Beware 

America’s 

Silent Killer

Detecting and 

Managing High 

Blood Pressure

Achoooooo!

This Is the “Season 

of the Itch”—What You 

Can Do About It

Dream Robber

The Challenges of Living 

with Parkinson’s Disease

Winning 

the Race

Lance Armstrong 

Shares His Struggle 

To Survive Cancer...

and Thrive!

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Institutes of Health

MedlinePlus Summer 2006

t h e m a g a z i n e

A publication of the National Institutes of Health and the Friends of the National Library of Medicine
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The Hon. Paul G. Rogers

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and former member of the 

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Helping the Library Extend Medical Knowledge
NIH MedlinePlus Summer 2006 1

Letter from the Friends Chairman

 1 Table of Contents

 2 Introductions

 4 Clinical Trials

 6 Winning the Race: Lance Armstrong shares his struggle to survive cancer 

... and thrive!

11 Pressure Points Detecting and managing high blood pressure

14 Dream Robber

The challenges of living with Parkinson’s Disease.

20 Achoooooo! This is the “season of the itch”—

what you can do about it

26 NIH Research News

28 Advisors & Sponsors

IBC NIH MedlinePlus Editorial Board 

Summer 2006

Table of Contents

6

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2 Summer 2006 NIH MedlinePlus

MedlinePlus and NIH’s National Library of Medicine

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t is a pleasure to support the 

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With roots in the 19th century, 

the National Institutes of Health 

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for conducting and supporting 

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Supported by the American 

taxpayer, NIH research has led 

to tremendous breakthroughs 

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and how to prevent, detect, diagnose and treat them. More than 

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awarded through almost 50,000 

competitive grants to more than 

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NIH MedlinePlus Summer 2006 3

Dear Reader,

It is a pleasure to welcome you 

to NIH MedlinePlus magazine, your 

guide to the vast resources that 

you will find at MedlinePlus.gov, 

the free Web site of authoritative 

health information from the 

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expanded its mission and now serves the general public as well as health 

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There is no advertising, no registration and the site is completely free. In addition to a remarkable array of consumer-friendly information, there are convenient links to the scientific medical literature (PubMed), a registry of 27,000 

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explore www.medlineplus.gov.

A National TreasureHouse of Knowledge

The National Library of 

Medicine (NLM), on the campus 

of the National Institutes of 

Health in Bethesda, Maryland, 

is the world’s largest medical 

library. The Library, which has 

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medical history collections of 

old and rare medical works. NLM 

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of Medicine.
4 Summer 2006 NIH MedlinePlus

Clinical Trials

Aclinical trial is a research study 

designed to answer specific 

health questions by using 

human volunteers to help 

test those answers. Carefully conducted 

clinical trials are the fastest and safest way 

to find treatments that work in people, 

and there are clinical trials going on all 

the time in virtually every area of medical 

research. People who volunteer to take part 

in clinical trials do so for several reasons, 

including the chance to play a more active 

role in their own health care, gain access 

to new research treatments before they 

are widely available and help others 

by contributing to medical research.

There are several different kinds 

of clinical trials, including:

n Treatment trials to test experimental 

treatments, new combinations of 

drugs or new approaches to surgery 

or radiation therapy.

n Prevention trials that look for better 

ways to prevent disease in people 

who have never had the disease, or to 

prevent a disease from returning. These 

approaches may include medicines, 

vitamins, vaccines, minerals 

or lifestyle changes.

n Diagnostic trials to find better 

tests or procedures for diagnosing a 

particular disease or condition.

n Screening trials that test the best way 

to detect certain diseases or health 

conditions.

n Quality of Life trials (or Supportive 

Care trials) that explore ways to 

improve comfort and the quality 

of life for individuals with chronic 

illnesses.

The latest and most complete 

information about clinical trials today 

is available at the ClinicalTrials.gov

A Crucial Key to Human Health Research

At the forefront of 

human health research 

today are clinical trials—

studies that use human 

volunteers to help 

medical professionals 

observe and test new 

treatments for a wide 

array of health products 

and practices
NIH MedlinePlus Summer 2006 5

Web site (http://clinicaltrials.gov). This 

is a free, confidential online resource 

from the National Institutes of Health 

(NIH), which anyone with a computer 

and Web browser can tap into for 

a comprehensive listing of clinical 

studies—in the U.S. and abroad—

sponsored by the NIH and other federal 

agencies, pharmaceutical companies, 

universities and nonprofit organizations.

Here’s how it works. After you enter 

the ClinicalTrials.gov Web site, you can 

search for a trial by the name of the 

disease, the location of the study, the 

type of treatment or the sponsoring 

institution. The results will show you 

what studies are under way, whether a 

trial is actively recruiting, the purpose 

of the study, where and when it will take 

place and whom to contact for more 

information. 

“From the very beginning, 

ClinicalTrials.gov has been designed 

for use by patients,” observes Donald 

Lindberg, M.D., director of the National 

Library of Medicine (NLM), the 

coordinating agency for NIH. “With 

patients taking an increasingly active role 

in their own healthcare, they now have 

a chance to learn more about clinical 

studies on everything from Alzheimer’s 

disease to zinc supplementation. 

Without question, it has helped 

investigators with their research 

recruiting efforts, too.” 

Launched in February 2000, 

ClinicalTrials.gov currently contains 

information on more than 27,000 trials. 

The site has proven very popular with 

the public, logging approximately 

8 million page views monthly and 

hosting over 20,000 visitors daily. The 

site is updated regularly, with new 

information added every day.

ClinicalTrials.gov has many helpful 

features for the consumer. If you are 

checking out trials on breast cancer, 

for example, the site also links you 

to the NLM’s MedlinePlus (www.

medlineplus.gov), with in-depth 

information on the topic, including 

recent news articles and an interactive 

tutorial. ClinicalTrials.gov also points 

you to NLM’s Genetics Home Reference 

site (www.ghr.nlm.nih.gov), helping you 

understand possible genetic factors that 

can increase the incidence of the disease. 

It allows you to search medical journal 

references via NLM’s PubMed 

(www.pubmed.gov) and links to the 

National Cancer Institute (www.nci.

nih.gov), the lead NIH institute on this 

particular topic. 

“It’s really one-stop shopping, 

allowing the user to dig deeper for 

information on the disease or condition 

after viewing the list of clinical trials,” 

says Dr. Lindberg. “ClinicalTrials.gov

is a powerful tool for the individual 

health care consumer, and it has untold 

benefits for the public health, too, as new 

drugs and therapies evolve from these 

important studies.” n

How to Participate 

Clinical trials are sponsored or 

funded by a variety of organizations 

or individuals, such as physicians, 

medical institutions, foundations, 

voluntary groups and pharmaceutical companies, in addition to 

federal agencies such as the NIH, the 

Department of Defense (DOD) and 

the Department of Veterans Affairs 

(VA). Trials can take place in different 

locations, such as hospitals, 

universities, doctors’ offices 

and community clinics.

If you would like to participate 

in a clinical trial, you can find opportunities and more information 

at government Web sites such as:

n http://www.clinicaltrials.gov

n http://www.cancer.gov/search/

clinicaltrials (Cancer studies) 

n http://www.aidsinfo.nih.gov/

clinical_trials (HIV and 

AIDS studies) 
6 Summer 2006 NIH MedlinePlus

T

Armstrong, whose non-profit Lance 

Armstrong Foundation (LAF) is now a 

leader in the fight against cancer, knows 

all too well the impact that cancer of any 

kind can have on an individual. In 1996, 

his own aggressive form of testicular 

cancer metastasized into his lymph 

nodes, lungs and brain. Armstrong 

underwent two surgeries, one to remove 

his cancerous testicle and another to 

remove two cancerous lesions on his brain. 

Over a three-month period, he received 

four rounds of chemotherapy. For these 

reasons, he understands that defeating 

cancer cannot be done alone.

As he told doctors, researchers and 

clinical trial participants on one of his visits 

to the NIH’s National Cancer Institute 

(NCI), without their cancer research and 

that of others, “...quite frankly, I wouldn’t 

be here today. And I certainly wouldn’t 

have clipped into a pedal and started a bike 

race ever again.”

Success stories such as Armstrong’s 

are part of an evolving strategy in the 

fight against cancer, notes Andrew von 

Eschenbach, M.D., NCI director and 

acting commissioner, U.S. Food and Drug 

Administration.

“Over the course of the 20th century, 

the primary strategy for treating cancer 

was ‘seek and destroy’,” he says. “Now, in an 

effort to preserve healthy cells and improve 

outcomes, we are increasing efforts to 

‘target and control’ cancer by modulating 

and altering the behavior of the disease. 

Someday we will eliminate cancer, but for 

today, our immediate goal is to eliminate 

the suffering and death due to cancer.” 

(Read more comments from Dr. von 

Eschenbach on page 8.)

That is one of the many reasons that 

Dr. von Eschenbach finds Lance 

Armstrong’s story so compelling: “Lance 

is a cancer survivor who represents so 

many, many others across this country and 

the world who have faced the challenge 

of cancer,” he says. “He is an example to 

us of what is possible, what is within our 

grasp—a world in which no one suffers 

and no one dies as a result of cancer.”

