Why Do Babies Hate Getting Their Nose and Face Wiped???

I have often been asked this question by parents... and even more so by my wife as we try to clean the snot off our little kids' noses as they shriek as if we're torturing them.

Given it seems ALL young kids have this nose-wiping aversion across cultures and racial ethnicities, it would seem that this reflex reaction is hard-wired into human babies. But why would evolution favor this reaction?

I tried to find an answer to this question to see if any bright researchers actually studied this topic, but was unable to find any. So... here are my thoughts on this topic.

To warn other healthy humans

Evolutionarily, it may have been helpful for the human population as a whole if it was obvious to others when an individual was sick. To see a toddler with snot running out the nose, that would have been a pretty clear sign for other children and their parents to stay away lest they also get sick. This isolation of a sick child would have been nature's way of quarantining to prevent spread of illness to the rest of the human group.

To get eaten by predators

Not to be morbid, but predators tend to feed on the sick. It is nature's cruel way of removing the weakest in an animal population which over time will only strengthen the prey animal population as a whole (Darwin's theory of only the fittest survive). Back in the REALLY old days (caveman era), sick humans would have been just such a prey that would have been targeted by wild predator animals. To be not just a young human, but one that also shows signs of illness would be indicators to a predator of who to go after.

Protect the airway

This is my wife's favorite theory who feels the last idea to be horrible and inhuman (never mind that just because evolution is horrible and inhuman does not make it false). This airway idea is based on the fact that breathing is essential to life. Anything that covers the nose or mouth, even briefly, is a potential hazard that may lead to death. Evolutionarily, this reflex would be favored and strengthened over time... even if avoidance involves just a quick wipe. Who knows? Perhaps SIDS (Sudden Infant Death Syndrome) would be much more prevalent if the nose/face wipe aversion was not present.

Any other ideas? Even better, does anybody know of any studies that actually looked into this topic?

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Nasal Spray Cure for the Common Cold?

Well maybe not cure per se, but at least effective treatment to reduce the duration and severity of the viral cold at least. Austrian researchers have reported on the results of a randomized, double-blind, placebo-controlled trial involving 211 patients suffering from early symptoms of the common cold. [link]

Treatment of the non-placebo group involved using a nasal spray containing carrageenan (a sulphated polysaccharide found in red seaweed/algae) three times per day for 7 days. Cold symptoms were found to resolve 2.1 days faster and viral loads in the nasal washings were significantly decreased compared to placebo group. At day 21 of observation, one sixth of patients given the placebo were still ill, while only one twentieth were in the treatment group.

Personally, I would like to see larger studies conducted by other independent groups to verify the findings.

So how does this nasal spray work?

The problem with the common cold is that there are SO many viruses that manifest the same disease including rhinovirus, coronavirus, parainfluenza, influenza, respiratory syncytial virus, adenovirus, enterovirus, and metapneumovirus. As such, an effective treatment should be able to disable all these virus types and not just one.

The way carrageenan works is by sticking to the virus regardless of type and preventing it from attaching to the nasal lining. As such, the virus is unable to enter into the body and cause problems. It essentially blocks the virus like the wall of a castle.

The caveat is that in order for this nasal spray to work, you have to start using the medication as soon as cold symptoms appear (within 2 days). Remember... it works by blocking the virus from entering the body. If you wait too long, the virus has already entered the body making any type of blocking medication ineffective.

Where can you buy it?

It is available over-the-counter in most European countries and Canada. But NOT available in the United States.

The nasal spray is made by Marinomed in Europe using their Mavirex technology and also licensed for marketing/distribution by Boehringer. Carragelose is the brand name of the carrageenan ingredient. Depending on the country, the actual name of the nasal spray is sold under is different.

For example, in England, the nasal spray is called "Cold and Flu Defence Nasal Spray".

To make sure you have the right nasal spray, look under ingredients and make sure carragelose is listed.

