Endurance Athletes Should Only Drink When Thirsty, Experts Say

TUESDAY, June 30, 2015 (HealthDay News) — Endurance athletes or those who are very physically active should drink plenty of water — but only when they feel thirsty, new expert recommendations say.

Athletes should listen to their body and drink water as needed to prevent a potentially deadly condition called exercise-associated hyponatremia (EAH) or “water intoxication.” The new guidelines were developed at the International Exercise-Associated Hyponatremia Consensus Development Conference in Carlsbad, Calif., and published June 29 in the Clinical Journal of Sport Medicine.

Overdrinking, particularly when exercising or playing sports in the heat, can increase the risk of seriously low levels of sodium in the blood. Excessive intake of water, sports drinks or other fluids can exceed the body’s ability to get rid of fluids in sweat or urine. When the body can’t remove excess fluids, those fluids dilute the body’s sodium level, which can drop during exercise or up to 24 hours later.

Symptoms may appear mild at first, but progressively worsen. Warning signs of water intoxication include headache, vomiting, confusion and seizures.

These symptoms develop as the brain swells. Without treatment, water intoxication can quickly become deadly.

If people “drink when thirsty,” however, they can avoid this dangerous drop in blood sodium levels, according to the recommendations.

“The safest individualized hydration strategy before, during and immediately following exercise is to drink palatable fluids when thirsty,” the statement said.

The development of the new guidelines was prompted by the deaths of two high school football players from exercise-associated hyponatremia last summer, the researchers said.

“The release of these recommendations is particularly timely, just before sports training camps and marathon training begins within the United States — where the majority of EAH deaths have occurred,” said the report’s lead author, Dr. Tamara Hew-Butler, associate professor of exercise science at Oakland University in Rochester, Mich. “Our major goal was to re-educate the public on the hazards of drinking beyond thirst during exercise,” she said in a journal news release.

Athletes and coaches must also be aware of the risks associated with “forced hydration” practices. “Every single EAH death is tragic and preventable, if we just listen to our bodies and let go of the pervasive advice that if a little is good, more must be better,” Hew-Butler said.

The report also advised doctors that hyponatremia treatment should be based on the severity of patients’ symptoms — not just their sodium levels.

More information

The U.S. National Library of Medicine provides more information on water intoxication, or hyponatremia.

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Scans Suggest Recurrent Depression May Take Toll on the Brain

TUESDAY, June 30, 2015 (HealthDay News) — The area of the brain involved in forming new memories, known as the hippocampus, seems to shrink in people with recurring depression, a new study shows.

Australian researchers say the findings highlight the need to spot and treat depression when it first develops, particularly among young people.

Ian Hickie, who co-directs the Brain and Mind Research Institute at the University of Sydney, led the study. His team looked at the neurology of almost 9,000 people from the United States, Europe and Australia. To do so, they analyzed brain scans and medical data for about 1,700 people with major depression, and almost 7,200 people who didn’t suffer from depression.

The researchers noted that 65 percent of the participants with major depression had suffered recurring symptoms.

The study, published June 30 in the journal Molecular Psychiatry, found that people with major depression, particularly recurring forms of the condition, had a smaller hippocampus. This part of the brain was also smaller among participants diagnosed with depression before they reached the age of 21.

Many young people diagnosed with depression go on to develop recurring symptoms, Hickie’s team noted.

Recurrence seemed key: About a third of participants had had only one episode of major depression, and they did not show any reduction in the size of their hippocampus compared to non-depressed people.

According to the researchers, that suggests that it is recurring depression that takes a toll on brain anatomy.

The take-home message: Get depression diagnosed and treated before brain changes can occur, the Australian team said.

“This large study confirms the need to treat first episodes of depression effectively, particularly in teenagers and young adults, to prevent the brain changes that accompany recurrent depression,” Hickie said in a university news release.

According to co-researcher Jim Lagopoulos, “these findings shed new light on brain structures and possible mechanisms responsible for depression.”

