You can read more about Dr. Tolan’s impressive credentials below.

To summarize, Dr. Tolan is the real deal, and is perhaps the best-qualified person to answer my question:

Will nasal saline rinses result in death from brain-eating amoeba??

The main points from that conversation are these:

• Using a Neti pot or other methods of doing nasal saline rinses won’t cause your death by brain-eating amoeba.
• Just to be safe, for nasal saline rinses, simply use boiled tap water, or simply buy a jug of distilled water.

There you have it. For the rest of what Dr. Tolan had to say, read on …

Image: Brain-eating amoeba, N. fowleri (image credit: CDC). The central B&W image is a "phase-contrast" from under the microscope; the pics on either side are stained brain tissue showing infection with amoeba ("Amoebic Meningoencephalitis")

As a world-renowned expert on infectious diseases of the central nervous system, I called Dr. Tolan to ask his opinion about the recent cases in the media, specifically cases of “brain-eating Amoeba” – Amoebic Meningoencephalitis (AM), linked to use of a Neti pot.

I wanted to get to the bottom of this because I have colleagues, patients and their families (and readers of this blog), asking me whether it’s safe to be doing nasal saline rinses at all. Are we risking Amoebic Meningitis by doing nasal saline rinses??

There are two reports that I am familiar with, and both have received a lot of attention on the web, in social media like Facebook and Twitter.

Here is what Dr. Tolan had to say:

Boogordoctor: Dr. Tolan, thank you so much for taking time to offer your expert opinion about Amoebic Meningoencephalitis, from Neti pot use.

Dr. Tolan: My pleasure, Dr. Faust, glad to help.

Boogordoctor: Are you familiar with the recent cases of AM linked to Neti pot use?

Dr. Tolan: I am not, since they have not yet been confirmed by the CDC (Centers for Disease Control and Prevention). I have not seen them reported in the MMWR (Morbidity and Mortality Weekly Report). Don’t believe everything that you read on the internet. Many things are sensationalized to boost readership.

On the other hand, there are some important points to make using these examples.

Boogordoctor: Such as?

Dr. Tolan:

• The first point for your readers to keep in mind is that AM is incredibly rare. There are usually about 3 cases per year in this country annually.
• Most of those cases occur after swimming in ponds in warm environments – Southern states.
• The next point to keep in mind is that the organism responsible for those cases is usually Naegleria fowleri. It is important to point out that N. fowleri is EVERYWHERE in our environment, including our municipal water supply. It is ubiquitous.
• N. fowleri is difficult to kill, especially in environments where it is happiest – in the South, for example. There is simply no way to chlorinate our water supply in the South to levels that will eliminate all N. fowleri. The farther South you go, the warmer the water, the greater the risk of having N. fowleri in your tap water (and ponds, lakes, etc.).
• My recommendation is, for people using Neti pots or other methods of nasal saline irrigations, USE DISTILLED WATER, or BOILED tap water. Distilled water is not absolutely sterile, but will have much lower risk of containing amoeba species than tap water.

Regarding these cases of AM related to Neti pot use that are reported online, I will be interested to see what the CDC investigators tell us. Regardless, it is important to emphasize how rare these cases are in this country.

Boogordoctor: Dr. Tolan, that is great advice, and supports what I have been telling people: use distilled water for your Neti pot or squeeze-bottle for nasal saline rinses – whether you use a store-bought salt preparation or make your own from a recipe.

Again, thanks so much for lending your expertise.

Dr. Tolan: You are very welcome, call any time.

My take on this: if you are doing nasal saline rinses, you have little to fear from Amoeba, as long as you are using distilled water or boiled tap water. You have a much (much) higher risk of exposure to N. fowleri by swimming in lakes or ponds in Southern states.

Conclusions

• It’s not about the Neti pot, or even about nasal rinses.
• It’s about the water.
• Just be sure your water is safe. How?
• Use distilled or boiled water for your nasal rinses!

The Life-Cycle of N. fowleri

The image below shows how N. fowleri (and some other amoeba species) get into our brains: simply swimming in ponds or lakes with high concentrations of amoeba (think warm, Southern states), can result in amoeba reaching our noses; they crawl through our “olfactory neuroepithelium” – that part of our noses that give us the sense of smell), and enter our brains that way. Bad news!

Image: Life-cycles of amoeba

Please leave a comment / reply and let us know how you are doing nasal saline rinses.

And thanks for visiting!

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About Dr. Robert Tolan

Dr. Tolan is a world-renowned expert on infections of the central nervous system.

