You may have seen recent news reports about a rise in measles cases. While there have been a small number of cases, the risk of a widespread outbreak is low due to high vaccination rates in the United States. However, measles can be a concern for people who are unvaccinated, especially children traveling abroad to countries where immunization is low.

According to the Centers for Disease Control and Prevention (CDC), measles cases in the United States originate from unvaccinated international travelers. If you plan to travel internationally, you should ensure you and your loved ones are protected against measles before departure, no matter where you are going.

Kristin Oliver, MD, MHS

In this Q&A, Kristin Oliver, MD, MHS, Associate Professor, Pediatrics, Environmental Medicine and Public Health, and Global Health, Icahn School of Medicine at Mount Sinai, discusses the recent uptick in measles and explains new federal guidelines allowing children to get vaccinated as early as six months if traveling abroad.

Why are measles cases higher than usual?

There are several reasons. First, unvaccinated people who are traveling to and from countries with low immunization are likely catching measles and bringing it to the United States. Second, rates of measles vaccination have declined since the COVD-19 pandemic. Some parents were unable to get their children properly vaccinated during the pandemic or lack access to vaccines; others are hesitant about getting kids vaccinated. Some people may be unaware that their child needs to get a second dose of the vaccine to be fully protected.

What are the symptoms?

The first stages of measles look like many childhood illness: A cough, runny nose, high fever, and red eyes. After a few days, patients develop a red rash on their face that spreads to the rest of the body—the telltale sign of measles.

Who is most at risk?

Most people in the United States received the standard two-dose measles vaccines as children and are immune. If an unvaccinated person comes in contact with an infected person, their chances of catching measles are extremely high. According to the CDC, children less than five years old and adults older than 20 (especially those who are immunocompromised or pregnant) are more likely to experience complications. These include diarrhea, ear infections, pneumonia, and swelling in the brain. About one in five unvaccinated people in the U.S. who get measles is hospitalized.

When can I get my child vaccinated?

In general, the measles vaccine is a two-dose series. Children get the first dose between 12 and 15 months, and the second dose between four and six years old. However, the CDC recently changed its guidelines for parents with children who plan to travel internationally.

Under these guidelines, the recommendation is for kids to get early vaccines before they travel. Babies who are six to 11 months old are eligible for their first dose before travel. Children over 12 months old who have already received their first dose should get a second dose before travel. For example, if you plan to travel abroad with a two-year-old who received their first dose at age one, you should get them a second dose before you leave. Check with your pediatrician before you travel to learn about when your child should be vaccinated.

How can I get my child vaccinated?

Schedule an appointment with your child’s pediatrician. If you plan to travel abroad, let your pediatrician know so they can schedule the vaccines appropriately. If you are unsure about whether your child is up-to-date on vaccines, speak with their pediatrician. If you do not have a regular pediatrician, low- or no-cost immunizations are available through the New York City Department of Health and Mental Hygiene.

How can I protect my baby if they are too young to be vaccinated?

The best way to protect a baby too young to be vaccinated is to make sure you, your friends, and family are up to date on vaccines. If your baby is unvaccinated and you are traveling in a region where vaccination rates are high, the risk of exposure is low. If you are traveling to a country with low immunization rates, the risk is higher. Keep in mind that even in countries with high immunization, there may be communities within those countries where immunization is low. It’s important to research the location and communities you plan to visit to fully understand the risk.

I don’t know my vaccine history. How can I know if I’ve been vaccinated for measles?

You can get a blood test from your doctor to see if you’re immune. You may also be able to check the immunization records of the city where you grew up.

A sneezy, stuffy, runny nose makes it hard to concentrate and get a good night’s sleep. Nasal sprays, which are sprayed directly into the nose, can provide relief for your nasal allergy symptoms by targeting the mechanisms leading to them.

To make an appointment with Anthony G. Del Signore, MD, PharmD, call 212-844-8450

Many prescription and over-the-counter nasal spray options are available that reduce or eliminate nasal allergy symptoms, but each contains different medications that target different symptoms. In this Q&A, Anthony G. Del Signore, MD, PharmD, Director, Rhinology and Endoscopic Skull Base Surgery, Mount Sinai Beth Israel, and Assistant Professor of Otolaryngology, Icahn School of Medicine at Mount Sinai, explains what nasal sprays are available and how to choose the best one for you.

What nasal sprays are available to treat my allergy symptoms?

The following is a guide to some of the most popular nasal spray options. It provides details on how these sprays work, what they treat, and their potential side effects. However, you should consult your physician or otolaryngologist before using them.

Saline Spray or Gel:

These sprays help to lubricate dry nasal passages, and are often recommended for patients with epistaxis, or nosebleeds. However, they may not relieve nasal congestion.

Examples: Simply Saline™, Xlear®, A&H, Ayr®

Saline Irrigations:
These treatments, which mix purified, distilled or boiled tap water with salt and baking soda, help flush mucus from the nasal passages, thins nasal secretions and thus pair well with nasal sprays for relieving congestion.  These are often first line and the backbone of nasal regimens when treating allergies to viral and bacterial infections.

Tips: It is important to regularly clean your irrigation device and to use purified water. Depending on your symptoms, your physician or otolaryngologist may recommend using steroids or antibiotic ointments to achieve the best outcomes.

