Food Allergy

Causes

Normally, your body's immune system defends against potentially harmful substances, such as bacteria, viruses, and toxins. In some people, an immune response is triggered by a substance that is generally harmless, such as a specific food.

The cause of food allergies is not fully understood.

While many people have a food intolerance, food allergies are less common. In a true food allergy, the immune system produces antibodies and histamine in response to the specific food.

Any food can cause an allergic reaction, but a few foods are the main culprits. In children, the most common food allergies are to:

* Eggs
* Milk
* Peanuts
* Shellfish (shrimp, crab, lobster, snails, clams)
* Soy
* Tree nuts
* Wheat

A food allergy frequently starts in childhood, but it can begin at any age. Fortunately, many children will outgrow their allergy to milk, egg, wheat, and soy by the time they are 5 years old if they avoid the offending foods when they are young. Allergies to peanuts, tree nuts, and shellfish tend to be lifelong.

In older children and adults, the most common food allergies are:

* Fish
* Peanuts
* Shellfish
* Tree nuts

Food additives -- such as dyes, thickeners, and preservatives – may rarely cause an allergic or intolerance reaction.

An oral allergy syndrome may occur after eating certain fresh fruits and vegetables. The allergens in these foods are similar to certain pollens. Examples are melon/ragweed pollen and apple/tree pollen.

Many Americans believe they have food allergies, while in reality fewer than 1% have true allergies. Most people's symptoms are caused by intolerances to foods such as:

* Corn products
* Cow's milk and dairy products (See: Lactose intolerance)
* Wheat and other gluten-containing grains (See: Celiac disease)

The body's immune system normally reacts to the presence of toxins, bacteria or viruses by producing a chemical reaction to fight these invaders. However, sometimes the immune system reacts to ordinarily benign substances such as food or pollen, to which it has become sensitive. This overreaction can cause symptoms from the mild (hives) to the severe (anaphylactic shock) upon subsequent exposure to the substance. An actual food allergy, as opposed to simple intolerance due to the lack of digesting enzymes, is indicated by the production of antibodies to the food allergen, and by the release of histamines and other chemicals into the blood.

Symptoms

Symptoms usually begin immediately, seldom more than 2 hours after eating. Rarely, the symptoms may begin hours after eating the offending food.

If you develop symptoms shortly after eating a specific food, you may have a food allergy. Key symptoms include hives, hoarse voice, and wheezing. In severe reactions, you may have low blood pressure and blocked airways.

Other symptoms that may occur include:

* Abdominal pain
* Angioedema (swelling, especially of the eyelids, face, lips, and tongue)
* Diarrhea
* Difficulty swallowing
* Itching of the mouth, throat, eyes, skin, or any area
* Light-headedness or fainting
* Nasal congestion
* Nausea
* Runny nose
* Shortness of breath
* Stomach cramps
* Vomiting

Symptoms of oral allergy syndrome:

* Itchy lips, tongue, and throat
* Swollen lips (sometimes)


Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

Exams and Tests

A blood or skin test can be done to identify elevated antibody levels (particularly IgE) and confirm that you have an allergy.

Elimination diets involve avoiding the suspected food until the symptoms disappear, then reintroduced to see if allergic reaction develops

Provocation (challenge) testing involves exposing a person to a suspected allergen under controlled circumstances. This may be done in the diet or by breathing in the suspected allergen. This type of test may provoke severe allergic reactions. Challenge testing should only be done by a doctor.

Never try to deliberately cause a reaction or reintroduce a food on your own. These tests should only be performed under the guidance of a health care provider -- especially if your initial reaction was severe.


Dermatitis around the mouth (perioral) is most common in young to middle age women. Frequently, no specific cause is found. However, there appears to be an association with fluorinated steroids. In children, dermatitis around the mouth may be associated with irritation from specific foods or other materials carried to the face on the hands.

Treatment

The only proven treatment for a food allergy is to avoid the food. If you suspect you or your child has a food allergy, consult an allergy specialist.

If you have symptoms on only one area of the body (for example, a hive on the chin after eating the specific food), you may not need any treatment. The symptoms will likely go away in a brief time. Antihistamines may relieve the discomfort. Soothing skin creams may provide some relief.

Consult your doctor if you think you have had an allergic reaction to food, even if it is only a local reaction.

Anyone diagnosed with a food allergy should carry (and know how to use) injectable epinephrine at all times. If a person develops any type of serious or whole-body reaction, even hives, after eating the offending food, they should inject the epinephrine, and then go to the nearest hospital or emergency facility, preferably by ambulance. Seek immediate medical attention after injecting epinephrine for a food reaction.

Outlook (Prognosis)

Avoiding the offending foods may be easy if the food is uncommon or easily identified. However, success may involve a severely restricted diet and often requires diligent reading of all package ingredients and detailed inquiries when eating away from home.

Asthma, eczema, or other disorders may be triggered or worsened by food allergies.

