EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 16, 2004
To contact corresponding author Kenneth L. Tyler, M.D., call Dana Berry at 303/315-5571. To contact editorialist Roger N. Rosenberg, M.D., call Katherine Morales at 214/648-3404.

ORGAN TRANSPLANT RECIPIENTS EXPERIENCE SEVERE NEUROLOGIC SYMPTOMS CAUSED BY WEST NILE VIRUS

CHICAGO—Organ transplant recipients who become infected with West Nile virus develop more severe neurological illness caused by the virus, according to an article in the August issue of the Archives of Neurology, one of the JAMA/Archives journals.

West Nile virus (WNV) is a potentially lethal virus that can infect mosquitoes, birds, horses, humans, and other mammals. WNV affects the nervous system and can cause encephalitis - an inflammation of the brain, or meningitis - an inflammation of the membrane surrounding the brain and spinal cord. WNV is also associated with fever, headaches, fatigue and neurologic symptoms. According to the article, naturally acquired WNV first appeared in North America in 1999. Between July 2003 and October 2003, there were 2,947 confirmed cases of WNV and 63 deaths in Colorado. The article states that approximately 25,000 patients receive organ transplants in the United States each year. Transplant recipients are treated with long-term immune system-suppressing drugs that put them at greater risk for infections, including WNV.

B.K. Kleinschmidt-DeMasters, M.D., of the University of Colorado Health Sciences Center, Denver, and colleagues describe eleven transplant recipients (four kidney, two stem cell, two liver, one lung, and two kidney/pancreas) hospitalized with WNV encephalitis. All cases of WNV occurred between July 2003 and October 2003 and patients were seen in Colorado hospitals. All 11 patients received their organ five months to 15 years before being infected with WNV.

The researchers found that all but one patient had the usual early symptoms of WNV as documented in non-immunosuppressed patients. Ten patients developed meningoencephalitis (inflammation of the brain and membrane surrounding the brain and spinal cord), and three of the ten also developed acute flaccid paralysis (paralysis associated with loss of muscle tone). One patient developed acute flaccid paralysis without encephalitis. Six patients had significant movement disorders, including tremor.

Magnetic resonance imaging (MRI) of the brain revealed abnormalities in seven of eight tested patients. Nine of the 11 patients studied survived their infections, but three of them had significant problems caused by their infections and two patients died of complications of WNV.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 16, 2004
To contact corresponding author Alan C. Geller, M.P.H., R.N., call Jodi Petrie at 617/638-5432.

SUN PROTECTION DECLINES BETWEEN THE FIRST AND SECOND SUMMERS OF CHILDREN'S LIVES

CHICAGO—Mothers reported more sunburns and tanning in the second summer of their children's lives compared to the first summer, according to an article in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.

According to the article, many of the skin cancers diagnosed in the United States are caused by unprotected and excessive exposure to the sun. Sunburns during childhood are important in the development of melanoma (skin cancer) later in life, the article states, and it has been suggested that sun protection habits should begin early in life and be taught as part of routine preventive health care.

Lori Steinberg Benjes, M.D., of Boston University, and colleagues investigated whether an intensive intervention program aimed at mothers of newborns would increase sun protection practice and lower rates of sunburn for their children. The researchers also examined changes in sun protection practices and sunburn rates between the first and second summers of the children's lives.

A total of 92 mothers completed surveys on their own sun protection habits and how they protected their children from the sun in 1998, within the first six months of their child's life. Forty-five mothers were in the intervention group and after their child's birth received counseling from nurses on effective sun protection techniques for their newborns, received written materials, and participated in telephone counseling. The 47 mothers in the control group received only in-hospital sun protection counseling after their child was born.

The researchers found that the intervention and control groups had similar decreases in routine use of sun protection (long-sleeved clothing and pants, sunscreen and shading) between the first (average age, 6 months) and second summers (average age, 18 months) of the child's life.

However, sunscreen use increased 62 percent in the intervention group and 56 percent in the control group between the first and second summers of life.

The researchers also found that the proportion of mothers who reported that their child had experienced a sunburn increased from 7 percent to 45 percent in the intervention group compared with 17 percent to 37 percent in the intervention group. The increase in skin damage (burning plus tanning) for the children was 32 percent for the intervention group and 43 percent for the control group from the first to second summer of life.

"The overall analysis of the 92 families' experiences in the first and second summers revealed two major findings. First, skin damage rates increased from 22 percent in the first summer for 6-month-olds to 54 percent in the second summer for 18-month-olds, despite more than 90 percent of mothers reporting that they routinely used sunscreen in the second summer," the authors write.