How did you learn of your cancer, 

and how did you feel about it?

I was diagnosed with advanced 

testicular cancer on October 2, 1996. 

I had ignored the symptoms for 

months; pain comes with professional 

cycling, so it was easy to dismiss the 

soreness in my groin, headaches and 

difficulty breathing. I reluctantly went 

to the doctor after my testicle had 

swollen to three times its normal size. 

Winning

the Race

Lance Armstrong Shares His Struggle 

To Survive Cancer ... and Thrive!

The world knows and celebrates Lance Armstrong for his remarkable defeat of life-threatening cancer 

and for his unparalleled seven consecutive victories in the Tour de France bicycle race. But, as Armstrong 

reveals in this exclusive interview, he is prouder of his cancer victory than all of his racing wins. 
NIH MedlinePlus Summer 2006 7

I owe a lot to my neighbor—a friend 

and doctor who insisted I get it checked 

out. By the time I was diagnosed, the 

cancer had already spread to my lungs 

and brain, so it is fair to say I was in 

bad shape.

How did I feel about it? Probably 

the same as anyone who has ever been 

diagnosed feels about cancer—I was in 

complete shock. Here I was, young and 

healthy and riding better than ever and, 

suddenly, I have cancer. I was worried 

about losing my career and, frankly, my 

life. I didn’t know how to tell my mom, 

and I was scared and angry.

I can now say that my life is better 

because of my cancer experience. 

Though I wouldn’t wish it for anyone, 

I believe I appreciate my life in a 

completely new and better way 

because I faced cancer and was lucky 

enough to survive. Having said that, 

I also believe that cancer still affects 

far too many people, and we must 

continue to work to change that fact.

You say that “knowledge is power” 

in fighting cancer. From your 

experience, what are the two or three 

most important things you believe 

cancer patients should keep in mind?

My mom and a core group of 

friends helped me spend countless 

hours reading information and asking 

questions. It’s really important, and I 

can’t stress that enough. You must be 

your own best advocate to be sure the 

treatment you are getting is best for you.

I got a second opinion, which can 

be tough to do. We are inclined to 

trust our doctors implicitly and not 

question them, but the second opinion 

I got was the right one for me. So, 

I would encourage people to seek 

more opinions and to not be afraid to 

question their doctors.

I also think that a person with cancer 

needs to seek out support from friends 

and family. I had a group of people 

there for me—to listen to me, cheer 

me on or remind me that I wasn’t really 

alone. I was lucky to know that other 

people were invested in my survival; 

you can never overestimate the benefit 

of that kind of support and friendship.

In addition to talking with your 

doctors, did you seek information 

from the National Cancer Institute, 

and how important was it to you?

At the time, I didn’t know anything 

about the NCI and all the resources 

available to people with cancer. I 

discovered the NCI while researching 

information about my diagnosis, and I 

believe it is a very important resource.

I would encourage anyone facing 

cancer to seek more questions and 

not be afraid. Especially now, with the 

increased use of the Web, it is amazing 

how much information is available 

to a new patient. 

Beyond supplying information, 

the work of the NCI represents our 

government’s commitment to cancer. 

That is why the current $40 million in 

budget cuts proposed for the NCI are 

wrong. There is a long budget battle 

ahead, and I know the Senate has 

proposed an amendment to restore 

funding. We cannot back away from our 

MedlinePlus and 

NCI Cancer Resources

Main MedlinePlus Web page:

www.medlineplus.gov

MedlinePlus cancer types:

http://www.nlm.nih.gov/

medlineplus/cancers.html

Patient education tutorials:

http://www.nlm.nih.gov/

medlineplus/tutorial.html

Drugs, supplements and herbal 

information:

http://www.nlm.nih.gov/med

lineplus/druginformation.html

Updated information about federally and privately supported clinical 

research in human volunteers:

http://clinicaltrials.gov

Directories of health-care professionals, services and facilities:

www.nlm.nih.gov/medlineplus/

directories.html

National Cancer Institute (NCI):

www.cancer.gov/

Links to all types of cancer:

www.cancer.gov/cancertopics

Armstrong and the Lance Armstrong Foundation 

hold LIVESTRONG Challenge cancer-research 

fund-raisers in various cities across the country, 

such as this 2005 Ride Portland event in Oregon. 

For details, visit www.livestrongchallenge.org.
Cancer—in all its forms—continues to take a huge toll 

on people across the world. In your opinion, where do 

we stand in the fight today?

This year, more than 1.4 million Americans will hear 

the words, “You have cancer.” One out of every two men 

and one out of every three women during their lifetime 

will hear the words, “You have cancer.” One American 

every minute is dying as a result of this disease. Now, we 

need fresh thinking about new goals—goals that remain 

focused not as a cure but as a long-term solution for 

controlling cancer. 

In 1971—the same year that Lance Armstrong was 

born—the National Cancer Act was passed, and the 

country committed its resources to conquer cancer. That 

journey has led us to a truly transformational moment. The 

National Cancer Institute has committed itself to a goal, 

one based on our emerging understanding of cancer as a 

disease process. Our plan is to eliminate the suffering and 

death that result from this process that we understand as 

cancer, and we are committed to a goal of doing so as early 

as 2015.

In what ways do you see the fight against cancer 

changing so dramatically?

We have the ability within our grasp, based on the 

trajectory of progress, to expand our understanding of the 

fundamental mechanisms that give rise to our susceptibility to cancers, the early events of malignant transformation, 

the progression and the metastatic spread and the ultimate 

death that we see all around us in our friends and relatives.

Working Together, We Can Defeat Cancer

An interview with Andrew C. von Eschenbach

8 Summer 2006 NIH MedlinePlus

commitment to beating cancer, and the 

NCI is critical in that fight. 

 

What is the message you would 

most like to send to people recently 

diagnosed with cancer?

Hope. There can and should be life 

after cancer for more people, and I want 

people to know that. 

At a Lance Armstrong Foundation 

(LAF) event in Austin last fall, a lung 

cancer survivor told the audience that she 

changed doctors because the first one 

seemed to write her off. 

She said she fired the doctor because, 

as she put it, “I can’t have more hope than 

you do. I need someone to believe in me.” 

Maybe that’s why she is still here and was 

able to come to Austin to share her story. 

Cancer is tough, and it still claims too 

many lives, but I think that hope is the 

greatest weapon a person has. Ask the 

tough questions, get a second opinion, 

take care of yourself, surround yourself 

with family and friends, and do whatever 

you have to do to keep hope alive. 

The goal of this new magazine, 

NIH MedlinePlus, is to give people 

access to trusted, easily understood 

information about dealing with 

disease and staying healthy. Do you 

often hear from people seeking such 

reliable information?

Constantly. A cancer diagnosis 

changes a person forever. It is an 

overwhelming and confusing thing, 

particularly since there are so many 

types of cancer and so many outcomes. 

More than anything else, people just 

want information. They want to know 

about treatment, treatment centers, 

side effects, fertility and depression 

and, of course, how they are going to 

On Wednesday, May 17, you 

can help Lance and the LAF 

be a voice for change. Thousands of people will take part 

in LIVESTRONG Day events 

across the country to raise 

awareness of and bring attention to an issue that impacts 

all Americans—cancer. 

For more information, visit 

www.livestrong.org.
We are now understanding the molecular mechanisms 

that control the process, and we are learning how to 

exploit those mechanisms to prevent, detect, eliminate 

or control the process.

Would you give us examples of how the NCI and its 

many researchers across the globe are proceeding 

in their work?

Genomics, proteomics and emerging technologies are 

enabling us to profile not only diseases but the persons 

who bear those diseases. We can, thus, understand the 

genetic and molecular differences, so that we can begin 

to personalize intervention strategies.

In our recent experience with lung cancer, we have seen 

the introduction of the drugs Iressa and Tarceva, which are 

targeted to affect an enzymatic pathway involved in the 

proliferation and growth of cancer cells. By understanding 

the genetic mutations that lead to that abnormal pathway, 

we can identify those patients who 

might benefit from that particular 

intervention.

Also, we are moving from an 

era in which imagery is no longer 

simply enabling us to see a lump on 

a chest X-ray or a mass on a CT scan, 

but enabling us to visualize—using 

molecular imaging—the biology of the 

disease in real time. For example, in 

gastrointestinal cancer, using the new 

drug Gleevec, you can use radioactive 

imaging agents to see in 24 or 48 hours 

whether you have changed the biochemistry of that tumor.

What we thought was impossible back in 1971 is a 

reality today. What we think is impossible today—a world 

in which no one would suffer or die from cancer—can 

become a reality if we make it happen together.

NIH MedlinePlus Summer 2006 9

Andrew C. von 

Eschenbach, M.D.

Director, National Cancer 

Institute; Acting Commissioner, Food and 

Drug Administration

pay for their care. One of the goals of 

the LAF is to provide information to 

people about the physical, practical 

and emotional consequences of cancer. 

It’s a big job, and this information 

is in demand, so we welcome more 

resources for people with cancer. 

Could you share a brief anecdote or 

moment that occurred during your 

treatment that speaks to you about 

how the courageous struggle by 

cancer patients can be a meaningful 

boost to other cancer patients?

