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The Star Online: Lifestyle: Health

Astragalus: Chinese medicinal herb enlisted in fight against allergic rhinitis

Posted: 31 May 2014 09:00 AM PDT

A herb long used in traditional Chinese medicine for diabetes has been recently proven effective for allergic rhinitis, with some even touting the plant as a 'superfood'.

Take a look around you, is there someone you know who has symptoms of allergies?

This might be in the form of allergic rhinitis — runny and/or blocked nose, watery eyes and sneezing; food allergies — itching, rashes, and even, difficulty breathing, upon consumption of the trigger food; eczema or contact dermatitis — itchy, red skin rashes; and allergic asthma — difficulty breathing upon exposure to the allergen, among others.

There is a pretty good chance that you know one or more persons who have some form of allergy, or even have allergies yourself, as the Malaysian Society of Allergy and Immunology estimates that one in three Malaysians suffer from some sort of allergy.

In fact, allergies are a rising medical trend both globally and locally. Experts predict that if the present trend continues, around half the country's will be affected by ailments caused by allergies by 2020.

While allergies are unlikely to be fatal for most sufferers, they do seriously affect quality of life. This is especially so for those who are allergic to substances that are commonly found in the environment, like dust mites, pet dander and pollen.

According to Croatian medical doctor and researcher Dr Silva Pecanic, the current goals of allergic rhinitis management is to improve quality of life and minimise side effects from treatment.

"There are three main methods of management. First, of course, is the allergen avoidance. But this requires a lot of education of the patient, a lot of discipline, habit changes, and is quite restrictive," she says, noting that when one family member has an allergy, the entire family usually suffers along as well.

"The other method is pharmacotherapy. Current pharmacotherapy includes nasal steroids, which have a lot of side effects like dryness, and after long-term use, leads to thinning of the nasal mucosa, making it prone to bleeding or infections. There are also a lot of side effects for antihistamines, which are often used to decrease allergy symptoms, like dryness, drowsiness, dizziness, and sometimes, trouble urinating," she says.

The third method of treatment is with leukotriene inhibitors. However, Dr Pecanic notes that the US Food and Drug Administration has updated the precautions on this group of drugs to include warnings on reported adverse neuropsychiatric side effects like agitation, aggression, problems sleeping, hallucinations and suicidal thoughts.

She says: "All these treatments are directed at the final symptoms — after the histamine attack. And all these patients usually change their therapy because they are never fully satisfied with their medication — changing from one antihistamine to another, and the nasal steroids and the nasal decongestants."

Regulating allergy genes

Dr Pecanic, who is currently the Regulatory Department head of the South-East European Croatian-based health supplements and non-prescription drugs company Milsing, was in town recently to speak about a new allergy treatment based on the herb Astragalus membranaceus.

Also known as huang qi, bei qi or huang hu huang qi in Chinese, the dried root of A. membranaceus has actually been used in traditional Chinese medicine (TCM) for thousands of years. Its primary function in TCM is as an energising tonic and boosting the immune system, as well as treating diabetes.

It is this last function that led a group of researchers at the Ruder Bokovic Institute in Zagreb, Croatia, to take a deeper look at the root of this herb 14 years ago.

Milsing Product Development head and pharmacist Iva Martic shares: "During the research, they discovered that the activated root extract of A. membranaceus substantially influences some of the genes which are involved in the inflammatory reaction.

"After that, they performed a series of tests, and animal and clinical trials, to show that it does affect more than 20 genes involved in the inflammatory process."

In was at this stage in 2003 that Milsing, which develops such products commercially, got involved.

According to Martic, their research showed that the activated root extract of A. membranaceus helps to regulate the genes involved in the Th1 (Type 1 helper T cell) pathway. (See What are helper T cells?)

Increased activity of this pathway helps balances out the Th2 (Type 2 helper T cell) pathway, which is the one responsible for releasing histamine and other inflammatory chemical mediators that cause allergy symptoms.

Providing effective relief

In 2007, Dr Pecanic and her colleagues conducted a randomised, double-blind clinical trial at the University Hospital Dubrava in Zagreb. The results were published in Phytotherapy Research in 2010.