On another note... Afrin nasal spray has also been shown to have some anti-viral activity in unpublished reports. Just be aware to not use it more than 3 days or else you may get addicted to it.


References:
Efficacy of a Carrageenan nasal spray in patients with common cold: a randomized controlled trial. Respiratory Research 2013, 14:124 doi:10.1186/1465-9921-14-124

Efficacy and safety of an antiviral Iota-Carrageenan nasal spray: a randomized, double-blind, placebo-controlled exploratory study in volunteers with early symptoms of the common cold. Respir Res 2010. doi:10.1186/1465-9921-11-108

Lessons learned from a double-blind randomised placebo-controlled study with a iota-carrageenan nasal spray as medical device in children with acute symptoms of common cold. BMC Complement Altern Med 2012. doi:10.1186/1472-6882-12-147

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Vaccine to Prevent Throat Cancer

Spread through oral sex, it is well established that human papilloma virus (HPV) types 16 and 18 cause the vast majority of throat cancer especially in men... even more than smoking and drinking alcohol. What was not known, but suspected, was whether in BOTH men and women the HPV vaccine Cervarix (made by GSK) or Gardasil (made by Merck) would help prevent throat cancer as effectively as cervical cancer for which it is FDA approved for.

At least for the vaccine Cervarix, a randomized, control, double-blinded, prospective study has shown that it highly protects individuals from HPV 16 and 18 infection in the mouth/throat. The vaccine efficacy was calculated to be 93.3%. The big assumption being that reduced oral HPV 16/18 would lead to a decreased risk of throat cancer.

It is for these reasons that BOTH boys and girls are encouraged to get the HPV vaccine. We are talking about protecting our sons and daughters from getting throat and cervical CANCER later in life.

To be clear, more study is needed to really PROVE that such vaccines prevent throat cancer. For full disclosure, the weaknesses of this current study are as follows:

• It was performed only in women (the study would need to be replicated in males)
• The study lasted only 4 years... the question is whether life-long protection is present or will booster shots be needed?
• Does Gardasil also work for oral HPV 16/18?
• Does reduced HPV 16/18 presence in spit actually translate to decreased risk of throat cancer
• It is suspected that vaginal secretions carry a higher HPV viral load than the penis leading to a higher risk of throat cancer in men performing oral sex on infected women. As such, the other questions that need to be answered is whether such vaccines will:
     • Prevent a vaccinated woman from giving HPV to the man as well as
     • Prevent an infected woman to actually infect a vaccinated man?
     • Or, does BOTH partners need to be vaccinated to prevent HPV throat cancer?

It is truly an exciting time when vaccines can be given to prevent not only infections like mumps or shingles, but also cancer!

As a reminder, the HPV vaccines ONLY work when given to children before they become sexually active. It is too late to give the HPV vaccine for sexually active adults (ie, it won't work).

Source:
HPV Vaccine Found to Help With Cancers of Throat. NYT 7/18/13

Reference:
Reduced Prevalence of Oral Human Papillomavirus (HPV) 4 Years after Bivalent HPV Vaccination in a Randomized Clinical Trial in Costa Rica. PLOS One

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Can HPV be Caught by Kissing Someone with HPV Throat Cancer?

HPV transmitted by oral sex is the leading cause of oral and throat cancer now. And for spouses/partners of patients diagnosed with HPV throat cancer, the main concern is whether it is "contagious".

After all, if HPV is transmittable by oral sex, than it would seem that kissing can also transfer HPV to the partner as well.

Well, a small Johns Hopkins study suggests that intimately kissing someone who has HPV oropharyngeal cancer does NOT lead to a new HPV infection in the mouth or throat in the partner. Among 93 partners of 164 patients, prevalence of HPV infection in the throat was no higher than would have been expected. Specifically, about 1.2% had HPV which is equivalent to what one would find in couples without history of HPV throat cancer (1.3%). There were only six male partners, none of whom had oral infection with HPV.