While I was being treated, my nurse, 

Latrice Haney, started introducing me 

to other patients. It was good for me. 

That was when I truly began to grasp 

the magnitude of cancer—more than 

8 million people living with it at the 

time. I got really angry and became 

interested in fighting cancer, not just 

my own, but cancer in general. I knew 

that I needed to use this experience to 

help others, which was how the idea for 

the Foundation began. 

I’m lucky to meet so many people 

through the LAF that remind me how 

courageous the average cancer patient 

is. And it’s a reminder that cancer 

doesn’t discriminate. I have met people 

from all over the world with all types of 

cancer and more brave kids than I can 

count. A person could get discouraged 

by that, but we use it to inspire us to 

work harder. 

What is your goal for the Lance 

Armstrong Foundation?

We want to inspire and empower 

people with cancer. We want to provide 

people with the practical tools and 

information they need to live strong.

We are doing that through 

research, advocacy and public health 

programs. It’s a big job; we are fully 

dedicated to it. 

What does the future hold for 

Lance Armstrong?

I hope to live up to the words of one 

of my doctors—Dr. Craig Nichols—and 

continue to fulfill the obligation of 

the cured by leading a grassroots 

movement to reduce incidence, 

increase survival and offer each person 

with cancer the opportunity to live their 

life on their own terms.

I am grateful for the tremendous and 

unforgettable experiences my cycling 

career has brought me, but I am most 

proud to be a cancer survivor and a 

parent. It is these two roles that will 

guide my future. n
d � H E A R T D I S E A S E oesn’

C A R E W H A T Y O U W E A R 

The Red Dress is a red alert to take heart disease seriously. I T ’ S T H E # 1 K I L L E R O F W O M E N 

These women know The Heart Truth—no matter how great you Talk to your doctor and get answers that may save your life. The

look on the outside, heart disease can strike on the inside. And Heart Truth is, it’s best to know your risks and take action now. 

being a woman won’t protect you. www.hearttruth.gov 

Try these risk factors on for size: Do you have high blood 

pressure? High blood cholesterol? Diabetes? Are you inactive? 

Are you a smoker? Overweight? If so, this could damage your 

heart and lead to disability, heart attack, or both. 

U . S . D E P A R T M E N T O F H E A L T H A N D H U M A N S E R V I C E S 

National Heart, Lung, and Blood Institute; National Institutes of Health • Office on Women’s Health 

American Heart Association • WomenHeart: the National Coalition for Women with Heart Disease 
NIH MedlinePlus Summer 2006 11 

N 

Faced with such alarming statistics 

and based on a landmark 2002 study 

called the Antihypertensive and LipidLowering Treatment to Prevent Heart 

Attack Trial (ALLHAT), the National 

Institute of Health’s National Heart, Lung, 

and Blood Institute (NHLBI) has begun 

a comprehensive, nationwide educational 

outreach program to better identify and 

treat high blood pressure. 

“It often takes years for the results of 

major studies to become part of standard 

healthcare,” says NHLBI Director 

Elizabeth G. Nabel, M.D. “The results of 

ALLHAT and the clinical guidelines could 

have an enormous impact on the health 

of millions of Americans. By aggressively 

sharing this information, we will be able 

to put the results into action more quickly 

and more effectively.”

Throughout May, which is National 

High Blood Pressure Education Month, 

physicians and communities across the 

country will be taking part in the activities 

planned to inform the public how to 

recognize and treat hypertension. 

Living by the Numbers

For patients and their families alike, it is 

critical to understand the basics in order to 

be able to better control the disease.

Simply put, blood pressure is the 

force exerted by blood on the walls of the 

arteries and veins as it courses through the 

body. Like the ocean tide, it is normal for 

blood pressure to rise and fall throughout 

the day. But when the pressure stays 

elevated over time, it causes the heart to 

pump harder and work overtime, possibly 

leading to various, serious health problems, 

ranging from hardening of the arteries, 

stroke and brain hemorrhage to kidney 

malfunction and blindness.

Blood pressure is recorded as two 

numbers, the systolic (pressure during 

a heartbeat) over the diastolic (pressure 

between heartbeats). For example, a 

measurement of 120/80 millimeters 

of mercury (mmHg) is expressed as 

“120 over 80.” Normal blood pressure is 

less than 120/80. People with pressures 

between 120/80 and 139/89 are considered 

to have pre-hypertension and be likely 

to develop high blood pressure without 

preventative measures. 

Today, clinical guidelines recommend 

that physicians work with patients to 

keep their blood pressures below 140/90 

mmHg, and even lower for people with 

diabetes or kidney ailments. In all cases, 

patients are encouraged to lose excess 

weight, exercise regularly, not smoke, 

limit intake of alcoholic beverages, 

and follow heart-healthy eating plans, 

including cutting back on salt and other 

forms of sodium.

Pressure

Points:

May is National High Blood Pressure 

Education Month, a good time 

for many Americans to make sure 

that they and their loved ones are 

protected against this silent killer.

Preventing and Controlling Hypertension 

Nearly one in three adults—almost 65 million Americans—suffers from hypertension, or high blood pressure. 

What’s more, high blood pressure leads to more than half of all heart attacks, strokes and heart failure cases 

in the United States. It also increases the risk of kidney failure, blindness and other serious health consequences. 
12 Summer 2006 NIH MedlinePlus

Assessing Your Risk

While many Americans develop high 

blood pressure as they get older, it is not a 

hallmark of healthy aging. This is especially 

critical for African-Americans, in whom 

the disease tends to begin at an earlier age 

and be more severe. In addition to being at 

increased risk, they also experience higher 

rates of death from stroke and kidney 

disease than does the general population.

As the following examples illustrate, 

the indicators for high blood pressure vary 

widely from individual to individual and 

bear very close, personal vigilance. 

n Ron Tucker, a 42-year-old 

African-American suffering from 

hypertension, is always on the go. 

His biggest challenge to lowering his 

blood pressure is to watch what he 

eats, especially fast food. “AfricanAmericans are very sensitive to salt,” 

he says, “so I’ve got to be more careful, 

especially at lunch when I usually grab 

a burger and fries. Besides the fat, that 

meal has lots of salt.” 

n Carol Jackson, 42 and white, has thus 

far managed to avoid a diagnosis 

of high blood pressure although 

her readings do fall within the prehypertension range, putting her on 

notice. Further reasons to remain 

on guard include a family history of 

high blood pressure, lack of regular 

exercise and the fact that she smokes. 

“My mother and father both had high 

blood pressure, and my father passed 

away from a stroke when he was only 

59,” she says. 

By adopting healthier lifestyles, Tucker, 

Jackson and the millions more facing 

hypertension can begin controlling their 

conditions. “Don’t wait until your pressure 

spikes to make changes,” urges Lawrence 

Appel, M.D., M.P.H., lead author of a 

February 2006 report in Hypertension: 

Journal of the American Heart Association, 

which links healthier eating habits to 

lowered blood pressure.

“While an individual’s blood pressure 

may be normal now, 90 percent of 

Americans over 50 years of age have a 

lifetime risk of high blood pressure,” 

says Appel, a professor at Johns Hopkins 

University School of Medicine. “Americans 

should take action before being diagnosed 

with high blood pressure.”

An Ounce of Prevention

For example, because blood pressure 

rises as body weight increases (and obesity 

is a known risk factor for developing high 

cholesterol and diabetes, which in turn can 

lead to heart disease), a loss of little as 10 

pounds can help to lower blood pressure.

Two recent studies confirm the blood 

pressure benefits of maintaining a healthy 

diet. First is the Dietary Approaches 

to Stop Hypertension (DASH) clinical 

study, which tested the effects of food 

nutrients on blood pressure. It emphasizes 

consumption of fruits, vegetables and lowfat dairy foods, whole grains, poultry, fish 

and nuts, and stresses reduction of fats, red 

meats, sweets and sugared beverages. 

Second is the DASH-sodium study, 

which demonstrates the importance of 

lowering sodium intake. Most Americans 

consume far more than the current, daily 

recommendation of 2,400 milligrams 

(mg) of sodium—about a teaspoon of 

table salt—or less. This includes all salt 

and sodium consumed, not just at the 

table, but also in cooking. For those with 

high blood pressure, consuming even less 

may be advisable, since the DASH-sodium 

study revealed that diets containing no 

more than 1,500 mg of sodium per day 

had still greater pressure-lowering effects.

Regular physical activity is another 

good step toward controlling or even 

preventing high blood pressure. Start with 

30 minutes of moderate-level activity, such 

as brisk walking, bicycling or gardening 

on most—preferably all—days of the 

week. The activity even may be divided 

into three, 10-minute periods each. For 

added benefit, these moderate half-hours 

may be increased or supplanted by regular, 

vigorous exercise. Of course, prior to 

upping the activity level, people should 

check with their physicians, especially if 

they have had heart trouble or a previous 

heart attack, a family history of heart 

disease at an early age or other serious 

health problems.