Forty-eight patients with seasonal allergic rhinitis were randomly put into two groups for the six weeks of the trial. Two-thirds of them received the activated root extract of A. membranaceus, while one-third received a placebo. No other pharmacological treatment for allergies was allowed.

According to Dr Pecanic, participants on the root extract showed significant improvement for rhinorrhoea (runny nose) after three weeks on treatment, and itching or burning eyes after six weeks, compared to those on the placebo.

In addition, subjective evaluations on treatment efficacy from patients and doctors respectively both showed an agreement that the root extract was significantly more effective than the placebo.

She adds: "There were very few adverse reactions, and all of them were actually symptoms from the allergy. The conclusion was that there were no adverse reactions related to the root extract."

While the treatment for the clinical trial was administered at the start of the allergy season, Dr Pecanic says that the treatment works best when begun a month before exposure to the allergen or allergy season (for example, spring in temperate countries when pollen starts to spread), as a preventive measure.

Patients need to take the treatment as long as there is risk of exposure to the allergen.

However, those who have perennial or constant allergies can also start the treatment at any time, as then, it will work to reduce the symptoms they are already suffering from. They would need to take a stronger dose of the root extract until their symptoms subside, whereupon they can continue with the maintenance dose until they are no longer at risk of being exposed to the allergen.

Dr Pecanic says that it takes up to about a week in such patients for the treatment to start showing effect. She adds that they can also combine the root extract with their usual pharmacologic treatments for symptom relief.

Although patients will probably have to continue taking the root extract for as long as they have allergies, which is usually lifelong, Dr Pecanic notes: "It is a natural product; it does not have side effects. And it is much better to take such products than drugs with side effects. It is safe."

'World Cup can kill you': Health experts caution fans to keep calm, eat healthy

Posted: 31 May 2014 09:00 AM PDT

As anticipation for the World Cup builds, health experts caution football fans to be careful of the physical stresses and violent reactions that can come from seeing their favourite teams lose. 

If the TV commercials piggybacking on the World Cup are to be believed, watching a football match is fun, healthy and sociable.

Slim young men and women spring up from the sofa like gazelles to celebrate a goal. If they lose, they commiserate peacefully with a rueful shrug. And, of course, they only consume alcohol and food in modest, balanced proportions. Reality, as you may have guessed, is rather different from the Never Never Land of television ads.

For hundreds of millions of fans, say experts, the World Cup will be a life-affirming fiesta, but for others, it will be unhealthy, painful or even lethal.

Statistics show that football's great parties are typically accompanied by a surge in heart attacks, suicide, depression, assaults, road accidents, binge-drinking and pigging out on artery-clogging, waistline-expanding junk food.

"The biggest risk comes from emotional stress, which builds up during the match," said Jean-Francois Toussaint, director of France's Institute of Sport Biomedical Research and Epidemiology. "The risk is naturally greater when a fan's team loses, rather than when it wins, because the cumulative stress is negative."

Investigators in the southern German city of Munich found that local hospital admissions for heart attacks or palpitations rose 266% on days when the national team were playing in the 2006 World Cup, which was hosted by the Germans.

Researchers at the University of Birmingham in central England even recommended that penalty shootouts be banned "on public health grounds" after discovering that the tally of heart attacks in Britain rose by a quarter on the day England lost on kicks against historic rival Argentina in the 1998 tournament.

In the northwestern English county of Lancashire, incidents of domestic abuse rose by 38% when England's team played and lost in the 2002, 2006 and 2010 World Cups, police reported.

Hormonal cause

One of the big movers-and-shakers is hormones — and not just testosterone, found in both men and women, which is associated with aggression.

Spanish researchers were intrigued when they monitored cortisol, a stress hormone released when one's social image is under threat, among 50 male and female supporters of the national team before, during and after the 2010 final against the Netherlands.

Cortisol levels surged in the run-up to the match, particularly among the most passionate supporters, men and among younger fans, but then fell back after the 1-0 victory.

The curve highlights fears about the crushing shame of defeat on group identity, the scientists believe. Combining such hormonal drivers with the emotional rollercoaster of football can powerfully affect behaviour, say specialists.

French scientists last year calculated that fans consumed nearly a fifth more calories after their team lost, than after when it won. Intake of unhealthy saturated fats and added sugars rose by nearly half in calorie terms. The suspected reason: when a favourite team loses, people feel an identity threat and are likelier to turn to comfort food to help them cope — an exercise psychologists call "escape from self-awareness".

