A new report links remnants of a once-common pesticide to lung infections and wheezing in kids exposed to the chemical before birth.

Known as DDE, the compound is a broken-down form of the harmful pesticide DDT and is found in many places around the world. it is absorbed into a person’s body when they eat contaminated food or breathe contaminated dust.

The study, published in the European Respiratory Journal, shows babies exposed to high levels of DDE in the womb grew up to have higher rates of pneumonia and bronchitis.

“We found that the risk of infections and wheeze increased with increasing DDE exposure,” Martine Vrijheid, associate professor at the Centre for Research in Environmental Epidemiology in Spain, told Reuters Health by email.

Vrijheid and her colleagues took blood samples from a large group of pregnant women in Spain, measuring the women’s exposure to three different pollutants.

Later, when the babies were about a year old, the researchers asked the mothers whether their toddlers had had breathing trouble or lung infections.

About 35 percent of the 1,342 children developed a lung infection within their first year, the team found, and the risk rose in tandem with the DDE levels in the mother’s blood.

Vrijheid estimates that with undetectable or very low levels of DDE, only 30 percent of the children would have developed infections.

The new study is the largest of its kind, according to the researcher. Past work has yielded mixed results, and until now has failed to show a significant association between DDE exposure and lung infections within a child’s first year of life.

DDT was once widely used to kill mosquitoes and prevent malaria outbreaks, but its use was called into question in the 1960s and was banned in the U.S. in 1973. But it and its breakdown products can last in the environment for hundreds of years.

People exposed to large amounts of DDT may experience tremors, seizures, sweating, headaches and vomiting, according to the Centers for Disease Control and Prevention. But those symptoms disappear when the person is no longer exposed to the pesticide.

Barbara Cohn, the director of Child Health and Development Studies at the Public Health Institute in California, told Reuters Health that DDT and its remains have been hard to study because of the time needed for it to show up in people.

“People thought it was a miracle compound,” said Cohn. “Nobody really knew what might be happening.”

DDT is still used in some parts of the world, because it is considered the best way to kill malaria-carrying mosquitoes, said Vrijheid.

In 2006, the World Health Organization sanctioned an altered technique for using DDT, which involves spraying the pesticide on the inside of a building to kill mosquitoes that land on its walls and other surfaces.

Vrijheid told Reuters Health that it’s hard to avoid chemicals like DDT and DDE, which are stored in fat and found in higher concentrations at the top of the food chain.

“One way of reducing exposure is by reducing the consumption of fatty foods and increasing the consumption of vegetables and fruits,” she said. “This does not mean we should stop eating meat, yogurts or certain types of fish, but just that we should have (a balanced) diet.”

(Reuters Health) – Though millions will turn to the herb echinacea for some relief this cold season, a study out Monday suggests they will get little, if any, benefit.

Based on their findings, the researchers say they cannot recommend the popular herbal remedy to cold sufferers. But they are not advising people against using it, either.

Echinacea, which is derived from the coneflower, has long been touted as a way to bolster immunity and prevent or ease the common cold.

Over the years, though, studies have come to conflicting conclusions as to whether the herb really works. And even the positive ones have generally suggested modest benefits at best.

In this latest study, published in the Annals of Internal Medicine, researchers pitted an echinacea supplement against inactive placebo pills for easing cold symptoms among 719 adults and teenagers.

They found that echinacea users recovered slightly more quickly — an average of a half-day sooner — and reported somewhat less severe symptoms.

But even those small differences were not quite statistically significant, which means they could have been due to chance.

“this echinacea formulation, which is a good one, did not show any major effect,” said lead researcher Dr. Bruce Barrett, of the University of Wisconsin-Madison.

On the other hand, he told Reuters Health, the findings do not rule out the possibility of a modest benefit.

Barrett said that while some experts will consider this study the “final nail in the coffin” for echinacea as a cold fighter, the positive findings from some past studies complicate the picture.

“before this trial, the evidence was inconclusive,” Barrett said. “And I don’t think we’re past the inconclusive stage.”

So what does that mean for cold sufferers right now? according to Barrett, it depends.

“If you’re an adult who has tried echinacea in the past and been happy with it, this study does not say you should stop using it,” he said. “on the other hand, it certainly doesn’t tell you should start.”

The problem with the common cold is that it can be caused by any of over 200 different viruses. so it is ubiquitous (Americans alone come down with 1 billion colds each year) and resistant to the treatments we throw at it, with symptoms like congestion, sore throat and cough often lasting up to two weeks.

