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[check mark] A Cure For Bad Breath?


[check mark] New Food Allergy Guidelines


[check mark] Bigger People, Bigger Pain


No Strong Evidence for Treating Strong Breath

Halitosis, a general term used to describe any disagreeable breath odor, usually originates from the gums and from the furrows on the surface of the tongue. Odor is caused by accumulated bacteria created by the decay of food particles and other debris in the mouth. The decay and debris produce volatile sulfur compounds that can cause "bad breath." Despite widespread use of mouthwashes, breath mints, sprays, chewing gums, and mechanical tongue cleaning, research is inconclusive about the best method for attacking bad breath.


In a recent evidence review by Butm, coinvestigator Zbys Fedorowicz said, "from the results of some low-powered trials, tongue cleaning, scraping and brushing do appear to have some benefit at reducing halitosis, and the effects appear to be short lived, but we were unable to find any reliable evidence confirming any benefits of using tongue-scraping over mouthwash, or vice versa, at reducing halitosis."


Currently, there are no standard and well-accepted methods for treating the odor associated with halitosis. Mouthwashes, mints, gums, and sprays provide a competing and temporary smell that masks the odor. Some mouth rinses have ingredients that can neutralize the odor or the bacteria that produce it.


Odor-causing bacteria can also be reduced through improving oral hygiene and by tongue cleaning, including brushing or scraping of the tongue to dislodge trapped food, cells, and bacteria from the taste buds. A variety of mechanical tongue scrapers and tongue cleaners are also commercially available.


Although Dr Fedorowicz said tongue brushing, scraping, and cleaning "have been in and out of vogue with no apparent clear guidance from the dental profession," the review authors all recommend periodic use of a brush.


Source: The Cochrane Database of Systematic Reviews, 2006, Issue 2.


New Guidelines Reveal the Complexity of Food Allergy Management

Allergists representing 3 organizations have developed evidence-based guidelines called "practice parameters" for food allergy diagnosis and management, which have become more sophisticated and challenging in recent years because of the increase in the prevalence of certain food allergies and important scientific developments.


The guidelines provide practicing physicians with an evidence-based, broadly accepted approach to the diagnostic evaluation and management of IgE-mediated (allergic) food reactions.


Although adverse food reactions have been reported in up to 25% of the US population at some point in their lives, the prevalence of food allergy, an IgE-mediated response to a food, is much lower than the number of suspected food allergies. It varies between 2% (adults) and 5% (children) in most studies and is higher in individuals with atopic dermatitis, certain pollen sensitivities, or latex sensitivities.


Food allergies are more common in children than in adults. The most common food allergens in infants and young children are cow's milk, hen's egg, peanut (a legume), tree nuts, soybeans, and wheat. Although sensitivity to most allergens is lost in late childhood, allergy to peanut, tree nut, and seafood is likely to continue throughout the patient's life. Only approximately 20% of children with peanut allergy lose their sensitivity. The most common foods causing allergy in adults are peanuts and tree nuts (walnut, hazelnut, and Brazil nut).


Because of the recent developments in laboratory technology, it has become common practice for physicians to order blood tests for 20 or 30 foods when testing for other allergies, even when there is no history of allergic food reactions. A detailed discussion of skin prick or puncture tests, serologic tests for specific IgE, and oral food challenges is provided in the practice parameter.


The guidelines recommend carrying more than 1 epinephrine autoinjector because anaphylactic reactions may be prolonged. The guidelines suggest that victims seek immediate medical care after a reaction and that they be monitored for an appropriate period. Most fatal and near-fatal food allergic reactions in the United States are caused by peanut and tree nuts, often with delayed administration of injectable epinephrine. The guidelines also include recommendations for food allergy management in special settings and circumstances, where patients have an increased risk for unintentional food allergy exposure.


Patient information on food allergies and other allergic diseases is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at or the AAAAI Web site at For food allergy patient information or support, call FAAN at 800-929-4040 or visit for a complete set of guidelines.


