradication of HCV using DAAs prolonged not only time to curative treatment failure but overall survival even in C-HCC patients with multiple courses of recurrence,” the authors wrote.

HCC is currently the second most common cause of cancer-related deaths globally, accounting for 780,000 deaths worldwide in 2012.

Effectiveness of direct acting antiviral agents for hepatitis C virus related recurrent hepatocellular carcinoma patients who had multiple courses of recurrence

Articles

The cumulative time to curative treatment failure rates of patients who received DAA were 93.6% and 73.2% at 1 and 3 years, respectively.

Direct Acting Antivirals Safe, Effective for HCC Patients

A new study observed disparities in health literacy between adolescents with and without 

An exploratory study led by Elizabeth Perry Caldwell, PhD, RN, CNE, and Erin Killingsworth PhD, RN, CNE, of Louise Herrington School of Nursing at Baylor University, measured health literacy among sickle cell disease patients using the Newest Vital Sign health literacy instrument, thus comparing scores with non-sickle cell individuals.

“Adult health literacy is shown to be a better predictor of health outcomes than educational level, race, age, employment status, or income," Caldwell and Killingsworth wrote. “Recent data suggest that health literacy may also significantly influence health behaviors in adolescents.

They explained the health literacy could influence health outcomes and transition experience among patients with sickle cell disease.

The investigators recruited a total of 239 individuals, 134 of whom had sickle cell disease. The mean age of the sickle cell population was 14.9 years—compared to 15.87 years in the non-sickle cell population.

The sickle cell cohort was recruited from a large, tertiary care center, while adolescents without sickle cell disease were recruited more widely across Texas.

Each participant was administered the NVS, a tool designed to evaluate literacy, numeracy, and the ability to locate and apply information.

The assessment consisted of an ice cream nutrition label, followed by relevant questions. The likelihood for limited health literacy was then determined based on the participant’s score (maximum, 6 points).

The mean NVS score for sickle cell patients was 2.66, versus 3.77 in the non-sickle cell population.  The differences in scores between the groups was found to be statistically significant (t = 4.772; 

Although these findings suggested lower health literacy levels in patients with sickle cell disease, Caldwell and Killingsworth noted that the mean scores from both groups demonstrated the possibility of overall limited health literacy.

They further observed that age (r = .286, 

 = .00) were significantly and positively correlated with health literacy. However, there were no significant relationships between health literacy and household income or parental education level.

On the contrary, among patients without sickle cell disease, annual household income (r = .235; 

<.05) and parental education level (r = .263; 

<.01) were significantly and positively associated with health literacy, while age or grade level had no such relationship.

“These differences are noteworthy and more research is needed to better understand these differences,” the investigators wrote. They emphasized the importance of conducting systematic evaluations of the influencing factors and consequences of health literacy.

“Gaining further insight into health literacy and health outcomes in adolescents with SCD provides a potential path forward towards more successful transitions from pediatric care to adult care in these patients,” Caldwell and Killingsworth wrote.

“With this knowledge, nurses can fight the struggle against systematic lifelong inequities of care for patients with SCD with more focus and fervor, with hopes of better health outcomes and longer lives for these patients,” they concluded.

The health literacy disparity in adolescents with sickle cell disease

Journal for Specialists in Pediatric Nursing.

Improving health literacy among these individuals may have a significant and positive impact on the transition from pediatric to adult care. 


Adolescents with Sickle Cell Disease Demonstrate Limited Health Literacy

Last week, the US Food and Drug Administration (FDA) approved a 

 for selexipag (UPTRAVI®) intravenous (IV) injection for adult patients with 

 who are temporarily unable to take oral therapy.

, Kelly Chin, MD, study senior author and Associate Professor of Internal Medicine and Director of the Pulmonary Hypertension Program at The University of Texas Southwestern Medical Center, discussed the FDA approval and the overall utility of selexipag IV injection in treatment of PAH.

HCPLive: What is the immediate benefit and utility of the drug in PAH treatment?

Dr. Chin: For patients with pulmonary arterial hypertension (PAH), uninterrupted treatment is considered key for continuity of care. The availability of selexipag in both an oral tablet and intravenous (IV) formulation represents a solution for a previously unmet need for PAH patients on selexipag who are temporarily unable to take oral therapy. With this new formulation, selexipag patients will now be able to continue on treatment even if they are temporarily unable to take oral medication.