Please keep in mind that this study is far from definitive and further study is required before one can say with absolute certainty that kissing and other intimate activities are totally safe. After all, oral sex leading to HPV infection of the mouth is a relatively recent discovery. Who is to say that with enough time and study, even kissing may eventually be found to do the same???

The study was originally presented at the 2013 annual meeting of the American Society for Clinical Oncology and published in April 2014.

Reference:
Oral Human Papillomavirus (HPV) Infection in HPV-Positive Patients With Oropharyngeal Cancer and Their Partners. Journal of Clinical Oncology. April 28, 2014, doi: 10.1200/JCO.2014.55.1341

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Just How Contagious is the Flu (and Other Viral Infections)?

Everybody knows the flu and other viral infections are contagious, but did you wonder just how contagious???

Well, here are some facts gleaned from a few studies:

• In just 4 hours, one sick worker can contaminate 50% of surfaces in a typical office
• After 8 hours, one sick worker can contaminate 70%+ of surfaces
• Non-sick workers have a 40-90% chance of getting infected after spending one day with a sick worker
• A sneeze or cough can hurl virus 6 feet away from the mouth
• A sick person literally "emanates" virus up to 6 feet away... even if they are NOT sneezing or coughing.
• Some sick individuals are super-carriers spreading the virus around them 32 times more than others

The good news is that viruses can not survive on surfaces for long... They usually die off within a day (type of surface, temperature, and humidity affecting duration).

Source:
Flu Virus Can Travel Up to 6 Feet, Infect Up to 90 Percent of People Just from Contaminated Surfaces. Medical Daily News 2/1/13

References:
Exposure to Influenza Virus Aerosols During Routine Patient Care. J Infect Dis. 2013 Jan 30. [Epub ahead of print]

InfluenzaVirus: Here, There, Especially Air? J Infect Dis. (2013) doi: 10.1093/infdis/jis774

Germs Spread Fast at Work, Study Finds. AHSC 1/30/13

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Infographic: HPV from Oral Sex Causes Throat Cancer

I have blogged in the past regarding how HPV transmitted through oral sex (and potentially even French kissing) has now become the number 1 cause of throat cancer in individuals under the age of 50, even more than smoking and drinking alcohol [link]. Of course, smoking and alcohol further exacerbates this risk.

Indeed, A 2007 study in the New England Journal of Medicine found that younger people with head and neck cancers who tested positive for oral HPV infection were more likely to have had multiple vaginal and oral sex partners in their lifetime. Having six or more oral sex partners over a lifetime was associated with a 3.4 times higher risk for oropharyngeal cancer; cancers of the base of the tongue, back of the throat, or tonsils. Having 26 or more vaginal-sex partners tripled the risk. The association continued to increase as the number of partners in either category increased. Of greater concern is that "French" kissing may also potentially be a mode of transmission.

In any case, Mt. Sinai Hospital published a great infographic to further educate the risks of oral sex. Needless to say, if you find/see an abnormal bump in the mouth, talk to your doctor about it!

References:
Human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007 Sep 13;357(11):1157; author reply 1157-8

Human papillomaviruses in head and neck carcinomas. N Engl J Med. 2007 May 10;356(19):1993-5.

Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007 May 10;356(19):1944-56.

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How Long Does it Take for a Cough to Clear Up?

Hypothetically speaking, how long would it take for a cough to clear up if a person comes down with an acute respiratory infection?

According to a telephone survey of 493 adults, the lay-public expect the cough to clear up in 7 to 9 days.

Now, is this one week guess actually true?

Not at all... In reality, it takes about 17.8 days on average.

This number was determined on a recent study that reviewed 19 prior studies that determined how long a cough lasts for.

It should also be mentioned that taking antibiotics does little to shorten this duration, especially given most upper respiratory infections are due to viruses.

In any case, the disconnect between patient expectations and reality in cough duration probably leads to some frustration between physicians and their patients.