He is currently Chief, Division of Allergy, Immunology and Infectious Diseases, The Children’s Hospital at Saint Peter’s University Hospital, New Brunswick, New Jersey and Clinical Associate Professor of Pediatrics, Drexel University College of Medicine, Philadelphia, Pennsylvania.

He earned a Master’s Degree in Microbiology before earning his Medical Degree at Washington University School of Medicine. Following his training in Pediatrics, he pursued advanced training and research in Infectious Diseases at Washington University/St. Louis Children’s Hospital. He is board certified in Pediatrics by the American Board of Pediatrics, and also the Sub-Board of Infectious Diseases. He teaches at Drexel University, where he is Associate Clinical Professor.

Dr. Tolan’s research is funded by the NIH; he studies various infections in children and infants, and his list of publications is longer than I am tall.

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Resources:

http://new.dhh.louisiana.gov/index.cfm/newsroom/detail/2332

http://www.medicalnewstoday.com/articles/239422.php – be sure to read the comments: this isn’t about Neti pots! It’s about the WATER.

http://health.yahoo.net/articles/flu/neti-pot-deaths-linked-brain-eating-amoeba-tap-water

http://phoenix.about.com/od/health/qt/Ameba.htm

http://www.wwltv.com/news/health/Doctors-explain-cause-of-brain-eating-amoeba-128043523.html

Image Credit:  All images from the CDC (Centers for Disease Control and Prevention) Image Library, in the Public Domain.

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

There are now several well-written reviews about managing allergic rhinitis during pregnancy. “Why should that be a special problem?” you may ask. Well, ANY time a woman who is growing a person inside of them is exposed to medications, there is the potential for harm to her fetus – that little peanut in the ultrasound pic, above. So the question of how to best treat allergic rhinitis during pregnancy poses some special considerations.

I have listed 4 well-written, erudite (scholarly) reviews below, under the Resources heading at the end of this article. Take a look if you are interested.

Allergic? Really?

There is only one problem with treating Rhinitis of Pregnancy as simple Allergic Rhinitis: most often the rhinitis that women experience during pregnancy is NOT from allergies. It’s not Allergic Rhinitis. So those guidelines may not be useful for the severe nasal congestion that you experience during pregnancy.

So, what exactly IS Rhinitis of Pregnancy?

What is causing that severe nasal stuffiness?

Those Pesky Hormones 

My peanut playing on beach (same peanut in the ultrasound, above)

In a word … hormones. The same thing that is causing most of those other changes that you experience during pregnancy. The same hormones that help increase vascular supply to your growing fetus can also cause vascular changes to the nasal lining, causing swelling of the nasal lining, and nasal congestion.

And, according to published studies, rhinitis of pregnancy may affect nearly a third of pregnant women. When severe, rhinitis of pregnancy can cause complete nasal obstruction.

I’ve said before, but it bears repeating – especially if you are pregnant and you are experiencing severe nasal congestion: the best remedy is daily nasal saline rinsing.

Saline rinses are the simplest, most effective remedy for Rhinitis of Pregnancy, but there are others. Things like reducing your exposure to dust, toxins; eat healthy (duh), get plenty of rest (good luck). Re-visit an old post on the Rhinitis of Pregnancy: What it is, What to Do About It? for more tips.

Also visit Nasopure.com for the best nasal rinse system available (the one that I use for my family, and recommend for my patients), and some great videos. There is a popular video there of a three-year-old girl doing nasal rinses. (It’s pretty difficult to whine about doing them once you see a little girl doing them without complaint.)

This topic – Rhinitis of Pregnancy – is THE most popular topic on this blog site. Let us know about YOUR experience. What, if anything, has worked for you? Leave a comment below so that we can all learn from each other.

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Resources

Treating Asthma and Comorbid Allergic Rhinitis in Pregnancy: A Review of the Current Guidelines. Posted on Medscape Today. In the journal, Journal American Board of Family Medicine. 2007;20(3):289-298.
Link: http://www.medscape.com/viewarticle/558444

Treating allergic rhinitis in pregnancy. In the journal, Current Allergy & Asthma Reports. 2006 May;6(3):232-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/16579874

Treatment of allergic rhinitis during pregnancy. In the journal, American Journal of Rhinology. 2004 Jan-Feb;18(1):23-8.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/15035567

Treating allergic rhinitis in pregnancy. Safety considerations. In the journal, Drug Safety. 1999 Apr;20(4):361-75.
Pubmed Link: http://www.ncbi.nlm.nih.gov/pubmed/10230583

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Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

According to the Americam College of Allergy, Asthma, & Immunology:

• More than 50 Million people in the US have allergies
• Adults and children of any age can be tested
• Testing options include Skin tests, or Blood tests
• 2 types of skin tests:
  • Drop of suspected allergen is scratched on the skin surface, usually on the back or forearm; can test many possible allergens at same time
  • Tiny amount of suspected allergen is injected just under the skin (“intra-dermal”); intra-dermal allergy testing is restricted to testing for allergy to insect stings or penicillins
  • For skin tests (both types), positive reactions usually appear within 20 minutes
  • Both types of skin test have little or no pain; positive reactions can cause annoying itching red bumps, like a mosquito bite
  • Note that some medications interfere with allergy testing – especially allergy meds like antihistamines
  • Both kinds of allergy skin tests are thought to be mediated by a type of antibody (IgE) that we make against the allergen
  • Allergy Blood Tests detect the presence of IgE that is made against an allergen.
    The Allergy Blood Tests can be used when: 
    • Patient is taking a medication that can interfere with skin testing, but the medication cannot be stopped for a few days
    • The patient suffers from severe skin condition such as eczema or psoriasis that would either be exacerbated by the testing, or interferes with interpretation of the results
    • Testing with a strong allergen might cause an extra large positive reaction
    • For babies and young children, a single needle stick to draw a small amount of blood to be used for allergy blood testing may be better tolerated than several skin tests
    • Allergy blood tests can take many days to get results
    • Allergy blood tests are generally less sensitive than skin testing methods

Which Test is Better?

Each test type has pluses and minuses.  Using either type of test, the results alone do not diagnose allergies.  Like all test results, they must be interpreted with the medical history.

The Benefits of Testing:

Some people with severe allergic rhinitis, sinusitis, otitis, or asthma (think Unified Airway Disorders), that is not controlled with standard therapy may benefit from allergy testing, if test results enable allergen avoidance or help guide allergy treatment using immunotherapy – either sub-cutaneous or sub-lingual immunotherapy (SCIT or SLIT).

If you enjoy these articles, please share them with others: scroll to the bottom of the page and click on one of the “Be Sociable, Share” buttons – send the link to your Facebook page, or Tweet it, or even just email it to a friend that you think may benefit from the information here! Thanks.

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For More Information on Allergy Testing:

• Allergy Testing. A Review by JAMES T. LI, M.D., PH.D., Mayo Clinic; Published in:
  Am Fam Physician. 2002 Aug 15;66(4):621-625:
  http://www.aafp.org/afp/2002/0815/p621.html
• Allergy Testing, According to the American College of Allergy, Asthma, & Immunology:
  http://www.acaai.org/allergist/allergies/Treatment/diagnosing-allergies/Pages/allergy-testing.aspx
• From this blog: How Rhinitis, Asthma, Sinusitis, Tonsillitis, Otitis, Are All Connected – the Unified Airway:
  http://www.boogordoctor.com/wp-admin/rhinitis-sinusitis-otitis-laryngitis-adenoiditis-tonsillitis-are-all-connected

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Image Credit:

Wolfgang Ihloff: http://de.wikipedia.org/wiki/Benutzer:Wolfgang_Ihloff

_______________________________________

Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-to-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)

_______________________________________

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For More Reading – this Blog:

This video: http://youtu.be/hgcSFXZez8k

Nose bleeds – Epistaxis: How to Stop It, How to Prevent It, When to See the Doc

Part 1 – Anatomy of Nose Bleeds: http://wp.me/pR4iB-S

Part 2 – Nose Bleeds: What To Do? http://wp.me/pR4iB-W

Part 3 – 8 Things You Can Do To Reduce Your Child’s Nose Bleeds: http://wp.me/pR4iB-10

Part 4 – 8 Reasons To See a Physician For Your Child’s Nose Bleeds: http://wp.me/pR4iB-19

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Hi, I’m Russell Faust, author of this medical education blog.

Let me know what topics are important to you and your child’s respiratory health.

Thanks to Jennifer for the suggestion to add brief instructional video clips.

Join the conversation by leaving a comment / reply below, or email me any time.

Thanks for visiting, see you here later.

In invite you to subscribe to this blog (it’s FREE).

Be sure to type in your best email address (the one that you actually use).  You will then receive an email with a “confirmation link” – click on that link to get weekly updates from this blog in your email.

It’s free, it’s convenient, it’s an easy way to stay up-t0-date on information to keep you and your family healthy.  You can un-subscribe at any time.

Stay informed.

Stay healthy.

Until next time, remember … you can pick your friends, and you can pick your nose, but you can’t pick your friend’s nose (unless you’re a boogor doctor ;~D)