TopPossible Complications

A life-threatening complication is anaphylaxis, a severe, whole-body allergic reaction that can result in death. While people with oral allergy syndrome rarely have an anaphylactic reaction, they should ask their doctor whether they need to carry injectable epinephrine.

Asthma, eczema, or other disorders may be triggered or worsened by food allergies.
Back to TopWhen to Contact a Medical Professional

* Call your local emergency number, such as 911, if you have any serious or whole-body reactions after eating a food (particularly wheezing or difficulty breathing).
* If your doctor prescribed epinephrine for severe reactions, inject it as soon as possible, even BEFORE calling 911. The sooner you inject the epinephrine, the better.
* Anyone who has had an allergic reaction to a food should be evaluated by an allergy specialist.

TopPrevention

Breastfeeding may help prevent allergies. Otherwise, there is no known prevention of food allergies except to delay introducing allergy-causing foods to infants until the gastrointestinal tract has had a chance to mature. The timing for this varies from food to food and from baby to baby.

Once an allergy has developed, carefully avoiding the offending food usually prevents further problems.

TopReferences

American Gastroenterological Association medical position statement: guidelines for the evaluation of food allergies. Gastroenterology. 2001 Mar;120(4):1023-5.

American College of Allergy, Asthma, & Immunology. Food allergy: a practice parameter. Ann Allergy Asthma Immunol. 2006 Mar;96(3 Suppl 2):S1-68.

Adkinson NF Jr. Middleton’s Allergy: Principles and Practice. 6th ed. Philadelphia, Pa: Mosby; 2003.

Review Date: 10/12/2008
Reviewed By: Stuart I. Henochowicz, MD, FACP, Associate Clinical Professor of Medicine, Division of Allergy, Immunology, and Rheumatology, Georgetown University Medical School. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

from New York Times

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The 11 Best Foods You Aren’t Eating

Maybe you should be eating more beets, left, or chopped cabbage. (Credit: Evan Sung for The New York Times, left

(This post was originally published on June 30, 2008, and recently appeared on The New York Times’s list of most-viewed stories for 2008.)

Nutritionist and author Jonny Bowden has created several lists of healthful foods people should be eating but aren’t. But some of his favorites, like purslane, guava and goji berries, aren’t always available at regular grocery stores. I asked Dr. Bowden, author of “The 150 Healthiest Foods on Earth,” to update his list with some favorite foods that are easy to find but don’t always find their way into our shopping carts. Here’s his advice.

1. Beets: Think of beets as red spinach, Dr. Bowden said, because they are a rich source of folate as well as natural red pigments that may be cancer fighters.
How to eat: Fresh, raw and grated to make a salad. Heating decreases the antioxidant power.
2. Cabbage: Loaded with nutrients like sulforaphane, a chemical said to boost cancer-fighting enzymes.
How to eat: Asian-style slaw or as a crunchy topping on burgers and sandwiches.
3. Swiss chard: A leafy green vegetable packed with carotenoids that protect aging eyes.
How to eat it: Chop and saute in olive oil.
4. Cinnamon: May help control blood sugar and cholesterol.
How to eat it: Sprinkle on coffee or oatmeal.
5. Pomegranate juice: Appears to lower blood pressure and loaded with antioxidants.
How to eat: Just drink it.
6. Dried plums: Okay, so they are really prunes, but they are packed with antioxidants.
How to eat: Wrapped in prosciutto and baked.
7. Pumpkin seeds: The most nutritious part of the pumpkin and packed with magnesium; high levels of the mineral are associated with lower risk for early death.
How to eat: Roasted as a snack, or sprinkled on salad.
8. Sardines: Dr. Bowden calls them “health food in a can.” They are high in omega-3’s, contain virtually no mercury and are loaded with calcium. They also contain iron, magnesium, phosphorus, potassium, zinc, copper and manganese as well as a full complement of B vitamins.
How to eat: Choose sardines packed in olive or sardine oil. Eat plain, mixed with salad, on toast, or mashed with dijon mustard and onions as a spread.
9. Turmeric: The “superstar of spices,” it may have anti-inflammatory and anti-cancer properties.
How to eat: Mix with scrambled eggs or in any vegetable dish.
10. Frozen blueberries: Even though freezing can degrade some of the nutrients in fruits and vegetables, frozen blueberries are available year-round and don’t spoil; associated with better memory in animal studies.
How to eat: Blended with yogurt or chocolate soy milk and sprinkled with crushed almonds.
11. Canned pumpkin: A low-calorie vegetable that is high in fiber and immune-stimulating vitamin A; fills you up on very few calories.
How to eat: Mix with a little butter, cinnamon and nutmeg.

You can find more details and recipes on the Men’s Health Web site, which published the original version of the list last year.