Reference:
How Long Does a Cough Last? Comparing Patients’ Expectations With Data From a Systematic Review of the Literature. Annals of Family Medicine. doi: 10.1370/afm.1430 Ann Fam Med January/February 2013 vol. 11 no. 1 5-13

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Arena Stage 'My Fair Lady' Laid Low by the Flu with Performance Cancellations

It has been an early and bad start to the flu season in the DC metro area. It is just the beginning of the traditional 3 month flu season and flu numbers have already exceeded last year's.

Although professional singers may feel they should have a special exemption from this debilitating illness which also adversely affects the voice, it is not to be...

The flu has literally crippled performances of "My Fair Lady" at the Arena Stage this season with two show cancellations and another possible show cancellation this past Saturday Jan 5, 2013 when both the lead singer AND understudy were unable to perform due to laryngitis. It was not just the lead singer out with the flu, but also 3 other parts which fortunately did have understudy coverage. [more]

However, rather than canceling the show, the show did go on with the lead role being performed by a member of the regular ensemble with script in hand and only a few hours of rehearsal.

Sounds like an episode of the TV show "Smash," but apparently the ensemble singer Hannah Willman did spectacularly well.

I'm also sure Arena Stage breathed a sigh of relief not just for the standing ovation, but also because it was the show's last weekend.

Source:
‘My Fair Lady’ replacement shines at Arena Stage in an unforgettable evening. Washington Post 1/6/13

Flu spreading earlier, faster than usual this season. Washington Post 1/6/13

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"Bitter" Taste Sense Contributes to Immune Defense

As children, we all learned about the 4 different taste qualities the human tongue can appreciate: salty, sugar, bitter, and sour. Savory or umami was added in 1985. "Calcium" has been proposed in 2008 as well as more recently, "fatty" taste.

However, we are slowly learning that "taste" is much more complex than simply the ability to perceive the taste qualities associated with food.

That tongue map we all memorized in elementary school? It's a lie... Read more here.

But even cooler... the "bitter" taste may actually help fight infections!

University of Pennsylvania researchers have discovered that the bitter taste receptor T2R38 also participates in upper airway immune defense.

They demonstrated that the T2R38 receptor was expressed in the upper respiratory tract lining and could be activated by molecules (acyl-homoserine lactone) secreted by Pseudomonas aeruginosa and other gram-negative bacteria (staph and strep are gram-positive bacteria). When the receptor is activated, it stimulates muco-ciliary clearance and initiates direct cellular antibacterial effects.

Furthermore, small mutations in the T2R38 gene had a direct influence on the frequency of bacterial sinus infections.

These findings may explain WHY some patients are more prone to getting infections versus another patient... It's because of their bitter taste receptor!

Reference:
T2R38 taste receptor polymorphisms underlie susceptibility to upper respiratory infection. J Clin Invest. doi:10.1172/JCI64240.

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How Many Infections in a Child is "Normal" Per Year?

Kids get a lot of infections... but at what point should a parent be concerned on how often these infections occur, particularly upper respiratory infections?

A German study went about to determine the answer to just that question... They prospectively followed 760 children born in 1990 and followed them for 12 years. Parents recorded the child’s illnesses in a diary and answered structured questions yearly up to age 12.

This is what they found... The mean number of infections per year for each age group (standard deviation):

• 0-2 years: 3.4 episodes (3.7) per year
• 3-5 years: 2.3 episodes (2.6) per year
• 6-12 years: 1.1 episodes (1.2) per year

Two standard deviations above the mean can be still considered within normal limits, though on the high side of normal:

• 0-2 years: 11 episodes per year

• 3-5 years: 8 episodes per year

• 6-12 years: 4 episodes per year

If a child gets more than this number of infections per year, one may need to consider possible immunodeficiency.

Source:

History of respiratory infections in the first 12 yr among children from a birth cohort. Pediatric Allergy and Immunology. Volume 19, Issue 6, pages 505–512, September 2008.