“Despite intensive research aimed at identifying brain structures linked to depression in recent decades, our understanding of what causes depression is still rudimentary,” Lagopoulos, who is an associate professor at the institute, said in the news release.

The study couldn’t prove cause-and-effect, however, and the study authors say that more research could help explain if the brain changes are the result of chronic stress, or if these changes could help spot people who are more vulnerable to depression.

More information

The U.S. National Institute of Mental Health provides more information on depression.

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White Men May Get Better Treatment for Abnormal Heartbeat

By Steven Reinberg
HealthDay Reporter

TUESDAY, June 30, 2015 (HealthDay News) — Women, Hispanics and blacks are less likely than white men to receive optimal treatment for atrial fibrillation in the United States, researchers say.

The study of more than a half-million Medicare patients found that women with this abnormal heart rhythm are less likely than men to get blood thinners to prevent stroke, which is a serious risk with atrial fibrillation. Women, blacks and Hispanics are also less likely to get catheter ablation, a surgical procedure that can restore the heart’s normal rhythm.

“Across the board, women are offered less aggressive care, particularly in cardiology,” said lead researcher Dr. Prashant Bhave, a clinical assistant professor of internal medicine at University of Iowa Health Care.

“There are still gaps in how patients are treated,” he said. “The most important one is the difference in prescribing blood thinners. Ablation may be a personal choice, but when it comes to stroke prevention, the decision is black and white, and these differences need to be addressed,” Bhave said.

The report was published in the July issue of the journal HeartRhythm.

Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York City, said the issue is serious. “Being that women are at a greater risk of stroke with atrial fibrillation, this inequality in care is putting women at risk,” she said.

“When patients are treated, the same guidelines need to be used, regardless of gender or ethnic background. There is a standard of care in treatment for newly diagnosed atrial fibrillation, and these guidelines are gender and racially blind,” said Steinbaum, who was not involved with the study.

If women and minorities are not treated based on this standard of care, the bias is coming from their doctor, she said.

Women need to realize that men and women are not treated equally for this common arrhythmia, she added. “We can only hope that women’s lives won’t fall victim to the health care disparities that unfortunately do exist,” Steinbaum said.

Atrial fibrillation is common in the United States, affecting about 5 percent of people 65 and older, the researchers said. For the study, Bhave and his colleagues collected data on almost 518,000 Medicare patients diagnosed with atrial fibrillation in 2010-2011.

They found that women were less likely than men to receive blood thinning drugs (35 versus nearly 39 percent). And blacks and Hispanics were less likely than whites to receive these drugs (30.5 and 31.4 versus 37.3 percent, respectively).

Women were also less likely than men to have ablation therapy (0.6 versus 1.3 percent). And Hispanics were less likely to have this procedure than whites (0.6 versus 0.9 percent), the researchers found.

Moreover, Hispanics and women were less likely than white men to have a clinic visit with an electrophysiologist — a specialist in abnormal heart rhythm.

Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, said, “Atrial fibrillation is the most common type of arrhythmia.

“Further studies will be required to understand the reasons for these differences in care,” he said.

This disparity may reflect doctors’ bias or the unwillingness of women to undergo invasive procedures, Bhave said. “They may have been offered ablation but didn’t want it,” he said.

Bhave thinks blacks and Hispanics may have less access to care, which results in fewer referrals for ablation.

More information

For more about atrial fibrillation, visit the U.S. National Heart, Lung, and Blood Institute.

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Most U.S. Hepatitis C Infections May Be Missed: Study

By Dennis Thompson
HealthDay Reporter

TUESDAY, June 30, 2015 (HealthDay News) — New cases of hepatitis C are drastically underreported to federal officials, researchers contend in a new study.

And they suggested that may be hampering public health efforts to cope with the chronic infection that can lead to cirrhosis or liver cancer.

The new study found that only one out of 183 Massachusetts residents diagnosed between 2001 and 2011 with acute hepatitis C infection was reported to the U.S. Centers for Disease Control and Prevention.