In my own house, I only have two of these items — pumpkin seeds, which I often roast and put on salads, and frozen blueberries, which I mix with milk, yogurt and other fruits for morning smoothies. How about you? Have any of these foods found their way into your shopping cart?

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For the Overweight, Bad Advice by the Spoonful

By GINA KOLATA


Two-thirds of Americans are overweight or obese. For most, research shows, neither diets nor moderate exercise brings significant long-term weight loss.

In Brief:

Weight control is not simply a matter of willpower. Genes help determine the body's "set point," which is defended by the brain.

Dieting alone is rarely successful, and relapse rates are high.

Moderate exercise, too, rarely results in substantive long-term weight loss, which requires intensive exercise.

Americans have been getting fatter for years, and with the increase in waistlines has come a surplus of conventional wisdom. If we could just return to traditional diets, if we just walk for 20 minutes a day, exercise gurus and government officials maintain, America’s excess pounds would slowly but surely melt away.

Scientists are less sanguine. Many of the so-called facts about obesity, they say, amount to speculation or oversimplification of the medical evidence. Diet and exercise do matter, they now know, but these environmental influences alone do not determine an individual’s weight. Body composition also is dictated by DNA and monitored by the brain. Bypassing these physical systems is not just a matter of willpower.

More than 66 percent of Americans are overweight or obese, according to the federal Centers for Disease Control and Prevention, in Atlanta. Although the number of obese women in the United States appears to be holding steady at 33 percent, for most Americans the risk is growing. The nation’s poor diet has long been the scapegoat. There have been proposals to put warning labels on sodas like those on cigarettes. There are calls to ban junk foods from schools. New York and other cities now require restaurants to disclose calorie information on their menus.

But the notion that Americans ever ate well is suspect. In 1966, when Americans were still comparatively thin, more than two billion hamburgers already had been sold in McDonald’s restaurants, noted Dr. Barry Glassner, a sociology professor at the University of Southern California. The recent rise in obesity may have more to do with our increasingly sedentary lifestyles than with the quality of our diets.

“The meals we romanticize in the past somehow leave out the reality of what people were eating,” he said. “The average meal had whole milk and ended with pie.... The typical meal had plenty of fat and calories.”

“Nostalgia is going to get us nowhere,” he added.

Neither will wishful misconceptions about the efficacy of exercise. First, the federal government told Americans to exercise for half an hour a day. Then, dietary guidelines issued in 2005 changed the advice, recommending 60 to 90 minutes of moderate exercise a day. There was an uproar; many said the goal was unrealistic for Americans. But for many scientists, the more pertinent question was whether such an exercise program would really help people lose weight.

The leisurely after-dinner walk may be pleasant, and it may be better than another night parked in front of the television. But modest exercise of this sort may not do much to reduce weight, evidence suggests.

“People don’t know that a 20-minute walk burns about 100 calories,” said Dr. Madelyn Fernstrom, director of the weight-management center at the University of Pittsburgh Medical Center. “People always overestimate the calories consumed in exercise, and underestimate the calories in food they are eating.”

Tweaking the balance is far more difficult than most people imagine, said Dr. Jeffrey Friedman, an obesity researcher at Rockefeller University. The math ought to work this way: There are 3,500 calories in a pound. If you subtract 100 calories per day by walking for 20 minutes, you ought to lose a pound every 35 days. Right?

Wrong. First, it’s difficult for an individual to hold calorie intake to a precise amount from day to day. Meals at home and in restaurants vary in size and composition; the nutrition labels on purchased foods — the best guide to calorie content — are at best rough estimates. Calorie counting is therefore an imprecise art.

Second, scientists recently have come to understand that the brain exerts astonishing control over body composition and how much individuals eat. “There are physiological mechanisms that keep us from losing weight,” said Dr. Matthew W. Gilman, the director of the obesity prevention program at Harvard Medical School/Pilgrim Health Care.

Scientists now believe that each individual has a genetically determined weight range spanning perhaps 30 pounds. Those who force their weight below nature’s preassigned levels become hungrier and eat more; several studies also show that their metabolisms slow in a variety of ways as the body tries to conserve energy and regain weight. People trying to exceed their weight range face the opposite situation: eating becomes unappealing, and their metabolisms shift into high gear.

The body’s determination to maintain its composition is why a person can skip a meal, or even fast for short periods, without losing weight. It’s also why burning an extra 100 calories a day will not alter the verdict on the bathroom scales. Struggling against the brain’s innate calorie counters, even strong-willed dieters make up for calories lost on one day with a few extra bites on the next. And they never realize it. “The system operates with 99.6 percent precision,” Dr. Friedman said.

The temptations of our environment — the sedentary living, the ready supply of rich food — may not be entirely to blame for rising obesity rates. In fact, new research suggests that the environment that most strongly influences body composition may be the very first one anybody experiences: the womb.

