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asthma in children

  • In the July issue (page 28) I reported on the dangers of synthetic chemical fragrances, the number of people affected in one way or another, symptoms manifested from fragrance exposure, and current research on their toxicity.

    This month I’m listing the most common chemicals so that you can use this as a guideline and, hopefully, begin to take seriously the “toxic soup” to which we have all become exposed. Don’t simply “buy into” the marketing campaigns instead of being informed about what you put on your body and the health consequences… remember…what goes on the skin goes in the body!

    I have devoted my life and private practice to victims of chemically-induced immune system disorders—counseling those whose immune systems can no longer protect them from chemicals. I believe that it’s a matter of decreasing tolerance—the more you’re exposed to the less the organs of detoxification can process and eventually we become allergic to substances we previously tolerated.

    Use the following information for your health, those around you and the health of the planet. Remember also that your perfume could be someone else’s poison when they’re immune system is already compromised.

    No one group works harder at consumer education than the Environmental Working Group (EWG); I have supported and followed their research for many years. The incidents described below were reported by the EWG and provided for your education with full credit.

    When sprayed or applied on the skin, many chemicals from perfumes, cosmetics and personal care products are inhaled. Others are absorbed through the skin. Either way, many of these chemicals can accumulate in the body. As a result, the bodies of most Americans are polluted with multiple cosmetics ingredients. This pollution begins in the womb and continues through life.

    Numerous other products used daily, such as shampoos, lotions, bath products, cleaning sprays, air fresheners and laundry and dishwashing detergents, also contain strongly scented, volatile ingredients hidden behind the word “fragrance.” Some of these ingredients react with ozone in indoor air, generating many potentially harmful secondary air pollutants such as formaldehyde and ultrafine particles (Nazaroff 2004).

    People have the right to know which chemicals they are exposed to. They have the right to expect government to protect them, especially vulnerable populations, from hazardous chemicals. In addition to required safety assessments of ingredients in cosmetics, the laws must be changed to require the chemicals in fragrance to be fully disclosed and publicly accessible on ingredient labels.

    Product tests initiated by the Campaign for Safe Cosmetics [] and subsequent analyses, detailed in this report, reveal that widely recognized brand-name perfumes and colognes contain secret chemicals, sensitizers, potential hormone disruptors and chemicals not assessed for safety:

    • SECRET CHEMICALS: Laboratory tests revealed 38 secret chemicals in 17 name-brand products, with an average of 14 secret chemicals per product.
    • MULTIPLE SENSITIZERS: The products tested contained an average of 10 chemicals that are known to be sensitizers and can trigger allergic reactions such as asthma, wheezing, headaches and contact dermatitis. All of these were listed on product labels.
    • MULTIPLE HORMONE DISRUPTORS: A total of 12 different hormone-disrupting chemicals were found in the tested products, with an average of four in each product. In each product, six of these chemicals mimic the hormone estrogen, and the seventh is associated with thyroid effects. Some of these potential hormone disruptors were listed on labels; others were undisclosed and were uncovered in product testing.
    • WIDESPREAD USE OF CHEMICALS THAT HAVE NOT BEEN ASSESSED FOR SAFETY: A review of government records shows that the U.S. Food and Drug Administration (FDA) has not assessed the vast majority of fragrance ingredients in personal care products for safety. The Cosmetic Ingredient Review (CIR), an industry-funded and self policing body, has assessed only 19 of the 91 ingredients listed on labels or found in testing for the 17 products assessed in this study. The International Fragrance Association (IFRA) and the Research Institute for Fragrance Materials (RIFM), which develop and set voluntary standards for chemicals in the “fragrance” component of products, have assessed only 27 of the 91 ingredients listed on labels or found in testing for the 17 products assessed in this study, based on a review of assessments published in the past 25 years.

    Products in these samplings were tested by Analytical Sciences, an independent laboratory in Petaluma, California. The lab found, in all, 40 chemicals in the tested fragrance products. Thirty-eight of these were secret, or unlabeled, for at least one of the products containing them, while the other two were listed on all relevant product labels. Ingredient labels disclosed the presence of another 51 chemical ingredients, giving a total of 91 chemical ingredients altogether in the tested products, including hidden and disclosed ingredients combined. Of the 17 products tested, 13 were purchased in the U.S. and four in Canada.