The rest went unreported, either because their test results didn’t come back quickly enough or because the results didn’t meet the strict CDC definition for hepatitis C infection, said senior study author Dr. Arthur Kim, director of the Viral Hepatitis Clinic at Massachusetts General Hospital in Boston.

“We were shocked to find only one made it to the CDC, reported as an acute hepatitis C case,” Kim said. “This indicates that only a small fraction of cases ever get reported to the CDC. They might be seeing only what amounts to the tip of a very large iceberg.”

The findings were published June 29 in the Annals of Internal Medicine.

Reported new cases of hepatitis C have more than tripled in recent years, rising from 694 cases in 2005 to 2,138 cases in 2013, according to the best CDC estimates.

However, the CDC believes the actual number of new hepatitis C cases is about 14 times the number of reported cases in any given year, due to the reporting troubles.

Based on that assumption, the CDC estimates that the “real” number of new hepatitis C infections in 2013 was anywhere between 23,500 and 101,400, rather than the reported number of 2,138.

Acute hepatitis C infection is a short-term illness that occurs within the first six months of exposure to the hepatitis C virus, according to the CDC. Drug abuse is a leading cause of hepatitis C infection, because the virus can spread through the sharing of tainted syringes, the researchers said.

Very few people die from acute hepatitis C infection, but about three out of four cases evolve into a chronic infection that remains in a person’s body for the rest of their lives, said Dr. David Bernstein, chief of hepatology at North Shore University Hospital in Manhasset, N.Y.

If left untreated, chronic hepatitis C infection can cause long-term liver damage and might result in liver cancer. Drug cocktails can treat chronic hepatitis C, but the course of treatment can run as high as $93,000, a recent analysis found.

“It’s really no surprise that so few cases are being reported,” Bernstein said. “Most people who get hepatitis C acutely don’t get sick, and the standard testing we use for hepatitis C is an antibody, which may not become positive for several months after being exposed.”

In the new report, researchers analyzed data from a government-funded study that followed a group of 183 Massachusetts patients diagnosed with acute hepatitis C between 2001 and 2011.

Researchers found that only 149 of those cases had been reported to the Massachusetts Department of Public Health and entered into the agency’s automated database. Of those cases, 130 were classified as a confirmed present or past hepatitis C infection, based on state-level case definitions, and 43 were investigated as potential acute hepatitis C cases.

However, only a single case fully met the definition of a confirmed CDC-reportable case. The others were disqualified because of factors such as the absence of specific symptoms or not meeting threshold lab test results.

“Massachusetts has a robust system of capturing new hepatitis C cases,” Kim explained. “However, it was very hard for our state health department to classify them as acute hepatitis C.”

Unless a better way of identifying hepatitis C is discovered, public health officials will find themselves ill-prepared to deal with a silent but growing epidemic, Kim said.

“We believe the multiplier might be even higher than that being used by the CDC, and the downstream cost of dealing with those new cases will be immense. We must be able to count cases accurately, so we know the true burden of the disease,” Kim cautioned.

More information

Visit the U.S. Centers for Disease Control and Prevention for more on hepatitis C.

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5 Things You Need to Know About Bronzer

Photo: Getty Images

Bronzer can be one of the trickiest products to shop for: Shimmer or no shimmer? Powder or cream? Too dark or just the right shade? Health spoke with Laramie, makeup artist and founder of Book Your Look, for her tips on finding the perfect bronzer for your skin type and tone. Read on to learn how to get your skin glowy and gorgeous for summer, sans sun damage.

Choose the right shade

Look for a bronzer that’s one to two shades darker than your natural skin color. Then determine your skin’s undertone and look for the same tone in a bronzer. Here’s how: “Your perfect bronzer tone is the color your skin turns when [you’ve spent a long day in the sun],” Laramie said. If your skin turns pinky-red post-tan, your go-to is a warm bronzer with a slight peachy (but not too orange) undertone. Are you more yellow-toned after a day at the beach? Stick to golden browns. If you don’t sunburn or tan at all, most neutral browns will work.