Winning, though, seems to provide a boost to self-control. There is no need for mood repair.

Sex, too, is an area that can be hugely affected by football mania. Last year, doctors in Catalonia, Spain, reported that local births rose by 16% nine months after Andres Iniesta scored a last-minute goal against Chelsea to give Barcelona a berth in the 2009 Champions League final. The infants have been dubbed the Iniesta Generation by the Spanish press.

In the 2010 World Cup, British health watchdogs enlisted the help of Beer Goggles Johnny to advise fans heading to South Africa. The cartoon character cautioned that being drunk alters perception of risk and of other people. Booze literally magnifies another person's attractiveness, and sex without a condom could lead to HIV and other diseases. "No glove, No love," Beer Goggles Johnny said sagely. – AFP Relaxnews

'I have Tourette's, it doesn't have me': Overcoming mysterious, misunderstood syndrome

Posted: 31 May 2014 09:00 AM PDT

Athletes with Tourette Syndrome inspire, as well as compete in their respective sports.

He stands in the batter's box, his head on a swivel, jerking in every direction. He looks at the umpire longer than the pitcher, holds the bat in one hand and punches himself in the ribs with the other.

Somehow, fighting the full-blown episode of his Tourette Syndrome, Kellen Webster sees the pitch he wants and plows it up the middle for a single. And his father doesn't know whether to laugh or cry, so he does both.

"He was doing what he loved and, selfishly, I was inspired," a tearful Todd Webster said of the experience in 2012, the summer before Kellen's junior year at Bothell High School, Washington, United States. "I tell people all the time that it was the worst thing I've ever seen, but at the same time, the best thing I've ever seen him do. It was very uplifting."

Leyton Thommasen's tics are much more subtle, and many who watch him tend goal for the Kennedy Catholic soccer team have no clue that he, too, has Tourette's. His is a milder form, yet like Kellen, he has overcome obstacles to excel athletically and academically.

Together, they epitomise the motto splashed across the Tourette Syndrome Association website: "I have Tourette's, but Tourette's Doesn't Have Me." They inspire family and friends, most awed by their accomplishments. They refuse to let Tourette's stand in their way and hope their stories will motivate others to compete.

'An itch that won't go away'

Imagine an itch that won't go away. One so insistent and irritating, you can't suppress the urge to scratch it. Now imagine that itch inside your head. That's how Leyton describes his Tourette's. "I can't scratch it by hand," he said. So, Leyton twitches his head for relief — sometimes even on the soccer field — and it feels like a good fingernails-down-your-back scratch, at least for the moment.

Kellen's eyes grow wide at hearing Leyton's depiction. "That's exactly what it feels like, having that itch, and the only way you can try to make it go away is to move it," he said.

Both 18-year-olds also suffer from Obsessive-Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD), often sidekicks of Tourette's.

Kellen's Tourette's was diagnosed at age five, when he began making loud humming noises — head movements are rare and his only tic seems to be elongated eye blinks. His condition has improved drastically over the past year, through medications and a new behavioural treatment, although a back injury prevented him from playing basketball and baseball as a senior at Bothell High this year.

Leyton was about the same age when he displayed a verbal tic — a frequent clearing of his throat — and a preschool teacher once told his parents he was too disruptive to be in class.

But it was just last spring that Mark and Denise Thommasen sought an official diagnosis for what they had already surmised — that Leyton already controls on his own.

Just as Tourette's varies in severity, so parents find different ways to deal with it, according to Dr Geoffrey Wiegand, a clinical psychologist at Children's Hospital in Seattle who specialises in Tourette's and OCD.

"Nobody wants their child to have anything wrong," he said, noting some parents might not notice subtle tics. "A lot of people will say, 'They'll grow out of it', and a lot of times that's the kind of advice paediatricians are giving parents."

As many as 30% actually do grow out of it, according to Dr Wiegand. "The unfortunate thing is we don't know which 30% that's going to be," he said.