Another healthy move is to limit 

alcohol intake. Excess alcohol can raise 

blood pressure as well as damage the liver, 

heart and brain. Drinks should be kept to a 

ADDITIONAL

INFORMATION ON 

HYPERTENSION

MedlinePlus: High blood pressure: 

http://www.nlm.nih.gov/

medlineplus/

highbloodpressure.html

Tutorial on high blood pressure: 

http://www.nlm.nih.gov/

medlineplus/tutorials/

hypertension/htm/index.htm

DASH eating plan: http://www.

nhlbi.nih.gov/health/public/

heart/hbp/dash/new_dash.pdf

Links to clinical trials: http://

clinicaltrials.gov/ct/gui/

action/FindCondition?ui=

D006973&recruiting=true

Types of blood pressure medications: http://www.nhlbi.nih.

gov/hbp/treat/bpd_type.htm
NIH MedlinePlus Summer 2006 13 

Why should Americans be concerned 

about high blood pressure?

Hypertension—or high blood pressure—is a serious 

public health problem affecting one in three Americans. 

Known as the “silent killer” because it usually has no 

symptoms, with high blood pressure, the heart works 

harder, your arteries take a beating and your chances of 

a stroke, heart attack and kidney problems are greater. 

Because it affects circulation, high blood pressure 

also creates a higher risk for mental deterioration and 

Alzheimer’s. Once high blood pressure develops, it 

usually lasts a lifetime but the good news is that it can 

be treated and controlled by keeping a healthy weight, 

exercising regularly, following a healthy eating plan, 

reducing intake of salt and sodium, and consuming 

alcohol in moderation if you drink.

I have heard about the DASH Eating Plan 

to help control hypertension. What is it?

DASH stands for Dietary Approaches to Stop 

Hypertension. The DASH Eating Plan is a diet rich in fresh 

fruits, vegetables, low-fat dairy, fish and poultry, which 

studies sponsored by the NHLBI have shown can achieve 

large reductions in blood pressure. For those who also 

reduce salt and sodium consumption, the decrease 

in blood pressure has been shown to be even more 

significant. The DASH Eating Plan promotes a diet that is 

low in saturated fat, cholesterol and total fat, as well as 

lowered intake of red meat, sweets and sugar-containing 

beverages. You can find and print out the DASH Eating 

Plan on the NHLBI Web site at 

www.nhlbi.nih.gov/health/

public/heart/hbp/dash/.

Where do we stand 

in the fight against 

hypertension?

High blood pressure causes 

more visits to doctors than any other condition and, 

along with its complications, costs the U.S. economy 

more than $100 billion annually. Just a 10 percent 

decline in the number of doctor visits would save $478 

million each year. Data from clinical trials indicate that 

controlling hypertension with medicines can produce 

a 55 percent reduction in heart failure, a 37 percent 

reduction in strokes and a 27 percent reduction in heart 

attacks. 

What is the long-range prognosis 

for controlling high blood pressure?

Controlling high blood pressure is doable, which is 

especially important news for the nearly 60 million 

Americans who are over the age of 55 and face a 90 

percent likelihood of developing high blood pressure in 

their lifetimes. They should have their blood pressures 

measured and follow their doctors’ advice and faithfully 

do the things that can make a healthy difference: lose 

weight; eat “heart healthy” diets low in fat, cholesterol, 

sodium and salt; and spend 30 minutes each day walking 

or doing some other form of physical activity. 

Hypertension—Listen to Your Heart

An interview with Elizabeth G. Nabel

Dr. Elizabeth G. Nabel

Director, National 

Heart, Lung, and 

Blood Institute (NHLBI)

maximum of one per day for women, and 

two for men. (One drink equals 12 ounces 

of beer or five ounces of wine.)

Finally, quit smoking. Among other 

things, smoking damages blood vessel 

walls and speeds hardening of the arteries. 

Ceasing smoking reduces the risk of heart 

attack in just one year.

Taking Control

High blood pressure is a silent 

killer, often with no obvious or visible 

symptoms. The only way to find out if 

you have hypertension is through testing 

by your physician, who will make the 

diagnosis on the basis of two or more 

readings taken on different visits.

For much more information on high 

blood pressure, log onto the NIH Medline 

Plus Web site (www.medlineplus.gov), 

the free, consumer-friendly health and 

medical resource featuring thousands 

of definitions, encyclopedia articles, 

interactive tutorials and clinical trials. n
Robber:

Living with Parkinson’s disease

Dream

14 Summer 2006 NIH MedlinePlus
NIH MedlinePlus Summer 2006 15 

Now 65, he has been permanently 

grounded by Parkinson’s disease, 

unable, due to the loss of motor control 

in his right hand and leg, to qualify 

for the special license he needs to fly 

the sleek kit airplane he dreamed of 

building and taking to the skies in 

retirement. 

“Except for having to give up flying, 

Parkinson’s hasn’t changed my life 

much,” he says bravely, but a little 

wistfully.

Diagnosed with the disease in 1998, 

actor Michael J. Fox perhaps best 

captured the dramatic impact it can 

have when he said, “Parkinson’s forced 

me to make a fundamental life decision: 

adopt a siege mentality—or embark 

upon a life journey.”

Fox since has become one of the 

nation’s foremost advocates for finding 

a cure for the disease, which was first 

described in 1817 by English physician 

James Parkinson as “the shaking palsy.” 

In the early 1960s, researchers identified 

a fundamental brain defect that is 

the hallmark of PD: the loss of brain 

cells, or neurons, in an area known 

as the substantia nigra that produce 

dopamine, a chemical that helps direct 

smooth, purposeful muscle activity. 

Like Kuhn, Fox, Muhammad Ali 

and former U.S. Attorney General Janet 

Reno, some 50,000 Americans from all 

walks of life are diagnosed each year 

with Parkinson’s, and more than onehalf million people are affected at any 

one time. Respecter of neither fame 

nor fortune, PD strikes all over the 

world, affecting men at a slightly higher 

rate than women. 

Subtle onset of classic symptoms

Parkinson’s disease—the most 

common form of parkinsonism, 

a group of disorders with similar 

features—produces a wide range of 

problems that appear and progress at 

different rates and to varying degrees 

from individual to individual. Early 

symptoms are often subtle and may 

include mild shaking of the limbs 

(tremor), slowness of movement or 

stiffness. 

Often, family or close friends 

may notice other changes in the 

person with PD, including decreased 

facial expression, increasingly soft 

voice or progressively more illegible 

handwriting. As the disease advances, 

four classic clinical signs typically 

appear:

n Tremor—rhythmic, back-andforth trembling of the hands, 

arms, legs, jaw or face

n Rigidity—stiffness of the limbs 

and/or trunk 

n Bradykinesia—the slowing down 

and loss of spontaneous and 

automatic movement, particularly 

frustrating because it may be 

unpredictable, and what once was 

routine, like washing or dressing, 

may take significantly longer

As a boy, John Kuhn dreamed of becoming a pilot. 

Mechanically minded and good with his hands, he earned 

his first “wings” at 16. At 26, he became a commercial 

airline pilot, eventually rising to captain on the strength of his 

experience and finely honed motor skills.

“It hasn’t changed 

my life much 

except...”
16 Summer 2006 NIH MedlinePlus

n Instability—impaired balance and 

stooped posture 

Other clinical features sometimes 

present include depression; emotional 

problems, such as anxiety; loss of 

motivation; difficulty swallowing; 

urinary problems or constipation; oily 

skin and scalp; excessive sweating and a 

variety of sleep difficulties. 

Difficult to diagnose 

Typically a disease of late middle age, 

Parkinson’s usually affects people over 

the age of 50, with 60 being the average 

age of onset—just what happened 

to John Kuhn two months after his 

mandatory 60th birthday retirement 

as a commercial pilot. However, 

research over the last several years 

has demonstrated that as many as 10 

percent of Parkinson’s patients may 

experience onset before 40, like Michael 

J. Fox when he was diagnosed.

Even for experienced neurologists, 

accurately diagnosing Parkinson’s 

in its early stages can be difficult in 

some cases. No blood or laboratory 

tests are available, so physicians may 

have to observe patients for some time 

until it is apparent that clinical signs 

and symptoms are consistent with a 

diagnosis of PD. 

Effective drug relief 

Although there currently is 

no cure, various medications can 

provide dramatic relief from many 

of Parkinson’s debilitating motor 

(movement-related) symptoms. 

Physicians tailor treatment to a patient’s 

particular condition since no two people 

react the same way to a given drug.

The primary therapy for PD is 

replacement of dopamine via levodopa 

(also called L-dopa, from the full name 

L-3,4-dihydroxyphenylalanine), a 

simple chemical found in plants and 

animals with which neurons can make 

dopamine to replenish the brain’s 

dwindling supply; dopamine agonists, 

which mimic the role of dopamine in 

the brain; or a combination of both.

Introduced in the 1960s, levodopa 

relieves many troublesome symptoms 

of PD, extending the time in which 

the majority of patients—who would 

otherwise be very disabled—can lead 

relatively normal, productive lives. 

(Dopamine itself cannot be given 

Unraveling Parkinson’s: 

Three Clues

As yet, there is no way to predict the 

majority of cases of PD or prevent disease progression. Studies have shown 

that Parkinson’s patients have lost 60 to 

80 percent of the dopamine-producing 

cells in their substantia nigra before 

symptoms begin. Researchers don’t 

know why or how the cells die, but 

they are beginning to find fascinating 

new clues.