Know the best formula for your skin type

If you have oily skin: A gel is your best bet because they have greater staying power than powders. “A lot of times if I’m on set and it’s going to be a long day, I’ll use a gel bronzer to warm up the skin and a powder bronzer to touch up later in the day,” Laramie noted. Try Make Up For Ever Pro Bronze Fusion ($36, sephora.com), a new gel-to-powder bronzer.

Photo: courtesy of Sephora

If you have dry skin: Opt for a cream or balm formulation for a dewiness that’s normally tricky for this skin type to achieve, like RMS Beauty Buriti Bronzer ($28, rmsbeauty.com).

Photo: courtesy of RMS Beauty

If you have combination skin: A powder formulation, like this Giorgio Armani Sun Fabric Sheer Bronzer ($54, sephora.com), is the way to go.

Photo: courtesy of Giorgio Armani

RELATED: The Best Facial Cleanser For Your Skin Type

Say yes to shimmer (but no to sparkle)

To achieve a believable tan, choose a bronzer that has a touch of shimmer in it. “Shimmer is different from sparkle,” Laramie notes. “You don’t necessarily want a sparkly bronzer, because you’ll be able to see the individual flecks on your face when you’re out in the sun. Shimmer is more finely ground sparkle; that’s what’s going to give you a warm glow that looks healthy and sun-kissed.”

Follow these easy application tricks

For powders Swirl a large fluffy brush into the bronzer, tap off excess, and sweep over just these key areas in big circles: your forehead, tip of the nose, highest point of the cheeks, and chin. Laramie also recommends sweeping a little bit along the jawline and around your ears.

For cream, gel, or liquids Press a synthetic, flat-top kabuki brush into bronzer. Gently brush off excess onto the back of the hand. In small circles, start in the center of the area you want to apply to—as with powders, you’re aiming for the forehead, tip of the nose, tops of the cheeks, and chin—and buff out. Optional step: Use a damp beauty sponge to further blend out. While you can never over-blend, less is definitely more when it comes to the amount of bronzer you first pick up to apply. It’s easier to add on thin layers than attempting to evenly blend out one thick, goopy layer.

RELATED: Makeup Brush Decoder

Know that “bronzing” is different from “contouring”

“Bronzing” and “contouring” are often used interchangeably, but contouring is very different from bronzing. For contouring, you need a matte (not shimmery) brown formula with cool, grey undertones since you want to create a true shadow and give your cheekbones a lift, not add an overall glow and highlight. If you’re a beginner (or just not looking for adding that much drama to your routine, start out with this super-easy starter technique you can do with bronzer.

RELATED: How To Contour Your Face With One Simple Makeup Trick

 

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The Surprising Truth About the Dates on Food Labels

Photo: Getty Images

Food waste is a big problem: Americans estimate they toss $640 worth of food each year, according to a new survey from the American Chemical Council. And an earlier analysis by the Institute of Food Technologists (IFT) found that consumers to throw away approximately 133 billion (!) pounds total of wasted food a year.

Confusion over those tiny date stamp on food products is a big part of the problem.

That’s because, while they may sound similar, “use-by,” “sell-by,” and “best-by” dates actually mean three different things when it comes to food safety. And none of these dates are literal expiration dates that reflect exactly when a product will become harmful or dangerous to eat. They only mark the point at which it’s reached peak quality, consistency, or flavor—leading to a lot of confusion and still-good food thrown out before its time, according to the IFT.

RELATED: How to Keep Summer Foods Safe Outdoors

To help you decide when it’s really time to toss that carton of milk, we’ve laid out the differences between common dates you’ll find on food packaging.

Use-by date

You should, theoretically, eat food before this date, which is based more on when the quality of the product will go down than the chance that it will make you sick. But “quality is likely to go down much faster and safety could be lessened” after this point, Bob Brackett, PhD, director of the Institute for Food Safety and Health, noted in a press release. So when in doubt, it’s a good rule of thumb to throw food out on or very close to this date.