    Thirteen Most Common Chemicals Found in Fragranced Products

    (based on EPA study)

    1. ACETONE
    Found in…cologne, dishwashing liquid and detergent, nail enamel and remover.

    Facts…On the lists of the EPA, RCRA, and CERCLA as Hazardous Waste—“Inhalation can cause dryness of the mouth and throat; dizziness, nausea, loss of coordination, slurred speech, drowsiness, and, in severe exposures, coma—acts primarily as a central nervous system (CNS) depressant.

    Found in…perfume, cologne, hairspray, laundry bleach, deodorants, detergent, Vaseline™ lotion, shaving cream, shampoo, bar soap, and dishwasher detergent.

    Facts…Narcotic. Sensitizer. Local aesthetic, CNS depressant. Irritant to the mouth, throat, eyes, skin, lungs, and GI tract—causing nausea and abdominal pain. May cause kidney damage. Do NOT use with contact lenses.

    Found in…perfume, cologne, shampoo, fabric softener, stickup air fresheners, dishwashing liquid and detergent, soap, hairspray, bleach, after shave and deodorants.

    Facts…Carcinogenic (linked to pancreatic cancer). Dangers from vapors: irritant to eyes and respiratory passages, produces cough. In mice: hype-anemia of the lungs. Is absorbed through the skin causing systemic effects. Do not flush into the sewer or septic tank.

    Found in…perfume, cologne, soap, shampoo, nail enamel and remover, air fresheners, laundry bleach and detergents, Vaseline lotion, deodorants, and fabric softeners.

    Facts…Irritant to upper respiratory tract. Other symptoms include: headaches, nausea, vomiting, dizziness, drop in blood pressure, central nervous system depression, and death, in severe cases, due to respiratory failure.

    5. CAMPHOR
    Found in…perfume, shaving cream, nail enamel, fabric softener, dishwasher detergent, nail color, and stickup air fresheners.

    Facts…Local irritant and CNS stimulant readily absorbed through body tissues, irritant to eyes, nose and throat, causes dizziness, confusion, nausea, twitching muscles and convulsions. Avoid inhalation of vapors.

    6. ETHANOL
    Found in…perfume, hairspray, shampoo, fabric softener, dishwashing liquid and detergents, laundry detergents, shaving cream, soap, Vaseline lotion, air fresheners, nail color and remover, paint and varnish removers.

    Facts…showing symptoms that include: fatigue, irritant to eyes and upper respiratory tract even in low concentrations. Inhalation of ethanol vapors can have similar to those characteristic of ingestion. These include an initial stimulatory effect followed by drowsiness, impaired vision, ataxia, and stupor. Known to cause CNS disorders.

    Found in…after shave, cologne, perfume, shampoo, nail color, nail enamel remover, fabric softener, and dishwashing liquid.

    Facts…Narcotic. On the EPA Hazardous Waste List warning of the following health effects: irritant to the eyes and respiratory tract, headache and narcosis (stupor), defatting effect on the skin and may cause drying and cracking, may cause anemia with leukocytosis and damage to liver and kidneys. Wash thoroughly after handling.

    Found in…disinfectant sprays, bar soap, shaving cream, deodorants, nail color and removers, fabric softeners, dishwashing liquid, air fresheners, after shave, bleach, paint and varnish removers.

    Facts…Carcinogenic. Warnings include: prevent contact with skin or eyes because it is an irritant and sensitizer, wash thoroughly after using this material and before eating, drinking, or applying cosmetics, do not inhale limonene vapor.

    Found in…perfume, cologne, bar soap, shampoo, hand lotion, nail enamel remover, bleach powder, fabric softeners, shaving cream, after shave and solid deordorant.

    Facts…Narcotic. Causes respiratory disturbances, attracts bees, depressed heart activity and causes CNS disorders. In animal tests: ataxic gait, reduced spontaneous motor activity, depression, development of respiratory disturbances leading to death.

    Found in…shampoo, cologne, paint and varnish removers.