Free radicals: One theory holds that 

free radicals—unstable and potentially 

damaging molecules generated by the body’s normal chemical reactions—may contribute to nerve cell death, thereby leading to Parkinson’s in 

a process called oxidation. Evidence that oxidative mechanisms may cause 

or contribute to the disease includes the findings that Parkinson’s patients 

exhibit increased brain levels of iron and decreased levels of ferritin, a protein that stores, or binds, iron in the body.

Environmental toxins: Some scientists have suggested that Parkinson’s 

may occur from exposure to an environmental risk factor such as a pesticide or a toxin. This theory is based on the fact that a number of toxins are 

known to induce Parkinsonian symptoms in humans.

Genetics: A relatively new theory explores the role of genetic factors, since 

15 to 25 percent of Parkinson’s sufferers have a close relative who has experienced parkinsonian symptoms (such as a tremor).
NIH MedlinePlus Summer 2006 17 

What are the risk factors for developing Parkinson’s?

The clearest risk factor is age. In addition, researchers have 

identified a number of genes that cause or contribute to 

Parkinson’s disease (PD), as well as potential environmental risk factors. A primary piece of evidence that environmental factors play a role is that the relative risk of PD is 

higher in industrialized countries. Farmers and other agricultural workers also have an increased risk of developing 

PD, suggesting that exposure to toxic chemicals or other 

environmental factors present in industrial and agricultural 

areas might increase the risk of PD. In some studies, coffee 

drinking has been inversely associated with PD, but the 

evidence is uncertain, and combining coffee and hormone 

therapy may actually increase women’s risk for developing 

PD. Smokers have a lower rate of PD—about 50 percent 

less—than nonsmokers, but the relationship between 

smoking and Parkinson’s disease is not clear. Contrary to 

popular belief, minor head injury does not cause Parkinson’s disease. A new study indicates that exercise may 

lower PD risk.

What is the most promising area 

of current research?

There are a lot of promising areas in PD research, but one 

of the most exciting is genetics. Researchers have identified a number of genes and chromosomal regions believed 

to play a role in PD. Studying the gene mutations responsible for inherited cases can help researchers understand 

both inherited and sporadic types of the disease. Identifying gene defects may be able to help researchers develop 

animal models that accurately mimic the neuronal death 

in human PD, identify new drug targets and improve 

diagnosis. Based on genetic findings, investigators have 

already developed improved animal 

models, so essential for our understanding of what causes the disease 

and for testing new treatments, and 

have made breakthroughs in cell biology that are helping to elucidate the 

various neurodegenerative processes 

and mechanisms in PD. In the future, 

it may become possible to test for 

individual gene differences in order to 

customize treatment of individual PD 

patients.

 And these basic research successes 

are translating into the clinic: We now have a number of 

new and exciting therapeutic strategies at or near the 

point of clinical testing. These include neuroprotection using various medications, other substances, or nerve growth 

(neurotrophic) factors and gene therapy. Other potential 

therapies still being tested in animals include a vaccine to 

modify the immune system in a way that can protect dopamine-producing neurons, stem cell therapy and inhibition 

of inflammatory enzymes, including COX-2.

How close are we to developing a cure?

It is not possible to predict a precise time line for major 

breakthroughs or a cure for PD—even in this time of great 

scientific progress. But we are initiating clinical trials that 

we believe will be critical to improving the treatment and 

quality of life of individuals with PD, developing a framework so that basic research can be effectively translated 

into treatments, and continuing to invest in essential basic 

research—the foundation for progress in medical science.

Parkinson’s Disease: The Newest Advances

An interview with Story C. Landis

Story C. Landis, Ph.D.

Director, National 

Institute of Neurological Disorders and 

Stroke

because it doesn’t cross the blood-brain 

barrier, the elaborate meshwork of fine 

blood vessels and cells that filters blood 

reaching the brain.) 

Levodopa is combined with the 

drug carbidopa, which delays the 

conversion of levodopa into dopamine 

until it reaches the brain; prevents or 

diminishes some of its common side 

effects, such as nausea, vomiting and 

low blood pressure; and reduces the 

amount of levodopa needed. 

Levodopa does not, however, replace 

lost nerve cells or stop Parkinson’s 

progression. Bradykinesia and rigidity 

respond best, while tremor may be less 

responsive. Problems with balance 

and other symptoms are often not 

responsive to dopaminergic therapy. 

Recent studies show that adding 

certain medications, either tolcapone 

or entacapone, can prolong the relief 

gained from levodopa-carbidopa.

There are other medications for 

particular symptoms or stages of 

Parkinson’s, including:

n Apomorphine, bromocriptine, 

pergolide, pramipexole, 

ropinirole—which mimic 
18 Summer 2006 NIH MedlinePlus

Additional 

Information 

on Parkinson’s

Web Links

MedlinePlus: http://www.nlm.

nih.gov/medlineplus/

parkinsonsdisease.html

Information from NINDS: Parkinson ’s Disease: Hope through 

Research: http://www.ninds.

nih.gov/disorders/parkinsons_

disease/detail_parkinsons_

disease.html

Links to clinical trials:

http://clinicaltrials.gov/ct/gui/

action/FindCondition?ui=D010

300&recruiting=true

Genetic information:

http://ghr.nlm.nih.gov/condi

tion=parkinsonsdisease

Interactive tutorial from MedlinePlus (slideshow): http://

www.nlm.nih.gov/medlineplus/

tutorials/parkinsonsdisease/htm 

Handy Publications*

n“Know Your Brain,” an 8-page 

fact sheet that explains how 

the healthy brain works and 

what happens when the brain 

is diseased or dysfunctional

n“Parkinson’s Disease: Challenges, 

Progress, and Promise”

n“Deep Brain Stimulation 

for Parkinson’s Disease”

* Available from:

NIH NINDS

P.O. Box 5801

Bethesda, MD 20824

http://www.ninds.nih.gov/

1-800-352-9424

dopamine and can be given alone 

or with levodopa, may be used in 

the disease’s early stages or started 

later. 

n Selegiline—also known as 

deprenyl, selegiline provides some 

benefit for the symptoms of PD 

and may prolong the effect of 

levodopa 

n Anticholinergics—initially 

the principal treatment for 

Parkinson’s prior to levodopa, the 

benefit of these drugs is limited 

but they may help to control 

tremor and rigidity 

n Amantadine—an antiviral drug 

often used alone in the early 

stages of the disease, or with 

an anticholinergic or levodopa. 

Amantadine is sometimes also 

used to treat side effects of 

levodopa called dyskinesias. 

Surgery to relieve symptoms

Prior to the development of 

levodopa, treating Parkinson’s 

with surgery was common but it is 

currently reserved primarily for those 

patients with advanced PD. Today’s 

preferred surgical approach is deep 

brain stimulation (DBS), which 

uses a surgically implanted, batteryoperated medical device called a 

neurostimulator—similar to a heart 

pacemaker and approximately the size 

of a stopwatch—to deliver targeted 

electrical stimulation to block the 

abnormal nerve signals that generate 

Parkinson’s symptoms.

Unlike previous surgeries, DBS does 

not damage healthy brain tissue by 

destroying nerve cells. The advantage 

to DBS as compared with lesion surgery 

is that the stimulation settings can be 

adjusted by a physician in the office, 

and to some extent by patients in 

particular cases. 

Although most patients still need 

to take medication after undergoing 

DBS, many experience considerably 

reduced symptoms and some are able 

to lower their doses. This helps reduce 

side effects, such as involuntary 

movement, associated with the longterm use of levodopa. 

Fighting for future health

As a world leader in research on 

neurological disorders, the National 

Institute of Neurological Disorders and 

Stroke (NINDS) supports twelve Morris 

K. Udall Parkinson’s Disease Research 

Centers of Excellence throughout the 

country. Much of the recent progress 

on Parkinson’s has been funded 

through the Centers and many other 

NIH grants.

New studies have identified several 

genes that cause or contribute to PD 

and some potential environmental risk 

factors. These findings are improving 

our understanding of the processes that 

cause cell death in PD. In addition, a 

number of promising therapies are now 

being tested. And continuing research 

into the underlying biology of the 

disease is certain to lead to better ways 

of relieving Parkinson’s debilitating 

symptoms and, ultimately, to halting or 

preventing the disease itself. n
Who can

happen?

make it choose fruits & vegetables

plan active outings share low-fat meals

play active games

ALL PARENTS CAN!

For a free handbook with food, activity and screen time tips,

visit http://wecan.nhlbi.nih.gov or call 1-866-35-WECAN.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health
Nothing to Sneeze At

Achoooooo!

20 Summer 2006 NIH MedlinePlus
NIH MedlinePlus Summer 2006 21 

If you are one of the 18.2 million 

Americans who suffer from allergic 

rhinitis, or “hay fever,” chances are you 

may be sneezing, reaching for a box of 

tissues or rubbing your itchy, red, watery 

eyes as you read this. It’s May and the 

start of yet another allergy season, when 

pollen seems to cover the universe and 

very little relief is in sight. 