According to several animal studies, conditions during pregnancy, including the mother’s diet, may determine how fat the offspring are as adults. Human studies have shown that women who eat little in pregnancy, surprisingly, more often have children who grow into fat adults. More than a dozen studies have found that children are more likely to be fat if their mothers smoke during pregnancy.

The research is just beginning, true, but already it has upended some hoary myths about dieting. The body establishes its optimal weight early on, perhaps even before birth, and defends it vigorously through adulthood. As a result, weight control is difficult for most of us. And obesity, the terrible new epidemic of the developed world, is almost impossible to cure.

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AIDS

Causes

AIDS is the fifth leading cause of death among people aged 25-44 in the United States, down from number one in 1995. About 25 million people worldwide have died from this infection since the start of the epidemic, and 40.3 million people around the world are currently living with HIV/AIDS.

Human immunodeficiency virus (HIV) causes AIDS. The virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening infections and cancers.

Common bacteria, yeast, parasites, and viruses that ordinarily do not cause serious disease in people with healthy immune systems can cause fatal illnesses in people with AIDS.


Antigens are large molecules (usually proteins) on the surface of cells, viruses, fungi, bacteria, and some non-living substances such as toxins, chemicals, drugs, and foreign particles. The immune system recognizes antigens and produces antibodies that destroy substances containing antigens.

HIV has been found in saliva, tears, nervous system tissue and spinal fluid, blood, semen (including pre-seminal fluid, which is the liquid that comes out prior to ejaculation), vaginal fluid, and breast milk. However, only blood, semen, vaginal secretions, and breast milk generally transmit infection to others.

The virus can be transmitted:

* Through sexual contact -- including oral, vaginal, and anal sex
* Through blood -- via blood transfusions (now extremely rare in the US) or needle sharing
* From mother to child -- a pregnant woman can transmit the virus to her fetus through their shared blood circulation, or a nursing mother can transmit it to her baby in her milk

Other transmission methods are rare and include accidental needle injury, artificial insemination with infected donated semen, and organ transplantation with infected organs.

HIV infection is not spread by casual contact such as hugging, by touching items previously touched by a person infected with the virus, during participation in sports, or by mosquitoes.


HIV (human immunodeficiency virus) is a viral infection that gradually destroys the immune system. Practicing effective safe sex methods significantly reduces the risk of disease transmission.

It is NOT transmitted to a person who DONATES blood or organs. Those who donate organs are never in direct contact with those who receive them. Likewise, a person who donates blood is not in contact with the person receiving it. In all these procedures, sterile needles and instruments are used.

However, HIV can be transmitted to a person RECEIVING blood or organs from an infected donor. To reduce this risk, blood banks and organ donor programs screen donors, blood, and tissues thoroughly.

People at highest risk for getting HIV include:

* Intravenous drug users who share needles
* Infants born to mothers with HIV who don't receive HIV therapy during pregnancy
* People engaging in unprotected sex
* People who received blood transfusions or clotting products between 1977 and 1985 (prior to when standard screening for the virus began)
* Sexual partners of those who participate in high-risk activities (such as anal sex)

AIDS begins with HIV infection. People infected with HIV may have no symptoms for 10 years or longer, but they can still transmit the infection to others during this symptom-free period. Meanwhile, if the infection is not detected and treated, the immune system gradually weakens, and AIDS develops.

Acute HIV infection progresses over time (usually a few weeks to months) to asymptomatic HIV infection (no symptoms) and then to early symptomatic (some symptoms) HIV infection. Later, it progresses to AIDS (very advanced HIV infection with T-cell count below 200).

Almost all people infected with HIV, if not treated, will develop AIDS. There is a small group of patients who develop AIDS very slowly, or never at all. These patients are called nonprogressors, and many seem to have a genetic difference that prevents the virus from damaging their immune system.
Back to TopSymptoms

The symptoms of AIDS are primarily the result of infections that do not normally develop in individuals with healthy immune systems. These are called opportunistic infections.

People with AIDS have had their immune system depleted by HIV and are very susceptible to these opportunistic infections. Common symptoms are fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.

See the signs and tests section below for a list of common opportunistic infections and major symptoms associated with them.

Note: Initial infection with HIV can produce no symptoms. Some people, however, do experience flu-like symptoms with fever, rash, sore throat, and swollen lymph nodes, usually 2 weeks after contracting the virus. Some people with HIV infection remain without symptoms for years between the time the are exposed to the virus and when they develop AIDS.
Back to TopExams and Tests

The following is a list of AIDS-related infections and cancers that people with AIDS may get as their CD4 count decreases. In the past, having AIDS was defined as having HIV infection and getting one of these additional diseases. Today, according to the Centers for Disease Control and Prevention, a person is diagnosed as having AIDS if they have a CD4 cell count below 200, even if they don't have an opportunistic infection.

AIDS may also be diagnosed if a person develops one of the numerous infections and cancers that occur with HIV infection. These infections are unusual in people with a healthy immune system.