    Facts…It was banned by the FDA in 1988, yet no enforcement is possible due to trade secret laws protecting the chemical fragrance industry. It’s on the Hazardous Waste lists on the EPA, RCRA, and the CERCLA. When absorbed, it is stored in body fat, metabolizes to carbon monoxide, reduces oxygencarrying capacity of the blood, causes headaches, giddiness, stupor, irritability, fatigue, tingling in the limbs, and CNS disorders.

    11. A-PINENE
    Found in…bar and liquid soap, cologne, perfume, shaving cream, deodorants, dishwashing liquids, and air fresheners.

    Facts…Sensitizer (damaging to the immune system).

    Found in…cologne, perfume, soap, shaving creams, deodorants, and air fresheners.

    Facts…Causes asthma and CNS disorders.

    Found in…perfume, cologne, laundry detergents, bleach powders, laundry bleaches, fabric softeners, stickup air fresheners, Vaseline lotion, cologne, soap, hairspray, after shave, and rollon deodorants.

    Facts…Highly irritating to mucous membranes, aspiration into the lungs can produce pneumonitis or even fatal edema, causes excitement, ataxia (loss of muscular coordination, hypothermia, CNS and respiratory depression, headaches, and repeated or prolonged skin contact can cause serious skin disorders.

    Since companies can get away with incomplete labeling, follow these guidelines to ensure healthy choices.

    • Choose products that list all ingredients, not generalized ones.
    • Examine the list of ingredients to check that the word fragrance does NOT appear. Essential oils should be listed separately.
    • Be prudent because even if the label advertises “un-scented,” most manufacturers use masking agents that block our ability to perceive odors; so not only is the fragrance still in the product, but even more chemicals are present to mask other chemicals.
    • Avoid phthalates and parabens (often listed as methylparabens), they disrupt reproductive and thyroid function.
    • Always inspect labels because formulas change.
    • Since no legal definitions exist for natural, nontoxic, and hypoallergenic, those words don’t signify a healthier product unless every ingredient is identified.
  • Asthma is a respiratory disorder in which breathing difficulty is caused by temporary narrowing of the bronchi, the airways branching from the trachea to the lungs. In many asthma patients, inflammation of the lining of the airways leads to increased sensitivity to a variety of environmental triggers that can cause narrowing of the airways, resulting in obstruction of airflow and breathing difficulty. In some patients, the mucus glands in the airways produce excessive thick mucus, further obstructing airflow. Attacks usually are brought on by allergic reaction to antigens such as grass and tree pollens, mold spores, fungi, animal dander, dust mites, and certain foods; attacks may also be caused by chemical irritants in the atmosphere, including cigarette smoke, or by infections of the respiratory tract. In addition, exercise provokes attacks in some asthma sufferers. Likewise, emotions do not cause asthma but can, in some, prompt symptoms.

    Conventional medical treatment of adult asthma can include prednisone, oral bronchodilators, and a variety of inhalers, which usually contain either bronchodilators or synthetic corticosteroids. While these treatments can be very effective in relieving symptoms, they rarely improve the health of either the lungs or the body in general. There are also nutraceuticals that can be used as part of a complementary approach to asthma treatment. This includes vitamin C, vitamin B6, magnesium, Ginkgo biloba, omega-3 Fatty Acids, and N-acetylcysteine.

    Vitamin C
    Research suggests that a diet low in vitamin C may be a risk factor for asthma.1 In fact, vitamin C levels of asthmatic children were found to be significantly lower than that for non-asthmatic children.2 Since evidence is accumulating that asthma may, in part, be a result of free radical reactions, and since vitamin C is an antioxidant that can help protect against these reactions,3 the importance of maintaining a healthy level of vitamin C intake should be emphasized. In fact, a review of scientific literature regarding vitamin C in asthma and allergy has revealed several studies that support the use of vitamin C. Significant results include positive effects on lung function tests, improvements in reactions to allergens, improvements in white blood cell function, and a decrease in respiratory infections.4 However, the same review revealed studies that did not show a beneficial role for vitamin C in asthma or allergy. Nonetheless, the general results are promising. Of particular interest is a study where 2000 mg of vitamin C was able to block exercise-induced asthma in eight of twenty patients.5

    Vitamin B6
    In one study, vitamin B6 levels were found to be lower in asthmatic patients than in non-asthmatics. In that same study, treatment with vitamin B6 caused patients to experience a dramatic decrease in frequency and severity of wheezing or asthmatic attacks while taking the supplement.6 A similar result was not seen with vitamin B6, however, in patients concurrently using steroids to treat their asthma.7 In any case, the use of the asthma drug theophylline has been found to decrease vitamin B6 levels in adult and children asthmatics.8,9Consequently, supplementation with vitamin B6 is a wise measure in asthmatics using theophylline.