While many of us endure mild to 

moderate symptoms, the larger truth 

is that the world of allergies is a complex 

and costly landscape. More than 50 

million Americans suffer from all forms 

of allergies, which are the sixth-leading 

cause of chronic diseases in the United 

States. In 1996, hay fever alone accounted 

for nearly 14 million doctor visits and 

cost the healthcare system approximately 

$1.9 billion. For unknown reasons, 

the incidence of hay fever has risen 

substantially in the past 15 years. 

These are just a few of the reasons 

why the NIH’s National Institute of 

Allergy and Infectious Diseases (NIAID) 

is committed to funding ongoing 

research for new ways to manage and, 

perhaps, even prevent allergic diseases. 

In 2005, NIAID awarded more than 

$116 million in grants and contracts 

for investigation into the mechanisms, 

diagnosis, treatment and prevention 

of allergic diseases, including asthma 

and allergic rhinitis.

For more than 50 years, NIAID 

research has led to new diagnostic tests, 

vaccines, therapies and technologies that 

have improved the health of millions 

of people in the United States and 

around the world. One such NIAIDfunded study has shown recently that an 

environmental intervention program to 

reduce indoor allergens, especially from 

cockroach and dust mites, in the homes 

of inner-city children with moderate 

to severe asthma is quite effective in 

reducing allergen levels and asthma 

symptoms. Since continued exposure to 

allergens induces asthma’s symptoms, 

avoiding them is an attractive approach, 

As we enter the sneezing season, outdoor allergies are on the rise for many 

Americans. The cost to our healthcare system from all allergies—indoor and 

outdoor—is becoming truly breathtaking.

Finding Relief from Allergy’s Grip

n Antihistamines. These medications counter the effects of histamine, the 

substance that makes eyes water and noses itch during allergic reactions. 

While helpful in alleviating symptoms, older antihistamines often can cause 

adverse side effects, such as drowsiness. Newer antihistamines are as effective as older antihistamines, but do not cause drowsiness and have very few 

side effects. However, antihistamines do not effectively treat severe allergy 

symptoms or nasal swelling (congestion).

n Topical nasal steroids. These anti-inflammatory nasal sprays help by 

decreasing the number of inflammatory cells in the nose and reducing 

mucus production and nasal swelling. Nasal steroids work well in combination with antihistamines and are relatively free of side effects.

n Cromolyn sodium. Also a nasal spray, cromolyn sodium can help stop 

hay fever, perhaps by blocking release of histamine and other symptomproducing chemicals. This product has few side effects.

n Decongestants. Decongestants constrict blood vessels and thereby may 

relieve nasal congestion. Available in oral and nasal preparations, decongestants thin nasal secretions and can reduce swelling and sinus discomfort. They are usually used in combination with antihistamines. They

are intended for short-term use; long-term usage can actually make 

symptoms worse.

n Immunotherapy. Immunotherapy (allergy shots) might be a good 

course of action for patients who have had inadequate symptom relief 

with antihistamines and topical nasal steroids. Through injection under the 

skin, immunotherapy alters the body’s immune response to allergens and 

thereby helps prevent allergic reactions. 
22 Summer 2006 NIH MedlinePlus

according to Anthony S. Fauci, M.D., 

NIAID Director. 

“The NIAID-sponsored Inner City 

Asthma Study in children demonstrates 

that environmental interventions reduce 

wheezing in proportion to the reduction 

in allergens,” he says. (Read more 

comments from Dr. Fauci on page 23.) 

Information on this and other NIHfunded allergy studies, as well as a host of 

other resources on allergies of all kinds, is 

available at www.medlineplus.gov.

Nuisance or Health Threat?

For most people, hay fever is a 

seasonal nuisance—something to 

endure for a few weeks once or twice a 

year. But for others, such allergies can be 

life-altering conditions that lead to more 

serious complications, including sinusitis 

and asthma.

n Sinusitis, one of the most commonly 

reported chronic diseases, is the 

inflammation or infection of the 

paranasal sinuses, which are four 

pairs of cavities located within the 

skull. Congestion here can lead to 

pressure and pain over the eyes, 

around the nose or in the cheeks 

just above the teeth. Chronic 

sinusitis is associated with persistent 

inflammation and is often difficult 

to treat. Extended bouts of hay 

fever, for instance, can increase 

the likelihood of development of 

chronic sinusitis.The annual cost 

of managing sinusitis has been 

estimated as high as $5.8 billion.

n Asthma is a disease of the lungs 

in which the primary symptom 

is a narrowing or blockage of the 

airways, resulting in wheezing, 

shortness of breath, coughing and 

other breathing difficulties. Asthma 

attacks can be triggered by viral 

infection, cold air, exercise, anxiety, 

allergens and other factors. Allergic 

asthma is responsible for almost 

80 percent of all asthma diagnoses. 

It presents the same symptoms as 

nonallergic asthma, but differs 

in that it is set off primarily by 

an immune response to specific 

allergens.

Both sinusitis and allergic asthma are 

manageable, but the research challenge 

always is to go beyond controlling the 

symptoms to address the root causes 

of disease.

Defending Against Invaders

In a normal immune system, 

invading bacteria and viruses trigger 

antibodies, which are “programmed” 

to remember and defend against these 

germs in the future. During an allergic 

reaction, however, the immune system 

treats generally harmless allergens, 

such as pollen, mold, animal dander 

or dust mites, as pathogens and 

begins producing large amounts of 

immunoglobulin E (IgE) antibodies.

Allergic reactions are the biological 

equivalent of a fire drill: The body 

defends itself against a potential 

pathogen although none is present. 

The process is repeated as long as the 

immune system detects the allergen. 

Some allergy sufferers are genetically 

disposed to have a sensitive immune 

system. In addition, the severity of 

allergy symptoms can become worse 

due to illness or pregnancy.

That is what happened to Amy Kindt, 

a Mt. Clemens, Michigan, mother of two, 

who always suffered from hay fever when 

pollen counts rose during the spring and 

fall. However, since she became pregnant 

with her first child in 2000, the frequency 

of her symptoms has gone way up. 
NIH MedlinePlus Summer 2006 23 

Fighting Allergies with Research and Information

An interview with Anthony S. Fauci

For more information on allergies and other infectious diseases, visit the National Institute 

of Allergy and Infectious Diseases at www.niaid.nih.gov.

Are seasonal allergies on the rise? If so, 

why? There has been an increase in seasonal allergies, 

but this trend may be leveling off . The reasons for 

the increase are unclear, but one explanation may be 

common lifestyle changes that include less physical 

exercise and more exposure to air pollutants and less 

contact with microorganisms and childhood infections 

as a result of the broad public health advances of the 

past century. With regard to the latter, the “hygiene 

hypothesis” suggests that microorganisms alter the way 

our immune systems react to allergens, so our chances 

of developing allergies increase in the absence of 

exposure to infectious agents. 

What research has been done recently in 

the area of seasonal allergies? Specifically, 

have there been any significant findings 

or breakthroughs in allergy shots, e.g. are 

there new medications that “last longer” 

between shots? Recent findings include the 

discovery that allergen therapy delivered under the 

tongue, called sublingual immunotherapy, is effective 

in treating seasonal allergies, and substantially safer 

than the standard two- to three-year course of allergy 

shots, called subcutaneous immunotherapy. Another 

recent finding is that children who do not have asthma, 

but have seasonal allergies and receive subcutaneous 

immunotherapy, are far less likely to develop asthma 

over the ensuing years . 

I read that an immunotherapy for airborneallergy vaccine is nearing FDA approval, 

perhaps in time for the 2006 allergy season. 

If so, what is the name of this product, what 

allergies will it protect against and when 

can people expect to have access to it?

Recently, the NIAID-sponsored Immune Tolerance 

Network partnered with Dynavax on the clinical trial 

of a product called Tolamba. This trial showed that 

Tolamba was highly effective in reducing ragweed 

symptoms, and symptom relief 

persisted for a year after the 

treatment was completed. If 

future clinical trials are equally 

successful, this could lead to Food 

and Drug Administration approval 

of the Dynavax product in two to 

three years, with major benefits 

to ragweed allergy patients by 

shortening the duration of treatment compared to 

standard allergen immunotherapy. The feasibility of 

developing comparable approaches against other 

seasonal allergies is still uncertain. 

Have there been changes in the 

effectiveness of over-the-counter or 

prescription medications? Over-the-counter 

and prescription medications are generally very 

effective for the treatment of seasonal allergies, even 

for patients with severe symptoms. In particular, 

“newer” antihistamines effectively reduce nasal allergy 

symptoms but have minimal sedative properties. 

Finally, can people hope for a cure? Or will 

relief only come through proper prevention 

and careful treatment of symptoms? Most 

patients can now obtain excellent symptom relief from 

allergic rhinitis, including complicating conditions, such 

as sinusitis and asthma. But further improvements will 

be possible with the development of new therapeutic 

approaches and a better understanding of the immune 

mechanisms that are responsible for allergic diseases. 

Since continued allergen exposure is necessary to 

induce symptoms, allergen avoidance is an attractive 

approach, and the NIAID-sponsored Inner City Asthma 

Study of children demonstrated that environmental 

interventions reduced wheezing in proportion to the 

reduction in allergens. 

Anthony S. Fauci, M.D.