CD4 cells are a type of immune cell. They are also called "T cells" or "helper cells."

Many other illnesses and corresponding symptoms may develop in addition to those listed here.

Common with CD4 count below 350 cells/mL:

* Herpes simplex virus -- causes ulcers/small blisters in the mouth or genitals, happens more frequently and usually much more severely in an HIV-infected person than before HIV infection
* Tuberculosis -- infection by the tuberculosis bacteria that mostly affects the lungs, but can affect other organs such as the bowel, lining of the heart or lungs, brain, or lining of the central nervous system (brain and spinal cord)
* Oral or vaginal thrush -- yeast infection of the mouth or vagina
* Herpes zoster (shingles) -- ulcers/small blisters over a patch of skin. it is caused by the varicella zoster virus
* Non-Hodgkin's lymphoma -- cancer of the lymph glands
* Kaposi's sarcoma -- cancer of the skin, lungs, and bowel, associated with a herpes virus (HHV-8). Can happen at any CD4 count, but is more likely to happen at lower CD4 counts, and is more common in men than in women

Common with CD4 count below 200 cells/mL:

* Pneumocystis carinii pneumonia, "PCP pneumonia," now called Pneumocystic jiroveci pneumonia
* Candida esophagitis -- painful yeast infection of the esophagus
* Bacillary angiomatosis -- skin lesions caused by a bacteria called Bartonella, which is usually acquired from cat scratches

Common with CD4 count below 100 cells/mL:

* Cryptococcal meningitis -- infection of the lining of the brain
* AIDS dementia -- worsening and slowing of mental function, caused by HIV itself
* Toxoplasmosis encephalitis -- infection of the brain by a parasite, called Toxoplasma, which is frequently found in cat feces; causes lesions (sores) in the brain
* Progressive multifocal leukoencephalopathy -- a viral disease of the brain caused by a virus (called the JC virus) that results in a severe decline in mental and physical functions
* Wasting syndrome -- extreme weight loss and loss of appetite, caused by HIV itself
* Cryptosporidium diarrhea -- Extreme diarrhea caused by one of several related parasites

Common with CD4 count below 50/mL:

* Mycobacterium avium -- a blood infection by a bacterium related to tuberculosis
* Cytomegalovirus infection -- a viral infection that can affect almost any organ system, especially the large bowel and the eyes

In addition to the CD4 count, a test called HIV RNA load may be used to monitor patients. Basic screening lab tests and regular cervical Pap smears are important to monitor in HIV infection, due to the increased risk of cervical cancer in immunocompromised women. Anal Pap smears to detect potential cancers may also be important in both HIV infected men and women.
Back to TopSupport Groups

Joining support groups where members share common experiences and problems can often help the emotional stress of devastating illnesses. See AIDS - support group.
Back to TopTreatment

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life of those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed highly active antiretroviral therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream, as measured by a blood test called the viral load. Preventing the virus from replicating can help the immune system recover from the HIV infection and improve T-cell counts.

HAART is not a cure for HIV, and people on HAART with suppressed levels of HIV can still transmit the virus to others through sex or sharing of needles. But HAART has been enormously effective for the past 10 years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mL), life can be significantly prolonged and improved.

However, HIV may become resistant to HAART in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether a particular HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each individual, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and prior to starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs coming out on the market for the treatment of drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise (a general sick feeling), and fat accumulation on the back ("buffalo hump") and abdomen. When used for a long time, these medications increase the risk of heart attack by increasing the levels of fat and glucose in the blood.

Any doctor prescribing HAART should carefully watch the patient for possible side effects associated with the combination of medications the patient takes. In addition, routine blood tests measuring CD4 counts and HIV viral load (a blood test that measures how much virus is in the blood) should be taken every 3-4 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the HIV amount of virus in the blood to an undetectable level.

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as Epogen (erthythropoetin) and G-CSF are sometimes used to treat anemia and low white blood cell counts associated with AIDS.

Medications are also used to prevent opportunistic infections (such as Pneumocystis uiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.
Back to TopOutlook (Prognosis)

Right now, there is no cure for AIDS. It is always fatal if no treatment is provided. In the US, most patients survive many years after diagnosis because of the availability of HAART. HAART has dramatically increased the amount of time people with HIV remain alive.

Research continues in the areas of drug treatments and vaccine development. Unfortunately, HIV medications are not always available in the developing world, where the bulk of the epidemic is raging.
Back to TopPossible Complications

When a person is infected with HIV, the virus slowly begins to destroy that person's immune system. How fast this occurs differs in each individual. Treatment with HAART can help slow and even halt the destruction of the immune system.

