Ask Dr. H: Baring details on PANDAS

Question: What can you tell me about a disorder called PANDAS? Our pediatrician believes our son may have it.

Answer: PANDAS stands for Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus. It's a rare and controversial condition in which certain behavior changes are observed in a previously healthy child within just a few weeks after a streptococcus bacterial condition, such as strep throat.

The most common behavioral changes seen are the abrupt development of obsessive-compulsive personality disorder (OCD) and Tourette's syndrome, with uncontrollable motor and/or vocal tics. One theory linking infection with neurological changes suggests that in these children, immune systems overreact and not only attack the streptococcal bacterial infection, but parts of the brain responsible for movement and behavior. It is not seen with viral infections or other bacterial infections.

No specific test can diagnose PANDAS, but there are certain clinical symptoms that support the diagnosis. Treatment of suspected PANDAS is often empiric use of an antibiotic such as Augmentin, even though the current belief is that the symptoms of PANDAS are due to an exaggerated immune-system response to a recent streptococcus infection, not to an active infection.

For children who fail to respond to antibiotic therapy, treatment is directed at addressing the neurological symptoms through medications that target the OCD or Tourette's syndrome symptoms. Dietary changes and cognitive behavioral therapy are also considered.

For information, contact www.internationalpandasfoundation.org.

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Q: I use Primatene spray for my asthma condition. Although it tends to make my heart race, I need it just occasionally. I hear it will no longer be available after Dec. 31. What do you recommend I use in its place?

A: Primatene mist inhalers use a CFC propellant that is bad for the ozone layer. That's why Primatene is being pulled off the shelves - at least until the manufacturer gets FDA approval for the more environmentally friendly HFA propellant in replacement.

While the absence of Primatene spray will be temporary, many physicians remain concerned over the safety and appropriateness of using inhaled adrenaline (the active ingredient in Primatene) to manage asthma. True, Primatene has been sold over the counter since 1963. And it is effective in treating mild, intermittent asthma.

Here are the issues with Primatene: (1) Inhaled adrenaline used on an "as needed" basis can lead to inadequate treatment of asthma. Persistent asthma is a disease of underlying inflammation, and adrenaline (or even the prescription albuterol) inhalers do nothing to help that problem. (2) There is a tendency to overuse Primatene since it is available without a prescription. Adrenaline inhalation can be dangerous in someone with underlying, sometimes unknown heart disease. I'm concerned that it makes your heart race with each inhalation. (3) It can raise blood pressure and is not good for folks with hypertension. (4) Asthma is a chronic disease that should be under the supervision of a physician.

For mild, intermittent asthma, an albuterol inhaler can be prescribed by a physician. If you are using your inhaler more than twice a week, you should add an inhaled steroid to control airway inflammation and prevent wheezing and shortness of breath.