    Magnesium participates in a number of biochemical reactions that seem to be important when lung function is disturbed. A low intake of magnesium in the diet increases bronchial reactivity (a problem in asthma). Magnesium supplementation reduces bronchial constriction and pressure in certain lung disorders.10 Research has shown that asthmatics have lower levels of muscle magnesium;11 as well as increased excretion of magnesium specifically in those patients with using glucocorticoid therapy.12 Furthermore, evidence suggests that magnesium supplementation has value in reducing asthmatic symptoms.13 In one study involving 17 asthmatic patients, a high magnesium intake was associated with improvement in symptoms.14 The Journal of Asthma reported that significant improvement of the asthmatic condition after a 4-week stay at the Dead Sea, "may be due to absorption of [magnesium] through the skin and via the lungs, and due to its involvement in anti-inflammatory and vasodilatory processes." 15 In the interest of preventing magnesium deficiencies, which might otherwise contribute to asthma and other conditions, researchers in Israel even recommended adding it to the national drinking water.16

    Ginkgo biloba
    Ginkgo biloba extract has been found to improve clinical symptoms and pulmonary functions in asthmatic patients, and was concluded by researchers to be an effective agent for airway anti-inflammation.17 One mechanism by which Ginkgo works is that it contains ginkgolides, which are antagonists of the potent inflammatory agent called platelet-activating factor (PAF). PAF plays an important role in disorders such as asthma.18 Similar benefits with Ginkgo and asthma were seen in animal research as well.19

    Omega 3 Fatty Acids
    The fatty acid, arachidonic acid (AA), can be converted via an enzymatic process into pro-inflammatory substances. Omega 3 fatty acids (O3FA) are able to compete with AA for enzymatic metabolism, which results in less production of less inflammatory substances. This same mechanism holds true for the inflammatory process involved in asthma, and the beneficial role of O3FA in treating this disorder. This was demonstrated in a clinical trial where O3FA significantly decreased bronchial hyper-reactivity in patients suffering from seasonal asthma due to airborne allergens.20 Similar research with O3FA in asthma has also shown a reduction of symptoms.21,22,23

    2,510 patients with acute and chronic bronchitis, bronchial asthma, and emphysema were given 200 mg, three times daily of the antioxidant N-acetylcysteine (NAC) (173 were given a lesser dose). All selected parameters (coughing, etc.) improved.24 NAC may work by more than one mechanism. Since free radicals play a major role in a variety of human disorders including asthma, NAC antioxidant activity may quench the offending free radicals.25 Another possible mechanism has to do with air pollution, since an increase in respiratory symptoms in relation to levels of particulate pollution has been well documented. Animal research has shown that some of the particulate pollution caused a secretion of cytokines (inflammatory substances), which in turn caused lung inflammation. That same research demonstrated that NAC reduced the cytokine secretion.26

    Vitamin B12
    Sulfites are substances that are often used as an additive in the food industry (e.g., wine often contains sulfites). Of interest is that four to eight percent of asthmatics are sensitive to sulfites, and may experience a sulfite-induced bronchospasm. Research suggests that Vitamin B12 is capable of totally or partially preventing the bronchospasm induced by sulfites.27