There are treatments that can make symptoms less severe, like acetaminophen for the headache and decongestants for the stuffy nose. But nothing — from cold medications to vitamin C — seems to speed recovery from the infection.

“there are no treatments out there that have been shown to reduce the duration of colds,” Barrett said.

And though a decongestant or cough suppressant might bring some temporary reprieve, they can also have side effects like dizziness, drowsiness or insomnia. so many people opt for alternative remedies that are commonly seen as safer. one study found that from 2000 to 2006, Americans shelled out between $100 million and $200 million per year on echinacea alone.

For the current study, Barrett’s team recruited 719 12- to 80-year-olds who had developed cold symptoms within the past 36 hours. They randomly assigned the patients to take nothing, use placebo tablets or use echinacea tablets; of the echinacea users, half knew they were taking the herb, while the half did not whether they were taking echinacea or the placebo.

The echinacea groups took a formulation made from the root of the plant, which is rich in constituents that, some studies suggest, would be most likely to battle cold symptoms. The patients took eight echinacea tablets on the first day of the study, then four a day over the next four days.

On average, the study found, people in both echinacea groups suffered cold symptoms for between six and seven days. The placebo and no-pill groups differed from them by only a matter of hours — roughly a half-day.

Similarly, there was no clear difference when the researchers looked at the groups’ self-rated symptom severity, which each patient had recorded twice a day while the cold lasted.

The researchers found no evidence that echinacea users suffered side effects, like headache, stomach upset or diarrhea, at a higher rate than the untreated groups.

That’s in line with the low risk of side effects studies have generally found when echinacea is taken as directed — though there is a small chance of allergic reaction.

As far as effectiveness, however, even the studies with positive results suggest echinacea has only modest benefits against cold symptoms.

“No large, well-done clinical trial has shown a large benefit,” Barrett said. “It doesn’t stop a cold in its tracks, that’s for sure.”

For people looking for non-drug ways to soften the blow of cold season, Barrett suggested tactics like getting plenty of fluids, getting enough rest and, yes, having some old-fashioned chicken soup.

Those things may not chase away a cold, but they can help you feel better while it’s around, he said.

The current study was funded by the U.S. National Institutes of Health and the Robert Wood Johnson Foundation. some of the co-researchers on the work are with Warwick, Australia-based MediHerb, maker of the echinacea product used in the study.

Sources

link.reuters.com/fuz54p Annals of Internal Medicine, December 21, 2010.

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NEW YORK (Reuters Health) — People with long-lasting depression may benefit from talk therapy when other treatment methods such as antidepressant drugs alone aren't working, suggests a new study. But the topic needs more research, the authors say – and they also point out that talk therapy isn't accessible or affordable for everyone.

About 15 million adults in America suffer from major depressive disorder – serious cases of depression that last more than two weeks – in any given year, according to the National Institute of Mental Health. Most people who are diagnosed with major depressive disorder get prescribed an antidepressant rather than going straight into talk therapy, explained Dr. Ranak Trivedi, the lead author on the current study from the University of Washington School of Public Health.

But up to half of those people might not feel any better after they start taking the medication, she said.

Guidelines point doctors to a few different options for treating patients who don't respond to their first antidepressant drug. the doctor can add a new antidepressant to the first one, or switch drugs completely. Sometimes it takes several attempts to find the drug or drugs that will help the patient feel better. They can also refer the patient to talk therapy, either in addition to medication or instead of medication.

However, "though the guidelines seem to suggest there are four ways to approach treating people who don't respond to (the first) treatment, we tend to gravitate toward giving medication," Trivedi told Reuters Health.

To see if patients could be getting more out of talk therapy instead of switching between different antidepressants, Trivedi and her colleagues reviewed a series of seven studies involving nearly 600 adults with major depressive disorder who hadn't been helped by medication.

In each of the studies, researchers either took patients off antidepressant medications and substituted talk therapy, or they added therapy on top of patients' usual medication routine. then they compared those patients to others who stayed on their antidepressant drug, switched to a new drug, or had another drug added to their original medication – but didn't have any talk therapy.

Each of the studies was a "randomized" trial, meaning participants and doctors didn't get to choose which treatment the patients got; instead, the assignments were made by chance. This type of study is the most reliable.

Taken together, the results published in the Journal of General Internal Medicine were generally favorable. Some of the studies suggested that patients improved more when they were in therapy and on medication than when they were only taking medication. others showed that adding or switching to talk therapy was beneficial, but not any more so than changing a patient's prescription or having the patient take additional drugs.

Researchers say the results show that talk therapy may be promising for people who don't get better on medication – but they also reflect the fact that many more studies are needed.