RELATED: How Worried Should I Be About Food Safety?

Best-by date

Much like the “use-by date,” this number tells consumers when a product should be eaten to guarantee ideal flavor and quality, not when a food will go bad.

Sell-by date

This marking informs retailers of the date by which they should sell the product or remove it from store shelves. Food is still safe for at-home consumption well after this point. In fact, according to Brackett, “typically one-third of a product’s shelf life remains after the ‘sell-by’ date for the consumer to use at home.”

RELATED: 8 Ways to Prevent Food Poisoning

Bottom line: While these dates are guidelines—and a good starting point—they’re not going to help you determine when food will make you sick, or even when exactly you should throw it out. The good news is, most food takes longer than you’d think to go bad.

Always try to make sure your cold food stays cold and that your cooked food stays hot, since bacteria multiply the fastest between 40 degrees and 140 degrees. To keep them from growing, refrigerate food at less than 40 degrees, and reheat cooked leftovers to at least 165 degrees. And keep in mind the “2-2-4” rule of thumb: Don’t leave food out longer than 2 hours, refrigerate it in containers less than 2 inches deep, and use or freeze all refrigerated leftovers before 4 days.

For even more in-depth pointers on when you should really toss specific food items out, look to sites like The Food Keeper, a web sites with a searchable database of guidelines for storing and keeping everything from cereal to baby food safe, as well as Foodsafety.gov.

RELATED: Eating Moldy Food: When It’s OK, When It’s Not

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California Governor Jerry Brown Signs Mandatory Vaccine Law

Photo: Getty Images

California Governor Jerry Brown signed a mandatory school vaccination bill into law Tuesday, abolishing the “personal belief” exemption that many parents use as a loophole to avoid vaccinating their children.

Now, under California law, which is among the strictest in the country, children would not be able to enroll in public school unless they have been vaccinated against diseases like measles and whooping cough. The law includes an exemption for children who have a medical reason to remain unvaccinated (like an immune system disorder) and can prove it with a doctor’s note. Parents who decline to vaccinate their children for personal or religious reasons will have to home-school them or send them to a public independent study program off school grounds.

Students who are unvaccinated because of “personal belief” who are already in public elementary school can stay until they’re in 7th grade, and then the parents will either have to vaccinate them or home-school them. Daycare students can stay until kindergarten, when they have to be either vaccinated or home-schooled. In the fall of 2014, almost 3% of California kindergartners were unvaccinated because of personal belief. Preschools in the most affluent areas are also the least likely to vaccinate, according to the Los Angeles Times.

The bill was proposed after a measles outbreak at Disneyland infected more 150 people, and many needed to be hospitalized. Supporters of the law argue that it is based on medical consensus that vaccinations improve public health. Opponents—who have been picketing outside the California legislature—argue that it’s an attack on personal freedom.

This article originally appeared on Time.com.

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Women’s Faces Are Redder During Ovulation, Study Says

TUESDAY, June 30, 2015 (HealthDay News) — Women’s faces are redder than usual during ovulation, but this subtle change isn’t detectable to the human eye, new research shows.

This change may be a possible signal of peak fertility, and it may have evolved to become less noticeable since controlling or hiding ovulation has greater benefits, the researchers suggested.

In primates, males only express interest in females when it’s apparent they’re ovulating. Among humans, however, ovulation is not obvious and sex is not limited to the period of time when women are ovulating.

Researchers investigated changes in the color of women’s faces over the course of a month. The study involved 22 women. They were photographed daily without makeup using a scientific camera able to capture color more accurately than a typical camera.

“We were able to recruit undergraduates in a number of colleges and photograph the women just before they had dinner in the college hall every evening. The collegiate routines and networks were vital to collecting data with such regularity,” the study’s leader, Hannah Rowland, from the zoology department at University of Cambridge in England, said in a university news release.