"Second, it appears that lack of full protection in the child's second summer rather than increased sun exposure resulted in more sunburning and tanning; that is, use of hats, long-sleeve shirts, and shade dropped substantially for children between ages six months to 18 months in both study groups, despite efforts that consistently publicized total and comprehensive sun protection," write the researchers.

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, August 16, 2004
To contact Glen H. Crawford, M.D., call Susan Winston at 215/349-8368.

MASSAGE THERAPISTS HAVE HIGH PREVALENCE OF HAND DERMATITIS

CHICAGO—Massage therapists who frequently use essential oils involved in aromatherapy treatments, have higher rates of hand dermatitis than the general population, according to an article in the August issue of the Archives of Dermatology, one of the JAMA/Archives journals.

Hand dermatitis (also known as hand eczema) is a skin disorder that causes the hands to develop a rash and become dry and cracked. Hand dermatitis can interfere with social activities and can cause permanent disfigurement, the article states. Currently, there are between 260,000 and 290,000 practicing massage therapists and massage therapy students in the United States. Many massage therapists are exposed to multiple factors known to increase the risk of hand dermatitis, including frequent hand washing, contact with fragrances, dyes, detergents, latex and other irritants and allergens found in massage oils, creams and lotions. The essential oils used in aromatherapy can also cause hand dermatitis.

Glen H. Crawford, M.D., of the University of Pennsylvania Medical Center, Philadelphia, and colleagues investigated the prevalence of hand dermatitis over a 12-month period among 350 massage therapists practicing in Philadelphia. The researchers used a mailed survey that included questions about use of essential oils, lotions, and other products, history of diagnosis of hand dermatitis, and symptoms of hand dermatitis.

The researchers found that the 12-month prevalence of hand dermatitis among the survey respondents was 15 percent by self-reported criteria (respondent had been diagnosed with hand dermatitis) and 23 percent according to symptoms reported. Those who reported using aromatherapy products, massage oils, lotions, or creams, were more than three times as likely to have hand dermatitis, and respondents with a history of dermatitis were more than eight times as likely to have hand dermatitis.

"The prevalence of hand dermatitis in massage therapists is high," the authors write. "Significant independent risk factors include use of aromatherapy products in massage oils, creams, or lotions and history of atopic dermatitis."

EMBARGOED FOR RELEASE UNTIL 3 P.M. (CT), MONDAY, June 21, 2004
To contact corresponding author Alexandre Grigorov, M.D., e-mail: alexandre.grigorov{at}charite.de.

POLLEN-BLOCKING CREAM MAY HELP REDUCE ALLERGY SYMPTOMS

CHICAGO—A cream applied to the inside of the nose appears effective in reducing the symptoms of allergic rhinitis, according to an article in the August issue of the Archives of Otolaryngology—Head & Neck Surgery, one of the JAMA/Archives journals.

According to the article, allergies are common and are often caused by inhaling or ingesting triggering allergens, such as pollen, dust, mites and animal dander. Hay fever is an inhalation allergy that causes rhinitis- an inflammation of the mucous membranes of the nose often accompanied by sneezing, itching, nasal discharge, and congestion. Some allergy medications can cause adverse effects, the article states. A new ointment (a "pollen blocker cream") applied inside the lower part of the nose is thought to form a barrier that traps allergens, reducing the number of allergens entering the nose and helps to reduce allergy symptoms.

Swetlana Schwetz, M.D., of the Federal Scientific Research Center, Moscow, Russia, and colleagues tested the effectiveness and safety of this pollen blocker cream in a double-blind, placebo-controlled study conducted from November 2001 through September 2002 in two outpatient centers in Germany and one in Russia.

Ninety-one patients between the ages of 18 and 55 years with at least a two-year history of rhinitis were randomly assigned to receive either pollen blocker cream (n=43) or placebo gel (n=48). Participants applied the products to the lower part of the nostrils four times per day for nine days.

On day one, patients' allergic reactions were measured before application of the product using a face mask in a procedure called the nasal provocation test. The allergen each patient was most allergic to (as determined by a skin prick test) was delivered through the face mask in increasing concentrations over time until a reaction was elicited. Symptoms were scored on a scale of one to four, with four being the worst symptoms.

On day two, patients applied either pollen blocker cream or placebo, and the nasal provocation test was performed again. The rate of airflow in the nasal passageways was measured, and the patients' symptoms were scored. On days two through five, the patients applied their products four times per day. On day six, the study was repeated, with patients who received the pollen blocker cream given placebo, and patients who had received placebo for the first part of the study switched to pollen blocker cream.

The researchers found that the median symptom score decreased from four to one after application of the pollen blocker cream and from four to three in the placebo group. They also found that the increased improvement in airflow in response to treatment was roughly 20 percent in the pollen blocker group and only about 10 percent in the placebo group.