As it becomes clearer that the first try at an antidepressant doesn't work for many people, "it's apparent that greater attention needs to be paid to this whole other avenue of treatment for people who aren't responding to first and second and third choice medications," Dr. Michael Thase told Reuters Health. Thase, a psychiatrist at the University of Pennsylvania School of Medicine, has participated in some of the research that suggests that talk therapy can be beneficial. (He wasn't involved in Trivedi's study, however.)

For some patients, however, getting access to talk therapy is more difficult and costly than taking medications, which have gotten cheaper as generic versions became available. As of August 2010, according to data from Wolters Kluwer Pharma Solutions reported by Consumer Reports, average monthly costs for antidepressants were as low, for example, as $19 for fluoxetine (the generic form of Prozac), $26 for sertraline (Zoloft), and $35 for citalopram (Celexa).

Talk therapy costs more than medication, at least in the short term. And insurance companies often put limits on reimbursements (although new rules issued by the Obama administration are intended to improve coverage of mental health care for people whose insurance comes through their employers).

But Trivedi said that in the long run, talk therapy may well be worth it. "People who take antidepressants often end up taking them for life," she said. with talk therapy, patients often go for a few months, or sometimes a few years, and then stop when their symptoms have gone away.

The bottom line is, treatment choices should come down to what the patient prefers, Thase said. In the early stages of chronic depression, "you should pick the (treatment) that you want, or the combination, and go with that. then consider the alternative if three months into it you're no better."

Trivedi agreed that people with depression should try to be attuned to the kind of help they want and need, while not losing hope of getting better. for those with chronic depression, she said, "keep at it. If you don't respond to the first treatment, you're not alone."

SOURCE: bit.ly/dMfUcd Journal of General Internal Medicine, online December 24, 2010.

NEW YORK | Thu Dec 9, 2010 4:19pm EST

NEW YORK (Reuters Health) – Under-the-tongue tablets may be a safe alternative to allergy shots for people who don’t get enough relief for their itchy eyes and runny noses with standard drugs, according to scientists who reviewed 60 studies on the treatment.

Allergy shots build up the immune system’s tolerance by exposing it to increasing amounts of the substance that’s bothering it, such as pollen, dust mites or cat dander.

But the shots can be uncomfortable and lead to itching, swelling or other more serious reactions. So researchers have been testing needle-free alternatives, either in a daily tablet or as drops left under the tongue, which patients can self-administer at home — so-called sublingual immunotherapy.

“Sublingual immunotherapy seems to be as effective as other treatments such as antihistamines and nasal steroids,” senior researcher Dr. Stephen Durham of the Royal Brompton Hospital in London said in an e-mail. “And it has the added value of long-term benefits after its discontinuation.”

Pooling the results of earlier studies, including some 5,000 patients, Durham and his colleagues found “allergy tablets” worked better for both adults and children than a dummy tablet lacking the immune triggers, or allergens.

Patients on the active therapy required less medication and reported fewer allergy symptoms than those given the placebo, especially when taking the tablets for 12 months or longer.

And none of them experienced any serious or life-threatening reactions, report the British researchers in the Cochrane Library.

The findings update a 2003 review, which also concluded that allergy tablets may be a good option for some of the 10 to 25 percent of Westerners who struggle with seasonal or chronic allergies.

Dr. Sandra Lin of Johns Hopkins University, in Baltimore, who was not involved in the review, said her patients generally tolerate the new treatment very well. she has, however, seen some minor side effects such as tingling or itching under the tongue.

“Both routes are effective, but it appears that sublingual may be safer than injections,” she told Reuters Health. “Of course, you still need to take precautions.”

Both Lin and Durham note the need for more head-to-head comparisons of the needle and under-the-tongue therapy routes.

The costs of allergy tablets generally range from $1 to $2 a day, but can vary widely depending on the dosage and number of allergens included, Lin noted. since the U.S. Food and Drug Administration has not yet approved the treatment, insurance companies usually won’t pay.

Injections, on the other hand, may be covered, although some patients can still pay between $15 and $30 for their weekly injections. After the first year of treatment, however, patients can generally cut back on the frequency.

“And then there’s the hidden costs, like having to take time off from work, drive and park to come into the office,” said Lin.

“I think the convenience of the (sublingual) therapy is really appealing. And I don’t think there are a lot of kids below 6th grade that are willing to tolerate the weekly injections,” she added. “This is opening it up to children.”

SOURCE: link.reuters.com/hyp49q Cochrane Database of Systematic Reviews, December 2010.