Once the immune system is severely damaged, that person has AIDS, and is now susceptible to infections and cancers that most healthy adults would not get. However, antiretroviral treatment can still be very effective, even at that stage of illness.
Back to TopWhen to Contact a Medical Professional

Call for an appointment with your health care provider if you have any of the risk factors for HIV infection, or if you develop symptoms of AIDS. By law, AIDS testing must be kept confidential. Your health care provider will review results of your testing with you.
Back to TopPrevention

* See the article on safe sex to learn how to reduce the chance of acquiring or spreading HIV, and other sexually transmitted diseases.
* Try not to use injected drugs. If IV drugs are used, do not share needles or syringes. Many communities now have needle exchange programs, where you can get rid of used syringes and get new, sterile ones for free. These programs can also provide referrals to addiction treatment.
* Avoid contact with another person's blood. Protective clothing, masks, and goggles may be appropriate when caring for people who are injured.
* Anyone who tests positive for HIV can pass the disease to others and should not donate blood, plasma, body organs, or sperm. An infected person should tell any prospective sexual partner about their HIV-positive status. They should not exchange body fluids during sexual activity, and should use whatever preventive measures (such as condoms) will give the partner the most protection.
* HIV-positive women who wish to become pregnant should seek counseling about the risk to unborn children, and medical advances that may help prevent the fetus from becoming infected. Use of certain medications can dramatically reduce the chances that the baby will become infected during pregnancy.
* Mothers who are HIV-positive should not breast feed their babies.
* Safe-sex practices, such as latex condoms, are highly effective in preventing HIV transmission. HOWEVER, there remains a risk of acquiring the infection even with the use of condoms. Abstinence is the only sure way to prevent sexual transmission of HIV.

The riskiest sexual behavior is unprotected receptive anal intercourse -- the least risky sexual behavior is receiving oral sex. Performing oral sex on a man is associated with some risk of HIV transmission, but this is less risky than unprotected vaginal intercourse. Female-to-male transmission of the virus is much less likely than male-to-female transmission. Performing oral sex on a woman who does not have her period carries low risk of transmission.

HIV-positive patients who are taking anti-retroviral medications are less likely to transmit the virus. For example, pregnant women who are on effective treatment at the time of delivery, and who have undetectable viral loads, give HIV to the infant less than 1% of the time, compared with about 20% of the time if medications are not used.

The US blood supply is among the safest in the world. Nearly all people infected with HIV through blood transfusions received those transfusions before 1985, the year HIV testing began for all donated blood. Currently, the risk of infection with HIV through a blood transfusion or blood products is almost zero in the United States, even in geographic areas with a lot of HIV infections.

If you believe you have been exposed to HIV, seek medical attention IMMEDIATELY. There is some evidence that an immediate course of antiviral drugs can reduce the chances that you will be infected. This is called post-exposure prophylaxis (PEP), and has been used to treat health care workers injured by needlesticks, to prevent transmission.


Tuberculosis is caused by a group of organisms Mycobacterium tuberculosis, M. bovis, M. africanum and a few other rarer subtypes. Tuberculosis usually appears as a lung (pulmonary) infection. However, it may infect other organs in the body. Recently, antibiotic-resistant strains of tuberculosis have appeared. With increasing numbers of immunocompromised individuals with AIDS, and homeless people without medical care, tuberculosis is seen more frequently today. (Image courtesy of the Centers for Disease Control and Prevention.)

There is less information available about how effective PEP is for people exposed to HIV through sexual activity or IV drug use. However, if you believe you have been exposed, you should discuss the possibility with a knowledgeable specialist (check local AIDS organizations for the latest information) as soon as possible. Anyone who has been raped should be offered PEP and should consider its potential risks and benefits.

References

Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: sect XXIV.
More Information on This Topic

* News & Features

Review Date: 5/19/2008
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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Alcoholism

Causes


Alcoholism is a type of drug addiction. There is both physical and mental dependence on alcohol.

Alcoholism is divided into 2 categories: dependence and abuse. People who are dependent on alcohol spend a great deal of time drinking alcohol, and getting it.

Physical dependence involves:

* A need for increasing amounts of alcohol to get drunk or achieve the desired effect (tolerance)
* Alcohol-related illnesses
* Memory lapses (blackouts) after drinking episodes
* Withdrawal symptoms when alcohol use is stopped

The most severe drinking behavior includes long drinking binges that lead to mental or physical problems. Some people are able to gain control over their dependence in earlier phases before they totally lose control. But no one knows which heavy drinkers will be able to regain control and which will not.

There is no known common cause of alcoholism. However, several factors may play a role in its development. A person who has an alcoholic parent is more likely to become an alcoholic than a person without alcoholism in the immediate family.

Research suggests that certain genes may increase the risk of alcoholism, but which genes or how they work is not known.


The liver serves a wide variety of body functions, including detoxifying blood and producing bile that aids in digestion.