HCPLive: Can you describe the current state of PAH care?

Dr. Chin: PAH is a serious progressive disease with no known cure. Over the past years, therapeutic advancements have been made that have been shown to reduce disease progression and to reduce hospitalizations. The hope for the future is to one day be able to transform PAH into a manageable condition and ultimately cured.

Because PAH is a progressive and often fatal disease, it’s important to decrease the time to diagnosis and treatment initiation for individuals with PAH. Regular risk assessment for PAH patients is also essential to help physicians evaluate disease progression and could inform treatment decisions based on an individual patient’s prognosis.

HCPLive: Furthermore, how does selexipag contribute to the PAH care space?

Dr. Chin: Selexipag is an oral selective prostacyclin IP receptor agonist first approved by the FDA in 2015 for the treatment of patients with PAH (WHO Group I, FC II-III) to delay disease progression and reduce the risk of hospitalization for PAH. The availability of selexipag IV allows continuation of PAH therapy for patients who may be unable to take oral selxipag therapy.

HCPLive: How does the bridging of oral and IV therapies ultimately benefit the patient and how they manage their PAH?

Dr. Chin: Given the progressive nature of this disease, maintaining treatment is central to help manage PAH. For patients on selexipag, bridging short-term temporary interruptions of selexipag tablets with selexipag IV may maintain the treatment effect and avoid the need to change therapy or re-titrate selexipag tablets after re-initiation.

HCPLive: What are you hopeful is the next breakthrough in the PAH or cardiovascular care space?

Dr. Chin: PAH therapies have come a long way in the last several decades, but we still have a long way to go. I’m hopeful that the coming years will identify novel compounds that will lead to additional clinical benefits—lower pulmonary arterial pressures, improved quality of life and better long-term survival. In addition, we need to better utilize existing therapies; this requires additional studies to ensure that we are using the right combinations of therapy at the right time and in the right patients.

HCPLive: Is there anything else you think is important to add about this approval?

Dr. Chin: The FDA approval of selexipag IV will give physicians an option to avoid treatment interruptions and deliver continuity of therapy for their PAH patients when they’re unable to take oral medication. This is important because staying on therapy is key for patients with PAH, given the progressive nature of the disease.

Kelly Chin, MD discusses the recent FDA approval of selexipag IV and breakthroughs in the cardiovascular care space. 

Kelly Chin, MD: Utility of Selexipag IV for Pulmonary Arterial Hypertension

A multicenter study from Massachusetts found that patients with prior 

 were twice as likely to develop a subsequent diagnosis of 

. The cases were identified in patients enrolled in the Medicaid program.

Systemic lupus erythematosus has been linked to clinical morbidity, kidney failure, heart disease, and premature death, and the prevalence of general of lupus and lupus nephritis are much higher in women and minority groups.

A prominent risk factor in the development of the chronic autoimmune disease was PTSD, and several traumatic events such as combat and sexual assault had been linked to changes in the immune system in prior studies.

With the recent study, Siobhan M. Case, MD, MHS, and colleagues examined the role PTSD had in the development of SLE in a diverse group of Medicaid patients.

The case-controlled study included 10,942 patients with cases of incident SLE, 94% of whom were female and came from diverse racial and ethnic backgrounds.

The investigators utilized the Medicaid Analytic eXtract (MAX) database to collect data on patients 19-65 years old. Participants were culled from the 29 most populated states in the US between January 1, 2007-December 31, 2010.

Incidents of SLE in patients were defined by having >3 ICD-9 codes from hospital discharge diagnoses or physician visit claims occurring at least 30 days apart. A control group was matched 1:10 to cases for age at index date, sex, and race/ethnicity.

Exposure for PTSD was based on an algorithm approved in a Veteran administration population with a positive predictive value (PPV) of 82%. Exposure was defined as having >2 ICD-9 codes for PTSD on different dates throughout 4 months.

Case and fellow investigators also administered a 20-item self-administered survey in the form of a PTSD Checklist for DSM-5 (PCL-5) to 67 civilian subjects who were also predominantly female (87%) with a mean age of 52 years.