NIAID Director
24 Summer 2006 NIH MedlinePlus

“Ever since my first pregnancy, it 

seems I’m allergic to something all day, 

every day,” she says. “I cough a lot from 

the drainage, and it makes it hard to 

sleep. Over-the-counter medications 

don’t seem to work any more.”

Testing for Allergies

When it comes to allergies, 

knowledge is power. Knowing 

exactly what you are allergic to 

can help determine the best way to 

lessen or prevent exposure and treat 

reactions when they occur. There are 

several tests that physicians use to 

pinpoint what you are allergic to. 

For example:

n Allergy skin test—The most 

commonly used allergy skin 

test, known as a “prick test,” this 

diagnostic procedure involves 

pricking your skin with the 

extract of a specific allergen, then 

observing the skin’s reaction. 

Another test, the intradermal 

injection, introduces allergens just 

below the skin’s outer layers, is 

more sensitive than the prick test 

and is sometimes used when the 

prick test produces negative results. 

Allergy skin testing is considered 

the most sensitive testing method 

and provides rapid results. 

However, skin tests cannot be used 

when a patient suffers from certain 

skin conditions, such as eczema.

n RadioAllergoSorbent Test 

(RAST) and enzyme-linked 

immunosorbent blood tests—

The RAST and enzyme-linked 

immunosorbent tests are two blood 

tests that provide information 

similar to allergy skin testing, 

namely the levels of allergic (IgE) 

antibodies to allergens. 

Searching for Relief

For allergy sufferers, the best 

treatment is to avoid the offending 

allergens altogether. This may be 

possible if the irritant is a specific food, 

like peanuts, which can be cut out of 

the diet, but not when the very air we 

breathe is loaded with allergens. For 

example, a single ragweed plant can 

produce a million grains of pollen a day, 

and ragweed pollen has been found 400 

miles out at sea and two miles high in 

the atmosphere.

Air purifiers, filters, humidifiers and 

conditioners provide varying degrees of 

relief, but none is 100 percent effective. 

Normally, allergy sufferers look to 

various over-the-counter medications 

and physician-prescribed therapies. 

(See sidebar story, “Finding Relief from 

Allergy’s Grip,” page 21.)

Hoping for a Cure

Relief may someday come in the form 

of an allergy vaccine, several of which are 

in development and show great promise. 

In one clinical trial, for instance, a series 

of six injections of a newly developed 

and specially formulated ragweed vaccine 

lessened symptoms and reduced the 

need for antihistamines among study 

participants. Perhaps more exciting 

is the fact that this particular vaccine 

seems to provide benefits for at least one 

additional year, without the need for 

booster shots.

For vaccines to be most effective, 

they must be specific. For someone 

allergic to ragweed, the new vaccine in 

development may be good news, but not 

to one who reacts only to grass pollen. 

Clearly, more research, development 

and testing are in order. While effective 

allergy vaccines are still years away from 

general release, research funded by NIH 

shows long-term promise. n

MedlinePlus.gov 

Resources

Want to know more about allergic 

rhinitis? Check out the resources at 

www.medlineplus.gov. Do a search 

on “allergy” or use one of the following quick links:

National Institute of Allergy 

and Infectious Diseases: http://

www3.niaid.nih.gov

Airborne Allergens: http://www.

niaid.nih.gov/publications/

allergens/airborne_allergens.pdf

Allergy Clinical Trials: http://

clinicaltrials.gov/ct/gui/action/

FindCondition?ui=

D006967&recruiting=true

Asthma and Allergy Resources:

http://www.niaid.nih.gov/

factsheets/allergyr.htm

Useful Publications

Fact sheets, symptom checklists, 

prevention tips and more are at 

http://www.niaid.nih.gov/

publications/allergies.htm
Wait too long to talk about kidney disease

and you could be waiting for a kidney.

If you have diabetes, high blood pressure or a family history of kidney failure, you're at high risk

for developing kidney disease. There may be no early symptoms, so talk to your family about

their medical history and to your doctor about getting tested. It could save your life. For a free

brochure, call toll-free 1-866-4-KIDNEY (1-866-454-3639), or visit www.nkdep.nih.gov today.

The National Kidney Disease Education Program is an initiative of the National Institutes of Health, U.S. Department of Health and Human Services.

You Have The Power To Prevent Kidney Disease

U.S. Department of 

Health & Human Services

National Kidney Disease

Education Program

National Institute of Diabetes

& Digestive & Kidney Diseases

National Institutes 

of Health
26 Summer 2006 NIH MedlinePlus

Results from a controlled clinical 

trial indicate that overweight people 

who cut their calories by 25 percent 

for six months have reduced fasting 

insulin levels and core body temperature—two markers associated with 

increased longevity in humans. The 

study is part of a project sponsored by 

the NIH’s National Institute on Aging 

(NIA) to learn more about the effects 

of sustained low-calorie diets in 

humans on factors affecting aging.

This type of intervention—maintaining a substantial percent reduction in caloric intake—has been 

shown to substantially extend the 

longevity of laboratory rodents if sustained over much of the animal’s life 

span. Effects of such an intervention 

on human aging are not yet known.

The study, part of the NIA-supported 

Comprehensive Assessment 

of Long-Term Effects of Reducing 

Intake of Energy (CALERIE), was conducted by Leonie K. Heilbronn, Ph.D., 

Eric Ravussin, Ph.D., and colleagues at 

the Pennington Biomedical Research 

Center of Louisiana State University 

in Baton Rouge.

The low-calorie diet also resulted 

in changes in some, but not all, of the 

metabolic factors that have been related to longevity or aging. That study 

is a pilot project for a longer CALERIE 

trial expected to start in the autumn 

of 2006 at three U.S. locations to test 

effects of lowering caloric intake 

for two years. 

Behavioral Therapy, 

Incentives Enhance 

Addiction Treatment

New research supported by the NIH’s 

National Institute on Drug Abuse (NIDA) 

indicates that people who are trying to 

end their addiction to marijuana can 

benefit from a treatment program that 

combines motivational incentives with 

cognitive-behavioral therapy. 

“Marijuana remains one of the most 

widely used drugs of abuse,” says NIDA 

Director Nora D. Volkow, M.D. “Heavy 

use of the drug impairs a person’s 

ability to form memories, recall events 

and shift attention from one thing to 

another.” There also are significant lung 

and respiratory risks for regular smokers. 

“The study results are largely positive, 

but there should be continued efforts 

to develop and evaluate effective treatments for marijuana addiction,” 

Dr. Volkow adds.

LactMed, a free online database with 

information on drugs and lactation, 

is one of the newest additions to the National Library of Medicine’s TOXNET 

system, a Web-based collection of resources covering toxicology, chemical 

safety and environmental health. LactMed may be searched at http://toxnet.

nlm.nih.gov/cgi-bin/sis/htmlgen?LACT.

Geared to the healthcare practitioner and nursing mother, LactMed contains 

over 450 drug records. It includes information such as maternal levels in breast 

milk, infant levels in blood, potential effects in breast-feeding infants and on 

lactation itself. The American Academy of Pediatrics’ LactMed category indicates 

the level of compatibility of the drug with breast-feeding and alternate drugs to 

consider. As a work in progress, LactMed will continue to expand, with additional 

drugs and with other substances, such as industrial chemicals and radiation.

Genetics Experts 

Unite to I.D. Unknown 

Katrina Victims

Research News from the National Institutes of Health

LactMed: New NLM 

Database on Drugs 

and Lactation

Low Calorie Diet 

Affects AgingRelated Factors

A multi-institution team of experts, coordinated by geneticists from the NIH’s 

National Human Genome Research 

Institute (NHGRI), is supporting efforts 

to identify more than 70 bodies in the 

aftermath of Hurricane Katrina.

“What we are discovering in the 

recent advances in molecular biology 

and genetics,” says team member 

Stephen Sherry, Ph.D., of NLM’s 

National Center for Biotechnology 

Information, “is that we have an unprecedented opportunity to identify 

people with precision and to affiliate 

them correctly with their families. 

This is a new aspect of science, and its 

impact is on everyone.”

Katrina claimed more than 1,200 

lives in Louisiana and Mississippi. More 

than 70 bodies remained unidentified.
NIH MedlinePlus Summer 2006 27 

Estrogen-alone hormone therapy does not increase the 

risk of breast cancer in postmenopausal women, according 

to an updated analysis of the breast cancer findings of the 

Women’s Health Initiative (WHI) Estrogen-Alone Trial.

The results contrast with the previously reported WHI 

Estrogen plus Progestin Trial, which found an increase in 

breast cancer over about 5 years among those taking combined hormone therapy. Over an average of about 7 years 

of follow-up, study participants taking estrogen had fewer 

breast cancer tumors than those in the placebo group. 

“Longer follow-up is needed to fully explain the reduced 

number of breast cancers in women taking estrogen. However, this new analysis does not alter the overall conclusion 

from the WHI that hormones, including estrogen-alone 

and estrogen plus progestin, should not be used for the 

prevention of chronic disease,” said NHLBI and WHI Director 

Elizabeth G. Nabel, M.D. “The findings still support current 

recommendations that hormone therapy should only be 

used to treat menopausal symptoms and should be used at 

the smallest effective dose for the shortest possible time.”