Psychological factors may include:

* A need for anxiety relief
* Conflict in relationships
* Depression
* Low self-esteem

Social factors include:

* Ease of getting alcohol
* Peer pressure
* Social acceptance of alcohol use
* Stressful lifestyle

The incidence of alcohol intake and related problems is rising. Data indicate that about 15% of people in the United States are problem drinkers, and about 5% to 10% of male drinkers and 3% to 5% of female drinkers could be diagnosed as alcohol dependent.
In-Depth Causes »
Back to TopSymptoms

Alcohol affects the central nervous system as a depressant. This leads to a decrease in:

* Activity
* Anxiety
* Inhibitions
* Tension

Even a few drinks can change behavior, slow motor skills, and decrease the ability to think clearly. It can impair concentration and judgment. Drinking a lot of alcohol can cause drunkenness (intoxication).

Some of the symptoms of alcoholism include:

* Abdominal pain
* Confusion
* Drinking alone
* Episodes of violence with drinking
* Hostility when confronted about drinking
* Lack of control over drinking -- being unable to stop or reduce alcohol intake
* Making excuses to drink
* Nausea and vomiting
* Need for daily or regular alcohol use to function
* Neglecting to eat
* Not caring for physical appearance
* Numbness and tingling
* Secretive behavior to hide alcohol use
* Shaking in the morning

Alcohol withdrawal develops because the brain adapts to the alcohol and cannot function well without the drug. Symptoms of withdrawal may include:

* Anxiety
* Confusion or seeing and hearing things that aren't there (hallucinations)
* Death (rarely)
* Increased blood pressure
* Loss of appetite, nausea, or vomiting
* Psychosis
* Raised temperature
* Rapid heart rate
* Restlessness or nervousness
* Seizures
* Tremors

Back to TopExams and Tests »

Men who have 15 or more drinks a week, women who have 12 or more drinks a week, or anyone who has 5 or more drinks per occasion at least once a week are all at risk for developing alcoholism. (One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor).

All doctors should ask their patients about their drinking. The health care provider can get a history from the family if the affected person is unwilling or unable to answer questions. A physical examination is done to identify physical problems related to alcohol use.

The following questions are used by the National Institute on Alcohol Abuse and Alcoholism to screen for alcohol abuse or dependence:

* Do you ever drive when you have been drinking?
* Do you have to drink more than before to get drunk or feel the desired effect?
* Have you felt that you should cut down on your drinking?
* Have you ever had any blackouts after drinking?
* Have you ever missed work or lost a job because of drinking?
* Is someone in your family worried about your drinking?

Tests for alcohol abuse include:

* A toxicology screen or blood alcohol level (this can tell whether someone has recently been drinking alcohol, but it does not necessarily confirm alcoholism)
* Complete blood count (CBC)
* Folate tests
* Liver function tests
* Serum magnesium
* Total protein
* Uric acid

In-Depth Diagnosis


A CT scan of the upper abdomen showing disproportional steatosis (fattening) of the liver.

Treatment

Those who are dependent need to stop drinking alcohol (abstinence). Those who are problem drinkers may be successful with moderation. Because many people refuse to believe that their drinking is out of control, trying moderation can often be an effective way to deal with the problem. If it succeeds, the problem is solved. If not, the person is usually ready to try abstinence.

Three general steps are involved in treatment once the disorder has been diagnosed:

* Intervention
* Detoxification
* Rehabilitation

INTERVENTION

Many people with alcohol problems don't recognize when their drinking gets out of hand. In the past, treatment providers believed that alcoholics should be confronted about their drinking problems, but now research has shown that compassion and empathy are more effective.

Studies find that more people enter treatment if their family members or employers are honest with them about their concerns, and try to help them to see that drinking is preventing them from reaching their goals.

DETOXIFICATION

Withdrawal from alcohol is done in a controlled, supervised setting in which medications relieve symptoms. Detoxification usually takes 4 to 7 days.

Examination for other medical problems is necessary. For example, liver and blood clotting problems are common.

A balanced diet with vitamin supplements is important. Complications can occur with alcohol withdrawal, such as delirium tremens (DT's), which could be fatal. Depression or other mood disorders should be evaluated and treated. Often, alcohol abuse develops from efforts to self-treat an illness.

REHABILITATION

After detoxification, alcohol recovery or rehabilitation programs can help people stay off alcohol. These programs usually offer counseling, psychological support, nursing, and medical care. Therapy involves education about alcoholism and its effects.

Many of the staff members at rehabilitation centers are recovering alcoholics who serve as role models. Programs can be either inpatient, where patients live in the facility during the treatment, or outpatient, where patients attend the program while they live at home.

Medications are sometimes prescribed to prevent relapses.

* Acamprosate is a new drug that has been shown to lower relapse rates in those who are alcohol dependent.
* Disulfiram (Antabuse) produces very unpleasant side effects if you drink even a small amount of alcohol within 2 weeks after taking the drug.
* Naltrexone (Vivitrol) decreases alcohol cravings. It is available in an injected form.