In addition to sex, race and ethnicity, the team also assessed variables associated with socioeconomic status (SES) including obesity, tobacco use, and oral contraceptive use.

Finally, they performed 2 sensitivity analyses and 1 stratified analysis.

The first sensitivity analysis excluded SLE cases with less than 24 months of enrollment without a code for SLE prior to the index date to increase the likelihood. The second sensitivity analysis excluded all patients with less than 6 months between the first code for PTSD and the first code for SLE or matched index date to increase the likelihood that PTSD occurred before the index date.

The stratified analysis compared the association of PTSD and SLE in individuals living in zip codes in the bottom and top half median household income brackets.

The investigators found that in the first sensitivity analysis, the prevalence of PTSD was 15.74 (95% CI 12.71-19.49) among cases of SLE as opposed to 9.97 (95% CI 9.09-10.93). Also, the incidence of PTSD among cases of SLE was 7.95 (95% CI 5.88-10.76), compared to 6.51 (95% CI 5.81-7.30) among controls.

The odds ratio for SLE in conditional logistic regression presented in the second sensitivity analysis was 2.11 (95% CI 1.74-2.57).

Researchers found no significant multiplicative interaction between PTSD and continuous area-level SES. However, they admitted 1 limitation to their study was a lack of a broader racially, ethnically, and sociodemographic-diverse study population.

Overall, while Case and her colleagues called for more research to be conducted regarding the relationship between PTSD and SLE, they remained confident in their findings of a doubling of odds of SLE associated with a prior diagnosis of PTSD.

They went on to urge researchers to seek out possible interventions that could mitigate the risk of developing autoimmune disease once a patient is diagnosed with PTSD, as well as determine which groups in the US population are truly the most vulnerable.

“Likewise, characterizing the ongoing interplay between PTSD symptoms and the later disease course of SLE could illuminate common pathways to target for treatment of both conditions,” the team said.

“Post-Traumatic Stress Disorder (PTSD) and Risk of Systemic Lupus Erythematosus (SLE) among Medicaid Recipients,”

 was published online in Arthritis Care & Research.

Researchers call for greater research on the relationship between PTSD and autoimmune diseases in Medicaid patients after finding a troubling association.

Increased Risk of Systemic Lupus Erythematosus in PTSD Patients

The US Food and Drug Administration (FDA) has given clearance for a new optical coherence tomography (OCT) imaging platform using Ultreon Software to allow physicians to gain an enhanced view of 

The approval allows Abbott to move forward with the combination of OCT and artificial intelligence technology aimed giving physicians a better look in order to aid in decision-making for the best pathway for treatment.

The software used in the technology integrates with Abbott’s Dragonfly OpStar imaging catheter and PressureWire X guidewire, which allows physicians to access a broad set of tools to assess coronary blood flow and blockages, while improving treatment planning.

"Abbott's new Ultreon Software for OCT provides an automated, comprehensive view of the artery that facilitates physician decision-making," said Ziad Ali, MD, DPhil, director of the DeMatteis Cardiovascular Institute at St. Francis Hospital and Heart Center, in a 

. "Ultreon Software guides stents to be placed with precision. These types of innovative technologies are instrumental in providing the best care for our patients."

Abbott released their annual Beyond Intervention study earlier this year, showing that 83.2% of physicians agreed that advances in diagnostic and treatment technologies have resulted in tangible improvements in patient care.

"As cardiologists continue to adopt OCT and move away from traditional imaging methods such as angiography, emerging technologies are pivotal to determine the best course of patient care," said Nick West, MD, chief medical officer and divisional vice president of global medical affairs at Abbott's vascular business, in a statement. "AI enables Ultreon Software to automatically detect calcium and vessel diameters allowing doctors to put stents exactly where they are needed."

The platform leverages optical coherence tomography and Ultreon Software. 

FDA Clears AI-Based Coronary Blood Flow Imaging Technology

 is increasing, there are limitations in medical diagnostic technology, despite recent improvements.

A recent study analyzed the expression of microRNAs, including miR-214, B-type natriuretic peptide (BNP), N terminal pro BNP (NT-proBNP), and soluble ST2 (sST2) in patients with AHF to determine the diagnostic relationship between the molecules and the disease.