Obese People May Be More Sensitive to Pain

Obese people may be more sensitive to pain than are their thinner peers who are not obese, a new study suggests. All of the older adults who completed this study had osteoarthritis of the knee, a disease that causes inflammation and extreme pain in the knees. Also called degenerative joint disease, osteoarthritis affects more than 20 million people in the United States.


The participants were given a mild electrical stimulation on their left ankle to measure their pain reflex. Before and after, the participants took part in a 45-minute coping skills training session that included a progressive muscle relaxation exercise.


Obese patients showed a greater physical response to the electrical stimulation than did the nonobese patients, both before and after the training session. This indicates that they had lower tolerance for the painful stimulation despite reporting in the questionnaires that they felt no more pain than did the nonobese people.


About a third of the study's 62 participants were obese, with body mass index scores of 30 to 35. The participants underwent 2 rounds of electrical stimulation-once before and once after a 45-minute training session where they learned different ways of coping with pain, including instruction in progressive muscle relaxation therapy.


All participants, obese or not, reported that they felt less pain after the relaxation session than they did before. However, the results of the nerve stimulus test showed that the obese participants did not tolerate the painful stimulus as well as the nonobese individuals did.


Source: American Psychosomatic Society annual meeting.


Exercise and Diet Program Improves Damaged Nerves and Reduces Pain

Exercise and diet can reduce neuropathic pain and help regenerate nerve fibers in patients with impaired glucose tolerance ("prediabetes"), according to research presented at the 2006 American Academy of Neurology Meeting.


Impaired glucose tolerance is found in 40% of patients with idiopathic neuropathy (nerve damage with no identified secondary cause). Impaired glucose tolerance neuropathy (IGTN) is characterized by loss of nerve fibers in the skin and is painful. It is thought that IGTN represents the earliest stage of diabetic neuropathy.


Diabetic neuropathy does not improve with any currently available treatment. Patients with impaired glucose tolerance are at risk for developing diabetes, but a program of diet and exercise counseling can reduce it. To test whether this same program could improve IGTN, researchers studied 32 patients over the course of 1 year while they received individualized dietary and exercise counseling.


They found that the number of nerve fibers (measured by taking a small skin biopsy) improved in approximately one third of the patients; those with the worst loss of nerve fibers in their extremities did not improve. However, overall, patients had reduced pain and better functioning of their sensory nerves.


The findings indicate that diet and exercise counseling for patients with IGTN may result in nerve regeneration and possibly suggest that the earliest stage of prediabetic nerve injury may be reversible.


Source: American Academy of Neurology annual meeting.


Source: Ann Allergy Asthma Immunol. 2006;96(no. 3, suppl 2).


Milk Avoidance During Pregnancy Is Linked to Lower Birth Weight

Women who spurn milk during pregnancy to avoid gaining weight tend to have lighter babies. In fact, both milk consumption and vitamin D intake were significant predictors of birth weight, according to researchers at McGill University in Canada. They suggest that most pregnant women should not avoid milk in an attempt to prevent excessive weight gain during pregnancy or food allergies in their children.


The study followed 72 pregnant women who reported drinking 1 cup or less of milk per day. Pregnancy outcomes in these women were compared with that of approximately 200 pregnant women who reported consuming more than 1 cup of milk per day. One cup of milk provides half of the recommended vitamin D intake for adults. Dietary patterns and vitamin D and other nutrient intake were estimated based on the information gathered.


The women with lower milk intake gave birth to infants who weighed less compared with those of mothers who consumed more milk. In addition, women who drank less milk also had significantly lower estimated daily vitamin D intake and lower daily protein intake than did those who drank more milk, the study found.


The investigators reported that both milk consumption and vitamin D intake were significant predictors of birth weight: Each additional cup of milk daily was associated with a 41-g increase in birth weight, and each additional microgram of vitamin D was associated with an 11-g increase.


Source: Medpage Today/Canadian Medical Association Journal