A computer program then selected the same patch of cheek from each woman’s photo. The images were converted into red, blue and green values to assess changes in color levels.

Meanwhile, the women tested themselves for hormonal changes at specific intervals during the month. The researchers identified when the women were most fertile based on these levels. Those who experienced a spike in their luteinizing hormone level were expected to ovulate within 24 hours.

Redness in the women’s faces changed significantly throughout the month, but peaked at ovulation, the study published online June 30 in PLOS One found.

The women’s faces remained extra red until after estrogen levels fell. The largest average difference in redness, however, wasn’t a level high enough to be detected by the human eye.

Once menstruation began, the redness in women’s faces dropped to much lower levels. The researchers said this redness closely matches changes in body temperature throughout an ovulation cycle.

“Women don’t advertise ovulation, but they do seem to leak information about it, as studies have shown they are seen as more attractive by men when ovulating,” said Rowland. “We had thought facial skin color might be an outward signal for ovulation, as it is in other primates, but this study shows facial redness is not what men are picking up on — although it could be a small piece of a much larger puzzle.”

Since people — and other primates — are attracted to red, women may subconsciously enhance this naturally occurring facial redness with makeup or red clothes, the researchers suggested.

“As far back as the 1970s, scientists were speculating that involuntary signals of fertility such as skin color changes might be replaced with voluntary signals, such as clothing and behavior,” the study’s co-leader, Robert Burriss, a psychologist from Northumbria University in England, said in the news release.

“Some species of primate advertise their fertility through changes in the color of their faces. Even if humans once advertised ovulation in this way, it appears that we don’t anymore,” he said.

Another theory is that women blush more often when they are in the company of attractive men, the study authors said.

“Other research has shown that when women are in the fertile phase of their cycle they are more flirtatious and their pupils dilate more readily, but only when they are thinking about or interacting with attractive men,” said Burriss. “We will need to do more research to find out if skin redness changes in the same way.”

More information

The American Pregnancy Association has more about ovulation.

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Did One Gene Mutation Launch the Black Death?

TUESDAY, June 30, 2015 (HealthDay News) — One small genetic change may have transformed Yersinia pestis — the plague bacteria — from a relatively mild germ into the deadly bug that killed millions in the Black Death and other historic epidemics, scientists report.

According to the U.S. Centers for Disease Control and Prevention, humans can contract Y. pestis after being bitten by a flea carried by a rodent or by handling the rodent themselves. While antibiotics can effectively treat plague today, an epidemic in the mid-1300s wiped out up to 60 percent of Europe’s population, the CDC said.

But what made the germ — which can trigger bubonic, pneumonic or septicemic plague — so lethal?

To find out, a team led by Wyndham Lathem, an assistant professor in microbiology-immunology at Northwestern University’s Feinberg School of Medicine in Chicago, examined ancestral strains of Y. pestis in mice.

They wanted to learn when and how the bacterium evolved from a bug that primarily caused an illness in the digestive tract, to one that could infect the lungs and cause the most severe form of plague, pneumonic plague.

The oldest ancestor of currently existing strains of the bacteria can infect the lungs, but it doesn’t result in the deadly respiratory disease that killed so many, Lathem’s group said.

The main difference between this strain and others that could cause pneumonic plague is a gene known as Pla, the study revealed.

The researchers theorized that the acquisition of this gene not only helped the bacteria infect the lungs, but also enabled it to cause a more serious, often fatal infection.

To test the theory, the team inserted the Pla gene into the less-lethal ancestral strain of the bacteria. They then watched how it affected the lungs.

As expected, the mutated strain became more deadly and was able to cause respiratory infections as serious as modern-day strains of Y. pestis.

The bacterium has gained and lost numerous genes over thousands of years, but the Pla gene was all it took for the bacteria to become so deadly, the Chicago team said.