You cannot take these medications if you are pregnant or have certain medical conditions. Long-term treatment with counseling or support groups is often necessary. The effectiveness of medication and counseling varies.
Back to TopSupport Groups

Support groups are available to help people who are dealing with alcoholism. Alcoholics Anonymous is a self-help group of recovering alcoholics that offers emotional support and a model of abstinence for people recovering from alcohol dependence. There are local chapters throughout the United States.

Members of AA:

* Are given a model of recovery by seeing the accomplishments of sober members of the group
* Have help available 24 hours a day
* Learn that it is possible to participate in social functions without drinking

Because alcoholism can also affect those around the person with the alcohol problem, family members often need counseling. Al-Anon is a support group for spouses and others who are affected by someone else's alcoholism. Alateen provides support for teenage children of alcoholics.

If you don't like the 12-step approach, there are several other support groups available. It is important to know about these other groups because in the past, those who did not find AA helpful or were troubled by its involvement of a "Higher Power" had no alternatives.

SMART recovery uses cognitive methods to help people with alcoholism recover. LifeRing recovery and SOS are two other non-religious programs. Women For Sobriety is a self-help group just for women - many women with alcohol problems have different concerns than men. Moderation Management is a program for problem drinkers who want to moderate their drinking. It recommends abstinence for people who fail at moderation.

See also: Alcoholism - support group
Back to TopOutlook (Prognosis)

Only 15% of people with alcohol dependence seek treatment for this disease. Starting drinking again after treatment is common, so it is important to maintain support systems in order to cope with any slips and ensure that they don't turn into complete reversals.

Treatment programs have varying success rates, but many people with alcohol dependency make a full recovery.
Back to TopPossible Complications

* Brain degeneration
* Cancers of the larynx, esophagus, liver, and colon
* Cirrhosis of the liver
* Delirium tremens (DTs)
* Depression
* Esophageal bleeding
* Heart muscle damage
* High blood pressure
* Insomnia
* Liver disease (alcoholic hepatitis)
* Nausea, vomiting
* Nerve damage
* Pancreatitis
* Poor nutrition because vitamins aren't absorbed properly
* Problems getting an erection in men
* Severe memory loss
* Stopping of the period (menstruation) in women
* Suicide
* Wernicke-Korsakoff syndrome

Alcohol consumption during pregnancy can cause severe birth defects. The most serious is fetal alcohol syndrome, which may lead to mental retardation and behavior problems. A milder form of the condition that can still cause lifelong problems is called fetal alcohol affects.

People who are dependent on or who abuse alcohol continue to drink it despite physical or mental problems. They may have problems with binge drinking (drinking 6 or more drinks at one sitting). Those with dependence have more severe problems and a greater need to drink.

Alcoholism is a major social, economic, and public health problem. Alcohol is involved in more than half of all accidental deaths and almost half of all traffic deaths. A high percentage of suicides involve the use of alcohol along with other substances.

People who abuse or are dependent on alcohol are more likely to be unemployed, involved in domestic violence, and have problems with the law (such as drinking and driving).
Back to TopWhen to Contact a Medical Professional

If you or someone you know has alcohol dependence and develops severe confusion, seizures, bleeding, or other health problems, go to the emergency room or call the local emergency number such as 911.
Back to TopPrevention

Educational programs and medical advice about alcohol abuse can help decrease alcohol abuse and its problems. Alcohol dependency needs more intensive management.

The National Institute on Alcohol Abuse and Alcoholism recommends that women have no more than 1 drink per day and men no more than 2 drinks per day. One drink is defined as a 12-ounce bottle of beer, a 5-ounce glass of wine, or a 1 1/2-ounce shot of liquor.

References

Goldman L, Ausiello D. Cecil Textbook of Medicine. 22nd ed. Philadelphia, Pa: WB Saunders; 2004:79-80.

Pettinati HM, O'Brien CP, Rabinowitz AR, Wortman SP, Oslin DW, Kampman KM, Dackis CA. The status of naltrexone in the treatment of alcohol dependence: specific effects on heavy drinking. J Clin Psychopharmacol, 2006;26:610-625.

Assanangkornchai S, Srisurapanont M. The treatment of alcohol dependence. Curr Opin Psychiatry, 2007;20:222-227.

Laaksonen E, Koski-Jännes A, Salaspuro M, Ahtinen H, Alho H. A randomized, multicentre, open-label, comparative trial of disulfiram, naltrexone and acamprosate in the treatment of alcohol dependence. Alcohol Alcohol, 2008;43:53-61.
See All References »
More Information on This Topic

* Background
* Causes
* Risk Factors
* Complications
* Diagnosis
* Treatment for Alcoholism
* Treatment for Alcohol Withdrawal
* Therapy
* Medications
* References
* News & Features

Review Date: 2/6/2008
Reviewed By: Christos Ballas, MD, Attending Psychiatrist, Hospital of the University of Pennsylvania, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

A.D.A.M. Copyright
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- 2008 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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