How many respiratory infections in children are "normal" per year? Allergy Notes by Dr. Ves.

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Celine Dion Cancels Shows Due to Laryngitis

In late Feb 2012, Celine Dion who was to have performed in Las Vegas Feb 22, 2012, cancelled her show at the last minute at the Caesar's Palace due to laryngitis on the advice of her doctors. According to media reports, her doctors instructed her to rest for 7 days to ensure full recovery due to vocal cord inflammation caused by a virus.

What does that mean exactly?

When a virus infects the mucosa of the upper airway, it causes inflammation of the mucosa lining including the vocal cords. With inflammation, the vocal cords swell.

That's why with laryngitis, the pitch of the voice decreases and it becomes more effortful to talk. To use an analogy, think of a violin string where the thicker string has a deeper pitch than a thin string. It also takes more power to play the thicker string. Watch the video below of normal vocal cord functioning:


In order for voice production to occur, the lining of the vocal cords vibrates very quickly when they come together. If the vocal cords are swollen, they don't vibrate as easily.

Here's what inflamed vocal cords might have looked like for Celine Dion. Note the slight bend to the vocal cords and overall dull appearance.

Below is what her vocal cords might look like when they are at peak health!

Voice rest is absolutely important for vocal recovery as quickly as possible. With talking/singing during active laryngitis, further trauma may occur to the vocal cord lining promoting even more inflammation and swelling. It may also lead to another vocal disorder known as muscle tension dysphonia.


Source:
Celine Dion cancels act: laryngitis. UPI 2/26/12

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Natural Remedies for a Sore Throat, Cough, and Viral Infections

Homeopathy and alternative medicine often get a bum rap, but they have come up with some treatments for sore throats and upper respiratory viral illnesses that actually have been proven to work.

Here's a few...

1) Honey

Sore throats (and coughing) can be soothed by swallowing honey straight-up or slightly diluted with warm water with honey to make it easier to swallow. The best time to do this is at bedtime given it will stick around for awhile (eating/drinking will wash away the coating). The purpose of honey is to create a throat barrier to ease the discomfort.

Think of it like chapstick to coat irritated lips, but meant for the throat.

Use of honey is also recommended by the World Health Organization which has also published a monogram on viral colds and the various treatments explained. Pay particular close attention to Annex 3 (Page 11) which gives various recipes to treat pediatric cough including the use of honey.

Reference:
Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

2) Humidification

Dry cool air increases risk of viral infections as well as giving it to others. As such, add room humidification to a bedroom and keep the door closed (small room humidifiers can't humidify an entire house... so keep door closed!).

Why does this help? Increased humidification inactivates viruses!

Humidification also helps minimize a persistent dry cough worse at night often due to reactive airway disease triggered by breathing in dry air.

However, keep in mind that if you actively have a viral illness, it is too late for humidity to help. It is best used as a preventative measure.

Reference:
Dynamics of airborne influenza A viruses indoors and dependence on humidity. PLoS One. 2011;6(6):e21481. Epub 2011 Jun 24. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007;3:e151.

Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2011 May 11;(5):CD001728.

3) Gargling and Saline Flushes

Gargle with saline water... or even just tap-water on a daily basis. Why does this help prevent viral infections? It washes away the viral particles before it gets a chance to cause problems.

It's also probably why drinking lots of fluids also helps since the viruses get deactivated in the stomach from the acidic digestion.

Unfortunately, gargling only helps with the throat... saline flushes are required to help with sino-nasal problems.

Reference:
Can we prevent influenza-like illnesses by gargling? Intern Med. 2007;46(18):1623-4. Epub 2007 Sep 14.

4) Xylitol

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly. It comes in nasal spray form as well as gum.

Reference:

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

Conclusion

Sometimes the BEST medicine are things you can do at home without need for a physician visit... and is based on fact rather than anecdotal evidence.

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