Investigators, led by Lingling Yao, Department of Cardiology, Renmin Hospital, Hubei University of Medicine, found the microRNAs can be used as effective biomarkers for AHF, noting a new strategy for diagnosis and determining severity of AHF.

Data was collected on patients with AHF from February 2018 - February 2020.

Inclusion criteria consisted of New York Heart Association (NYHA) function class II-IV, left ventricular ejection fraction <55% by echocardiography, and normal function of liver, kidney, and other organs.

Investigators collected 3 - 5 mL blood from all patients after overnight fasting. 

Further, expression levels of BNP level, NT-proBNP level, and sST2 level were detected through each respective detection kit.

In addition, the team collected miR-214 following the use of a sterile negative pressure suction sputum retention device.

Data was analyzed using a t-test to compare continuous variables and a chi-square test to compare all categorical data, while statistical significance was set at P <.05.

A total of 176 patients with AHF were included in the study.

Investigators noted the NYHA classification system showed 60 patients were class II, 59 patients were class III and 57 patients were class IV. 

Another 60 patients who came to the hospital for a physical examination at the same time as the study were considered the control group.

The team found the morbidity of CV diseases was higher in the AHF group when compared to the control group (P <0.05).

Furthermore, the expression of miR-21, BNP, NT-proBNP, and sST2 in the AHF group showed significantly higher levels than the control group (P <.05).

The team found the expression level of the microRNAs were all significantly higher in the AHF group than the control group (P <0.05).

In addition, the expression level of molecules in level IV were significantly higher than level III (P <.001) or level II (P <.001), while level III was significantly higher than level II (P <.001).

Data show the area under the ROC curve of miR-214, BNP, NT-proBNP and sST2 was 0.913, 0.836, 0.849 and 0.855, which they noted showed a good diagnostic value.

Investigators concluded the microRNAs in the study can be an effective biomarker for the diagnosis of AHF.

“The results showed that the expression levels of miR-214, BNP, NT-proBNP, and sST2 increased with the aggravation of cardiac function classification,” investigators wrote. “Therefore, their expression levels can be used as an important indicator of the severity of patients with AHF.”

Diagnostic performance of miR-214, BNP, NT-proBNP and soluble ST2 in acute heart failure

The International Journal of Clinical Practice

Data show the expression levels of miR-214, BNP, NT-proBNP, and sST2 were significantly higher compared to the control group. 

MicroRNA Detection Exhibits Value in Acute Heart Failure Diagnosis

With the population aging, clinicians might soon begin to see more and more older patients suffering from psychiatry disorders, including 

By 2030, the number of people over 60 years old is expected to increase 3.5 times more rapidly than the general population. Currently, about 25% of those with bipolar disorder are at least 60 years old.

However, researcher into the impact of bipolar disorder among older individuals are limited.

A team, led by Martha Sajatovic, MD, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, analyzed data from the Global Aging & Geriatric Experiments in Bipolar Disorder Database (GAGE-BD) to assessed older-age bipolar disorder associations among age, bipolar disorder symptoms, comorbidities, and functioning.

“With the global population of older adults increasing more rapidly than any time in history, there is an urgent need for data that are specific to late-life among individuals with BD,” the authors wrote.

In the analysis, the researchers identified harmonized, baseline, cross-sectional data from 19 international studies involving 1377 participants with a mean age of 60.8 years old. In addition, 72% of the patient population was diagnoses with bipolar disorder I.

The researchers used various standardized measures, including the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Depression Rating Scale (MADRS). And Global Assessment of functioning (GAF).

The mean total YMRS score was 4.3 and 22% of patients suffered from moderate to severe depression.

After controlling for sample effects, both manic and depressive symptom severity appeared lower in older participants (

 <0.0001). The negative relationship between older age and symptom severity was similar across sexes.

However, this relationship was stronger among participants with lower education levels.

GAF was mildly impaired (mean = 62.0; SD = 13.3), while somatic burden was high (mean = 2.42; SD = 1.97).

Finally, comorbidity burden was not linked to GAF, but higher depressive (

 <0.0001) symptoms were associated with lower GAF, most strongly among the older participants.