    1. Hatch GE, Am J Clin Nutr (1995) 61(3 Suppl):625S–630S.
    2. Aderele WI, et al, Afr J Med Med Sci (1985) 14(3-4):115–20.
    3. Florence TM, Aust N Z J Ophthalmol (1995) 23 (1):3–7.
    4. Bielory L, Gandhi R, Ann Allergy (1994) 73(2)89–96.
    5. Cohen HA, Neuman I, Nahum H, Pediatr Adolesc Med (1997) 151(4):367–70.
    6. Reynolds RD, Natta CL, Am J Clin Nutr (1985) 41(4):684–8.
    7. Sur S, et al, Ann Allergy (1993) 70(2):147–52.
    8. Shimizu T, et al, Pharmacology (1994) 49(6):392–7.
    9. Vermaak WJ, J Clin Invest (1996) 98(1):177–84.
    10. Bohmer T, Tidsskr Nor Laegeforen (1995) 115(7):827–8.
    11. Gustafson T, et al, Eur Respir J (1996) 9(2):237–40.
    12. Emel'ianov AV, Trofimov VI, Ter Arkh (1995) 67(12):31–3.
    13. Ziment I, Curr Opin Pulm Med (1997) 3(1):61–71.
    14. Hill J, et al, Eur Respir J (1997) 10(10):2225–9.
    15. Harari M, Barzillai R, Shani J, J Asthma (1998) 35(7):525–36.
    16. Bar-Dayan Y, Shoenfeld Y, Ann Med Interne (1997) 148(6):440–4.
    17. Li MH, Zhang HL, Yang BY, Chung Kuo Chung Hsi I Chieh Ho Tsa Chih (1997) 17(4):216–8.
    18. Braquet P, Hosford D, J Ethnopharmacol (1991) 32 (1–3):135–9.
    19. Touvay C, Etienne A, Braquet P, Agents Actions (1986) 17(3-4):371-2.
    20. Villani F, et al, Respiration (1998) 65(4):265–9.
    21. Broughton KS, et al, Am J Clin Nutr (1997) 65(4):1011–7.
    22. Masuev KA, Ter Arkh (1997) 69(3):33–5.
    23. Masuev KA, Ter Arkh (1997) 69(3):31–3.
    24. Volkl KP, Schneider B, Fortschr Med (1992) 110(18):346–50.
    25. Leuenberger P, Schweiz Med Wochenschr (1994) 124(4):129–35.
    26. Kennedy T, et al, Am J Respir Cell Mol Biol (1998) 19(3):366–78.
    27. Giffon E, Vervloet D, Charpin J, Rev Mal Respir (1989) 6(4):303–10.
  • A few weeks ago, I shared my general concepts of Green Medicine involving three components: the use of dietary, nutritional and natural substances (what I call our personal green), living in a clean home and office (our local green) and working to keep the greater world in which we all must live clean for the health of us all (our global green). In this article I take a look at asthma—a specific, epidemic and potentially dangerous problem, particularly as the disease occurs in children, the most vulnerable of us all, and walk you though my “Green Medicine” approach to this disease.

    ASTHMA 101
    First, some basics. Asthma is a major health problem in the U.S., its incidence increasing yearly and with cases up a whooping 75 percent since 1980. The American Academy of Allergy, Asthma and Immunology reports the disease afflicts 20 million Americans, and is responsible for nearly one fourth of all emergency room visits. Some nine million children under age 18 suffer from asthma, with some four million of these victims of serious attacks last year. The costs, in terms of missed time from school, are staggering; in 2002 for example, the disease accounted for over 14 million lost school days.

    To understand asthma, we need at least a basic primer in lung physiology. To live, we need to breathe, and with each inspiration, fresh air, and with it life sustaining oxygen, travels into the lungs within the bronchi and bronchioles, tubelike structures that reach into the furthest recesses of the lungs, the small alveoli. Here, our red blood cells absorb much needed oxygen and release carbon dioxide, good old CO2, a by-product of normal metabolism, which we then breathe out of our lungs with expiration.

    Now smooth muscle cells line all these air passages along what anatomists call the bronchial tree. These cells, when contracting, can actually reduce the diameter of the bronchi and bronchioles. Such activity can be of benefit, for example when we are exposed to severe pollution, or say smoke from a fire; with reduced air intake, we actually lessen our exposure to potentially dangerous materials.

    We also lose considerable water through breathing; just think of a cold day, and the white vapor that follows each expiration. That white smoke is water vapor, exhaled with each breath day and night. If we’re dehydrated—during a hike on a hot summer day, for example—we can lose a fair amount of water this way. So it makes sense that our lungs might slow down a bit to reduce the losses, and help keep our fluids in balance until we re-hydrate as needed.