After examining variations of the Pla gene, the study’s authors also found a gene tweak only found in more modern strains of the bacteria — this change enabled it to spread to the lymph nodes, causing bubonic plague.

“Our data suggests that the insertion and then subsequent mutation of Pla allowed for new, rapidly evolving strains of disease,” Lathem said. “This information can show how new respiratory pathogens could emerge with only small genetic changes.”

“Our findings demonstrate how Y. pestis had the ability to cause a severe respiratory disease very early in its evolution,” Lathem said in a Northwestern news release. “This research helps us better understand how bacteria can adapt to new host environments to cause disease by acquiring small bits of DNA.”

They concluded their findings could also help explain how Y. pestis infections advanced from small, local outbreaks of plague to pandemics like the sixth century’s Justinian Plague and the fourteenth century’s Black Death.

The study is published June 30 in the journal Nature Communications.

More information

The U.S. Centers for Disease Control and Prevention provides more information on the Yersinia pestis, the bacterium that causes plague.

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Under-the-Tongue Hay Fever Pills Offer Little Benefit: Study

By Kathleen Doheny
HealthDay Reporter

TUESDAY, June 30, 2015 (HealthDay News) — Under-the-tongue pills for hay fever sufferers provide little symptom relief and often come with bothersome side effects, new research finds.

Under-the-tongue, or sublingual, therapy is widely used in Europe as an alternative to allergy shots. In the United States, two such “immunotherapy” pills have been approved recently by the U.S. Food and Drug Administration for grass allergies.

For this study, Italian researchers looked at 25 clinical trials that evaluated the treatments’ effectiveness in reducing symptoms and the need for other allergy medications.

“The major finding here is that the benefit of SLIT [sublingual immunotherapy] tablets is very small, compared to placebo,” said Dr. Gabriele Di Lorenzo, of the department of internal medicine at the University of Palermo, who led the study. It was published online June 29 in JAMA Internal Medicine.

Di Lorenzo said some previous trials overestimated the drugs’ benefit because of the way differences between active medicine and placebo were calculated. For the new analysis, the researchers said the real difference was estimated correctly.

Many people with seasonal allergies — characterized by sneezing, itchy, watery eyes and congestion — get temporary relief from antihistamines and nasal corticosteroids. Allergy shots and sublingual therapy are different in that they expose the user to small amounts of allergen, in the hope of reducing allergic response over time.

Oralair, one of the drugs approved for use in the United States, includes freeze-dried extracts from the pollen of five grasses: Kentucky blue grass, orchard, perennial rye, sweet vernal and timothy. Another drug, Grastek, includes timothy extract.

In the analysis, when the pills were compared with placebo, symptom scores differed by just 1 point.

“Consider that the symptom score scale is 18 points,” Di Lorenzo said. “So, less than 1 point difference is not clinically significant. This means that the treatment alone is not sufficient to control symptoms.”

Study participants could also take allergy medicine, such as antihistamines, and this is what mainly controlled symptoms, Di Lorenzo said.

Side effects, reported by more than 61 percent of those taking the under-the-tongue pills, included swelling of the mouth, throat irritation and itchy skin. They were mostly mild to moderate, but some patients stopped the sublingual medicine because of them.

Di Lorenzo concluded that allergy injections at a doctor’s office, although less convenient and riskier, are more effective.

Referring to the concept of under-the-tongue allergy treatment, Dr. Gaston De Cardenas, ear, nose and throat chief at Nicklaus Children’s Hospital in Miami, said that “the idea is great.” However, ”they need to develop something that works better,” he said. De Cardenas was not involved in the study.

Doctors do have another alternative, said Dr. Jordan Josephson, an ear, nose and throat specialist at Lenox Hill Hospital in New York City. “It’s possible for a doctor to formulate sublingual drops to target a specific allergy,” he said.

Some doctors do this in their office, he said, while others send the prescription to a special compounding pharmacy. This type of off-label use is legal.

More information

For more about seasonal allergies, see the American Academy of Allergy Asthma & Immunology.

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