An Oprah moment

Denise's OMG moment came while watching Oprah when Leyton was in seventh grade. He'd gone through myriad maladies — from hearing loss (he once wore hearing aids) to peanut allergies to being hot all the time. It always seemed like one little thing after another. Denise never considered Tourette's, until she watched an Oprah show featuring a boy who displayed many of Leyton's characteristics.

"I watched that show, and it just hit me, oh my God, he has Tourette's," she said.

Mark wasn't buying it, although he now admits he was in denial. "In the back of my mind, everything added up," he said.

Leyton thrived in school and sports, especially soccer, and for the most part controlled his tics — although his neck and hand movements were particularly bad as he reached puberty, when Tourette's tends to peak. "You would have thought he was a third-base coach with all the tics he was doing," Mark said.

But none of them, including Leyton, thought he needed any outside help. Only when he struggled a bit in a Spanish class last year, did they decide to seek an official diagnosis. Students with disorders like Tourette's often receive special considerations for taking tests, like additional time. But once afforded that opportunity, Leyton turned it down.

"He decided he didn't want to be treated any different," Mark said. "He wanted to be like the rest of the kids."

Leyton, a B-plus student who will attend and play soccer for Pacific University in Oregon, shrugs off his disorders and is genuinely more annoyed by his mother's overprotective nature (she is a self-proclaimed mama bear) than the fact he has Tourette's. "I honestly don't care," he said. "I'm one of those people who likes to block things out."

Shrugging it off

For a while, the Websters thought their son's Tourette's might be mild, too. Most of Kellen's verbal tics quieted down until he reached junior high, and then some mild medication helped.

His Tourette's flared up occasionally, but he sailed through his sophomore year in high school as a starter in basketball and baseball. A six-foot-three guard, Kellen flew onto the college recruiting radar by hitting eight three-pointers at the 4A state tournament, one shy of the record.

Then the wheels fell off that summer as his Tourette's raged. His head nearly spun like a top, and he punched himself black and blue. He clapped and clucked and barked, and during one baseball game, his mouth stuck open.

His parents had a neurologist on speed dial and Kellen tried multiple medications. He began working with Dr Wiegand and became one of the first in the state to learn Comprehensive Behavioural Intervention for Tics (CBIT), which ultimately worked wonders.

Kellen was able to play basketball — sometimes sinking three-pointers with his head turned away from the hoop — until he suffered three concussions, his balance a casualty of his meds. He returned for baseball, but quit batting partway through the season for safety reasons — he might get beaned not watching the ball.

His team, the Cougars, reached the regional tournament, when Kellen selflessly told his coaches the team had a better chance with someone else at shortstop as his condition flared again. They lost to Kentwood by a run. 

While Leyton's Tourette's hasn't affected his athletic abilities, Kellen wishes he could say the same thing.

Tics have never made Leyton miss a soccer ball and he is among the top goalkeepers in the state. And he has a role model in Tim Howard, goalkeeper for the US National Soccer Team who has Tourette's.

Kellen's coaches say he could play at least Division II baseball and/or basketball, when his condition is under control.

Dr Wiegand said he believes sports can be therapeutic for Tourette's patients, especially those with depression, like Kellen. "Physical activity and social activity are really the two anecdotes to depression," he said. "And for those not doing well in school, it gives them another area of their life where they can excel and base their self-esteem."

But Kellen admits one reason he didn't push returning to the baseball team this spring, if his back allowed, was the fear his symptoms would rear again. "I don't want to sound overdramatic, but it was kind of scarring," he said of the struggles. "I didn't really want to risk it."

Yet, he asks for no one's pity. "It was hard for me to have the game taken away from me like that, with what I have, but my dad always says it will make me a better person, because everyone's going to face adversity, and I face it a lot, which I think will make me a better person," he said.

A month ago, Kellen thought he'd give up baseball and basketball to attend Washington State University, but he recently reconsidered and might pursue both at Bellevue College. "I missed it," he said.

About Tourette's

Tourette Syndrome is a neurological disorder characterised by repetitive involuntary movements and vocalisations called tics. The disorder is named for Dr Georges Gilles de la Tourette, a French neurologist who, in 1885, first described the condition in an 86-year-old French woman. Males are affected about three to four times more often than females. Most people with the condition experience their worst tic symptoms in their early teens. – The Seattle Times/McClatchy-Tribune Information Services

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