“Findings suggest an attenuation of BD symptoms in OABD, despite extensive somatic burden,” the authors wrote. “Depressive symptom severity was strongly associated with worse functioning in older individuals, underscoring the need for effective treatments of BD depression in older people. This international collaboration lays a path toward a better understanding of aging in BD.”

The results are generally in-line with other studies examining these trends, including an inverse association between duration of diagnosis and depressive symptoms in older patients with bipolar disorder. This suggests that older adults have acclimated to their bipolar disorder diagnosis and symptoms and have devices effective coping strategies.

However, the results were somewhat surprising.

“Our original hypothesis that greater somatic burden would be associated with reduced functioning was not confirmed in the full sample of studies,” the authors wrote. “This may be because our measure of functioning, the GAF, is not intended to reflect impairment due to physical or environmental limitations. It is also possible that the same acquired competence in mood symptom management that some people with OABD achieve might be helpful in optimizing functioning.”

Higher depressive and manic (symptoms were associated with lower GAF, most strongly among the older participants. 

New Research Addresses Symptoms of Older-Age Bipolar Disorder

, Brett King, MD, PhD, of Yale School of Medicine, offered perspectives on the emerging role of Janus Kinase (JAK) inhibitors in 

Before diving into the class’s potential across various dermatologic disease states, he provided an overview of the JAK-STAT pathway, noting its relationship to cytokines.

“At least 50 [of the known 200 cytokines] signal through the JAK-STAT pathway,” he said. “Think of signaling as a relay race, in which the extracellular cytokine binds to its unique receptor on the cell surface and passes the baton to an intracellular JAK protein — which passes the baton to a STAT protein, which goes to the nucleus and makes disease happen.”

Blocking a JAK protein would disrupt the signaling leading to disease.

These proteins include JAK 1, JAK 2, JAK 3, and tyranise kinase 2 (TYK 2). Since the enzymes are small molecules, JAK inhibitors are thus able to be administered either orally or topically.

King further noted that JAK inhibitors operate on a different level of targeted therapy form biologics. 

“These agents are not biologics,” he stressed. “We are not targeting a cytokine, but we are also not knocking down all T-cells like with cyclosporine. These are sort-of non-targeted targeted therapies.”

Listen to the full podcast episode below:

Videos

Brett King, MD, PhD, provides an overview of JAK inhibitors and their interaction with the JAK-STAT pathway.

New Frontiers in Dermatology: Defining the JAK-STAT Pathway

The push in recent years to manage and control the spread of 

 infections in Europe is slowly paying dividends.

However, many countries in Europe hope to improve HBV coverage, increase screenings for pregnant women, and conduct more hepatitis B seroprevalence assessments to help achieve HBV control targets.

According to a new report released by the US Centers for Disease Control and Prevention (CDC) of the 53 countries part of the European Region (EUR), 35, 19, and 17 met coverage targets for 3 doses of hepatitis B vaccine, the birth dose, and for hepatitis B screening of pregnant women, respectively, while Italy and the Netherlands have achieved hepatitis B control.

A team, led by Nino Khetsuriani, MD, PhD, Global Immunization Division, Center for Global Health, CDC, examined the progress in the last 5 years of European countries in general in HBV infection control.

The World Health Organization (WHO) estimates 14 million individuals in Europe were chronically infected with HBV in 2019, with approximately 43,000 individuals dying because of complications related to the chronic infection.

In 2016, the WHO Regional Office for Europe set hepatitis B control program targets for 2020 including at least 90% coverage with 3 doses of hepatitis B vaccine, at least 90% coverage with interventions to prevent mother-to-child transmission (MTCT) of HBV, and at most 0.5% prevalence of HBV surface antigen (HBsAg) in age groups eligible for vaccination with hepatitis B vaccine.

An example of progress toward this goal can be found in doses for young children as by the end of 2019, 94% (n = 50) offered routine vaccination to Hepatitis B for all children 1-12 years old. This includes 23 (43%) countries that offer HBV vaccination to all newborns.

Also, 73% (n = 35) of countries with universal infant HepB vaccination reached 90% hepatitis 3 dose coverage annually between 2017-2019 and 83% (n = 19) with universal birth dose administration achieved at least 90% timely birth dose coverage annually during the same period.

For counties that provide birth doses to infants born to mothers with positive HBsAg test results, 57% (n = 17) reached antenatal hepatitis B screening coverage of at least 90%.