Breast Cancer and Estrogen-Alone Update

Youths with superior IQ are distinguished by how fast the 

thinking part of their brains thickens and thins as they grow 

up, researchers at the NIH’s National Institute of Mental Health 

(NIMH) have discovered. Magnetic resonance imaging (MRI) 

scans showed that their brains’ outer mantle, or cortex, thickens 

more rapidly during childhood, reaching its peak later than 

in their peers—perhaps 

reflecting a longer developmental window for 

high-level thinking circuitry. It also thins faster 

during the late teens, 

likely due to the 

withering of unused 

neural connections 

as the brain streamlines its operations.

 “Studies of brains 

have taught us that 

people with higher IQs 

do not have larger brains,” 

says NIH Director Elias A. Zerhouni, M.D. “Thanks to brain 

imaging technology, we can 

now see that the 

difference may be in the 

way the brain develops.” 

Cortex Matures Faster 

in Youths With Highest IQ

NIH Researchers Identify 

OCD Risk Gene

Scientists at the NIH’s National Institute on Alcohol 

Abuse and Alcoholism (NIAAA) have identified a 

previously unknown gene variant that doubles an 

individual’s risk for obsessive-compulsive disorder (OCD). The new functional variant, or allele, is 

a component of the serotonin transporter gene 

(SERT), site of action for the selective serotonin 

reuptake inhibitors (SSRIs) that are today’s mainstay 

medications for OCD, other anxiety disorders 

and depression.

“Improved knowledge of SERT’s role in OCD 

raises the possibility of improved screening, treatment and medications development for that disorder,” said Ting-Kai Li, M.D., NIAAA Director. “It also 

provides an important clue to the neurobiologic 

basis of OCD and the compulsive behaviors often 

seen in other psychiatric diseases, including 

alcohol dependence.”

Approximately 2 percent of U.S. adults (3.3 million people) have OCD, the fourth most prevalent 

mental health disorder in the United States. Individuals with OCD have intrusive, disturbing thoughts 

or images (obsessions) and perform rituals (compulsions) to prevent or banish those thoughts. Many 

other individuals demonstrate obsessive-compulsive 

behaviors that do not meet OCD diagnostic criteria 

but alter the individuals’ lives.
28 Summer 2006 NIH MedlinePlus

National Institutes 

of Health MedlinePlus 

Advisory Group

Marin Allen, Ph.D., Office of Communications and Public Liaison, NIH 

Christine Bruske, National Institute 

of Environmental Health Sciences 

Vicky Cahan, National Institute 

on Aging 

Kym Collins-Lee, National Eye 

Institute 

Kate Egan, National Institute 

of Mental Health 

Marian Emr, National Institute 

 of Neurological Disorders 

and Stroke 

Sue Feldman, National Cancer 

Institute 

Ray Fleming, National Institute 

 of Arthritis & Musculoskeletal 

& Skin Diseases 

Susan Johnson, National Institute 

of Dental & Craniofacial Research 

Kathy Kranzfelder, National Insti-

 tute of Diabetes and Digestive 

and Kidney Diseases 

Lonnie Lisle, National Institute on 

 Deafness and Other Communication Disorders 

Terry Long, National Heart, Lung, 

and Blood Institute 

Claire McCullough, National 

 Institute of Allergy and 

Infectious Diseases 

John McGrath, Ph.D., National 

 Institute of Child Health and 

Human Development 

Gregory Roa, National Institute 

on Alcohol Abuse and Alcoholism 

Dennis Rodrigues, Office of Communications and Public Liaison, NIH 

Chris Thomsen, National Center 

 for Complementary & Alternative 

Medicine 

Larry Thompson, National Human 

Genome Research Institute 

Anne Thurn, Ph.D., Office of

 Dietary Supplements

Institutes

n National Cancer Institute (NCI) www.cancer.gov 

1-800-4-CANCER (1-800-422-6237) 

n National Eye Institute (NEI) www.nei.nih.gov 

(301) 496-5248 

n National Heart, Lung, and Blood Institute (NHLBI)

www.nhlbi.nih.gov (301) 592-8573 

n National Human Genome Research Institute 

(NHGRI) www.genome.gov 

n National Institute on Aging (NIA)

www.nia.nih.gov

Aging information 1-800-222-2225

Alzheimer’s information 1-800-438-4380

n National Institute on Alcohol Abuse and 

Alcoholism (NIAAA) www.niaaa.nih.gov 

(301) 443-3860 

n National Institute of Allergy and Infectious 

Diseases (NIAID) www.niaid.nih.gov 

(301)496-5717 

n National Institute of Arthritis and Musculoskeletal 

and Skin Diseases www.niams.nih.gov 

1-877-22NIAMS (1-877-226-4267)

n National Institute of Biological Imaging 

and Bioengineering (NIBIB)

http://www.nibib.nih.gov (301) 451-6772 

n National Institute of Child Health and Human 

Development (NICHD) www.nichd.nih.gov 

1-800-370-2943 

n National Institute on Deafness and Other 

Communication Disorders (NIDCD)

www.nidcd.nih.gov 

1-800-241-1044 (voice)

1-800-241-1055 (TTY) 

n National Institute of Dental and Craniofacial 

Research (NIDCR) www.nidcr.nih.gov 

n National Institute of Diabetes and Digestive and 

Kidney Diseases (NIDDK) www.niddk.nih.gov

Diabetes 1-800-860-8747

Digestive disorders 1-800-891-5389

Overweight and obesity 1-877-946-4627

Kidney and urologic diseases 1-800-891-5390

n National Institute on Drug Abuse (NIDA)

www.nida.nih.gov (301) 443-1124 

n National Institute of Environmental Health 

Sciences (NIEHS) www.niehs.nih.gov 

(919) 541-3345 

n National Institute of General Medical Sciences 

(NIGMS) www.nigms.nih.gov 

(301) 496-7301 

n National Institute of Mental Health (NIMH)

www.nimh.nih.gov niminfo@nih.gov

1-866-615-6464 

n National Institute of Neurological Disorders 

and Stroke (NINDS) www.ninds.nih.gov 

braininfo@ninds.nih.gov 1-800-352-9424 

n National Institute of Nursing Research (NINR)

www.nih.gov/ninr/ (301) 496-0207 

Centers & Offices

n National Library of Medicine (NLM)

www.nlm.nih.gov 1-888 FIND NLM 

n Center for Information Technology (CIT)

www.cit.nih.gov (301) 594-6248 

n Center for Scientific Review (CSR)

www.csr.nih.gov (301) 435-1115 

n Fogarty International Center (FIC)

www.fic.nih.gov 

n National Center for Complementary 

and Alternative Medicine (NCCAM)

www.nccam.nih.gov 1-888-644-6226 

n National Center on Minority Health and Health 

Disparities (NCMHD) www.ncmhd.nih.gov 

(301)402-1366 

n National Center for Research Resources (NCRR)

www.ncrr.nih.gov (301) 435-0888 

n Warren G. Magnuson Clinical Center (CC)

www.cc.nih.gov 

n Office of Research on Women’s Health (ORWH)

http://orwh.od.nih.gov (301) 402-1770

NIH

Quickfinder

For more information or to contact any of the following NIH institutes, centers 

and offices directly, please call or go online as noted below:
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NIH MedlinePlus Magazine Editorial Board

Don Detmer, M.D.

President, American Medical Informatics Association

Professor of Medical Education, University of Virginia

4915 St. Elmo Avenue, Suite 401

Bethesda, Maryland 20814

(301) 657-1291

E-mail: detmer@amia.org

Jordan Cohen, M.D.

President, Association of American Medical Colleges

2450 N Street, NW

Washington, DC 20037

(202) 828-0460

E-mail: jjcohen@aamc.org

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Partner, Hogan & Hartson

555 13th Street, NW, Suite 12W

Columbia Square

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School of Medicine

President Emeritus, American Telemedicine Association

1317 Vincent Place

McLean, VA 22101

(703) 448-9640

E-mail: jsanders@tgtg.com

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Dean, College of Nursing

Wayne State University

5557 Cass Avenue, 112 Cohn

Detroit, MI 48202

(313) 577-4070

FAX: (313) 577-4571

E-mail: B.Redman@wayne.edu

Roger Bulger, M.D.

Senior Consultant, National Center on Minority Health

and Health Disparities, NIH

Past President and CEO, Association of Academic 

Health Centers

6707 Democracy Boulevard, Suite 800

Bethesda, Maryland 20892-5465

(301) 402-1366

E-mail: bulgerr@mail.nih.gov

Kenneth Forde, M.D.

José M. Ferrer Professor Emeritus of Clinical Surgery 

and Special Lecturer in Surgery, 

Columbia University College of Physicians and Surgeons, 

Department of Surgery, MHB 7SK

177 Fort Washington Avenue

New York, NY 10032-3784

Telephone: (212) 305-2735

Email: Kaf2@columbia.edu

Leslie Kuhn, M.D.

Clinical Professor of Medicine

Mount Sinai School of Medicine, Division of Cardiology

Mt. Sinai Medical Center, Box 1030

5th Avenue and 98th Street

New York, NY 10028-0110

(212) 876-9009
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