    Asthma occurs when our bronchi and bronchioles overreact to irritating exposures in the air, or dehydration, shutting down air flow to the point we find ourselves struggling and fighting for each breath, sometimes, ironically, fighting even for our lives. Scientists recognize a variety of substances that commonly provoke asthma in susceptible people, including pollens in spring and animal dander, as well as a myriad of pollutants. These irritants can lead to an inflammatory reaction in the immune cells lining the bronchi, which in response release histamine and leukotrienes. It’s these molecules that then set off the smooth muscle contractions that can, if excessive, lead to asthma.

    Asthma’s Connection to the Environment
    Scientists aren’t sure why in so many people the bronchi overreact, but some suspect our constant exposure to increasing amounts of toxic materials in our air must be at least partially to blame. After all, our poor lungs must deal with a constant barrage of noxious materials in the air, literally thousands of different compounds, many of which are irritating to the lungs.

    Infection, which creates inflammation, cold air, even exercise can provoke attacks in asthma prone children and adults. Since we tend to lose considerable water vapor via breathing both when it’s cold outside, and when we’re breathing heavily during exercise, I suspect these situations result when we’re just not adequately hydrated, and our lungs desperately try to conserve water—perhaps too desperately.

    Standard treatments for asthma include steroids, which reduce inflammation along the bronchi, and bronchodilators, which relax the smooth muscle. In our office, we have some simple approaches to the problem that often help enormously, though I must advise any patient with asthma to follow strictly their doctor’s advice, and never change or stop medications without their doctor’s approval.

    Green Medicine Asthma Solutions
    First, as a simple intervention, I always make sure any patient with asthma understands the need to drink plenty of fluids. Considerable debate rages about the amount of water humans need, and a recent study just last week said we should only drink when we feel thirsty. But with asthma, often our thirst centers in the brain seem a little slow to react, so patients end up chronically dehydrated, even though they don’t feel thirsty. In my office, we advice anyone with asthma to drink at least 6–8 glasses of water daily.

    I have also had a number of patients who improved substantially with the addition of simple apple cider vinegar, two tablespoons in a glass of water 2–3 times daily. Apple cider vinegar contains ample quantities of acetic acid, which we quickly absorb and which quickly acidifies the blood stream. We find that with the blood slightly on the acid side, the inflammatory responses tend to subside, and broncho constriction lessens. And though much nutrition advice these days promotes low fat diets, we find many of our asthma patients do better with a fairly regular intake of, yes, red meat. There’s a reason, biochemically speaking, why red meat might help. Red meat contains nutrients called phosphates and sulfates that our bodies quickly convert to acid in the blood. Once again, a slightly more acidic blood seems to blunt the exaggerated inflammatory response so typical of asthma.

    But, whatever diet an asthmatic chooses to follow, the cleaner the food the better, and that means organic. Fortunately, we live in a time when few doubt that organic food, be it plant or animal, not only provides more nutrients than conventional, but is cleaner. For an asthmatic, I believe organic is the only way to go.

    In terms of our local environment, we always encourage our patients to think green. The fewer toxins in the environment, at home, in the office, and at school, the better an asthmatic patient will do. Use non-toxic cleaning agents, and if your house needs painting, use the gentler, greener low VOC paint readily available today. Patients often ask me to recommend air filters, but frankly, we find the best air filter to be plants—but of course, only those that won’t lead to an allergic asthmatic response! Scientists now know that plants very efficiently remove pollutants, even the nastiest, from the air around us. One article on reported that spider plants remove 96 percent of carbon monoxide, and 99 percent of nitric oxide, both noxious gases, after only 24 hours. Spider plants, philodendron, and aloe plants are among the most powerful pollution fights around. Plants also give off oxygen, as an added benefit for all of us. In my home and office, we have plants everywhere, and for good reason—not only do they bring a bit of nature to my city life, but they keep the air around me, my wife, and my patients clean.

    The cleaner the world, the less pollution and the better it is for all of us, but particularly, the better for asthmatics. Get involved with friends and community groups; help organize a tree planting initiative in your neighborhood. Join national organizations that fight to keep the earth clean. Small efforts can add up, bit by bit, and ultimately have a powerful global effect.