While the numbers are improving, there are some reccomendations that could help countries reach their target goals for HBV coverage.

“Countries can accelerate progress toward hepatitis B control by improving coverage with HepB and interventions to prevent MTCT and documenting achievement of the HBsAg seroprevalence target through representative serosurveys or, in low-endemicity countries, antenatal screening,” the authors wrote.

The investigators also promote serosurveys in an effort to fully understand the prevalence and spread of HBV.

“To accelerate validating achievement of the regional hepatitis B control target in EUR, some countries could consider submitting available documentation for validation, whereas others still need to generate the evidence required for validation,” the authors wrote. “Although conducting nationally representative hepatitis B serosurveys might be challenging, and because the COVID-19 pandemic has further challenged their implementation, hepatitis B testing can be incorporated into other nationally representative serosurveys, including COVID-19 serosurveys, where feasible.”

Italy and the Netherlands both achieved their target HBV control. 

Hepatitis B Dosing Programs A Challenge in Europe

 season promises to be complicated. Americans across the country are still grappling with the COVID-19 pandemic, which threatens to surge yet again in the coming fall and winter seasons, and despite mask mandates being lifted recently medical experts have urged all people, vaccinated or not, to continue wearing masks in public areas.

Shirin Peters, MD, founder of the Bethany Medical Clinic, spoke to HCPLive on what to expect in the coming cold and flu season, how the COVID-19 virus has influenced our precautions, and the implications of masks, and symptom management in the coming months.

HCPLive: What are the implications of stay-at-home orders that we had in the past 2 years? What should people be prepared for as we enter this new cold and flu season?

 We should expect more severe symptoms from exposure to common upper respiratory infections, and more frequent symptoms as our immune systems are less likely able to fight off now-unfamiliar infections before symptoms set in.

HCPLive: What are the causes of seasonal allergies during the cold and flu season, and how can we properly manage symptoms? How do we stay informed and protected?

 Causes of seasonal allergies in the fall are mainly pollen and mold, and in winter months the triggers are mostly indoor allergens like dust mites and pet dander. We can manage symptoms by reducing allergic triggers and by laundering fabrics (clothes and bedding) more frequently with hypoallergenic detergents such as Arm and Hammer Sensitive Skin.

HCPLive: How have our immune systems changed due to a lack of allergen/germ exposure during the Covid-19 pandemic? How have we benefited from social distancing and how have we become more vulnerable?

 During covid quarantine, we have had limited outdoor allergen exposures from pollen, etc. But indoor allergen exposures have increased. Exposure to new infections viruses and bacteria has been limited and for this reason, we may expect an increase in common respiratory infections in the fall if we remain unmasked in public spaces.

HCPLive: A concern with the upcoming fall/winter seasons is that as it gets colder, more people will take to crowding into small, enclosed areas such as restaurants. What are some of the complications that can arise from this? How do we avoid mass exposure to germs/allergens during colder seasons?

 Complications could be an increase in common respiratory infections and/or an increase in covid infection. Restarting the same precautions, we saw during last winter season will protect us again this winter season. This includes masking until being seated with your party at restaurants and continuing the outdoor dining setups that were effective last winter.

As mask restrictions loosen in some areas, an increase in summer colds and other respiratory illnesses is bound to occur, therefore, keeping a cold shortening product that contains Zinc, like Zicam, or an immune supplement such as Vitafusion Triple Immune Power on hand to proactively support yourself and others is advised.



HCPLive: The mask mandates have been lifted in most states in the US. What are your thoughts on masking up during the cold & flu season? Should people wear masks indoors/outdoors? Should masks be considered for this and future cold and flu seasons?

 As of this past Tuesday, the CDC and most experts agree that people in areas with “substantial” or “high” rates of COVID-19 should resume wearing masks in public indoor spaces. This is because for the new Delta strain of COVID, vaccinated people who rarely become infected with COVID-19 vaccine (and do not show symptoms) were found to carry the same viral load as unvaccinated people who are infected with COVID-19 and symptomatic. So, it’s reasonable to assume vaccinated people can still be infected with COVID-19 (although they have no risk of severe covid illness themselves) and can transmit COVID-19 to others.

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