Examples: Neti Pot, NeilMed®, Ayr

Steroid Sprays

Nasal steroids are typically recommended as a firstline treatment of nasal allergy symptoms. These sprays help decrease inflammation in the nasal passages, which reduces symptoms such as congestion, runny nose, and sneezing.

Tips: To achieve the full benefit of these sprays, you should use them as recommended—once or twice each day for several weeks. The benefit is not immediate and must be used consistently to see adequate relief of symptoms. To minimize the risk of nasal bleeding be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Side effects: Although oral steroid use has associated risks, including cataracts, elevated blood sugar levels, mood changes, and disturbances of sleep, these risks are considerably lower when steroids are taken in nasal form. The more common risks include nosebleeds and nasal perforations when improperly used.

Over-the-counter examples: triamcinolone acetonide (Nasacort®), fluticasone propionate (Flonase®), mometasone (Nasonex®)

Prescription spray examples: beclomethasone (Beconase®), ciclesonide (Zetonna®)

Antihistamine Sprays

Much like oral antihistamines, these sprays block the effects of histamine, a chemical in cells responsible for many allergy symptoms, including a runny nose and sneezing.

Tips: To achieve the full benefits of these sprays, it is important to use them once or twice daily. For an additive benefit, be sure to use in conjunction with the nasal steroid spray.

Side effects: Some patients have reported drowsiness when taking these sprays. If you experience drowsiness, consider taking them before bed. Other patients have reported a bitter taste, dry mouth, and dizziness.

Examples: Azelastine (Astelin®, Astepro®), olopatadine (Patanase®)

Steroid and Antihistamine Sprays

This combination spray (azelastine and fluticasone) is only available by prescription. It can provide relief from nasal allergies in cases where using a steroid spray is not fully effective.

Tips: Use consistently to see maximum benefits. Often prescribed up to two times in each nostril once or twice daily. To minimize the risk of nasal bleeding, be sure to aim away from the nasal septum and towards the side of the nose (think of pointing the bottle towards the eye).

Example: The only branded combination spray currently available is Dymista®.

Anticholinergic Sprays

Available only by prescription, these sprays help to block a neurochemical that increases mucus secretions in the nose. They mainly provide relief from nasal drip .

Tips: This spray can be added to other nasal spray regimens to control nasal drip. The spray can be used up to four times a day. Best results seen when a known trigger is identified, i.e., cold weather, eating, consuming hot beverages, and typically can be pre-treated prior to the inciting factor.

Side effects: Some patients have reported dryness, nosebleeds, bitter taste, headaches, and irritation when using these sprays.

Example: The only spray currently available is ipratropium bromide (Atrovent®)

Cromolyn Sodium Sprays

These over-the-counter sprays work by blocking mast cell release, which induce inflammation and lead to nasal congestion, runny nose, and sneezing.

Tips: To achieve the best possible results, you should use them one to two times a day, starting at least several weeks before allergy season begins.

Side effects: Some patients have reported a burning sensation in their nose and a bitter taste in their mouth when using this spray.

Example: There is only one branded cromolyn nasal spray: NasalCrom®.

Decongestant Sprays
These over-the-counter treatments work by reducing swelling of blood vessels in the nose, which helps to relieve nasal swelling and congestion.

Tips: Although decongestants are effective for short-term relief, prolonged use—seven or more days—can result in rebound nasal congestion, also known as rhinitis medicamentosa, with inflammation of the nasal passages. They are also not recommended if you have glaucoma or high blood pressure as they can make these conditions worse.

Side effects: In addition to rebound nasal congestion, some patients have reported dryness, stinging, rapid heartbeat, and higher blood pressure when using these sprays, particularly during prolonged use.

Examples: Oxymetazoline hydrochloride (Afrin®, Sinex™, Dristan®), phenylephrine hydrochloride (Sudafed®)

Remember, nasal sprays can provide effective relief from the allergy symptoms you experience. If you have tried one and it did not work, there are other options you can try. The key is to see an otolaryngologist and discuss your symptoms. Based on that, they will be able to recommend one that does work for you.

A corneal transplant is sight-saving surgery that allows a patient with eyesight compromised by cornea damage to have their vision restored, in some cases to 20/20. More than 44,000 corneal transplants are performed in the United States every year, making it one of the most common and successful procedures of its kind.

Advances have been made in technique and recovery, giving patients new hope in vision improvements.

New York Eye and Ear Infirmary of Mount Sinai (NYEE) is a leader in corneal transplants and, in recent years, has had great success with the latest technique called Descemet’s membrane endothelial keratoplasty (DMEK). By selectively replacing only the damaged portion of the cornea with ultra-fine donor tissue, surgeons are able to produce much better patient outcomes than other endothelial keratoplasty techniques.

Click here to make an appointment with Angie E. Wen, MD

In this Q&A, Angie E. Wen, MD, a cornea specialist at NYEE, explains why this procedure is becoming more popular.

“DMEK is the latest cutting-edge surgical technique, and at NYEE, patients get the best surgical and post-operative care, not only by our surgeons but the entire OR and post-op team,” she says.

What are the benefits of DMEK corneal transplant?

The DMEK technique is revolutionary. The technique offers a low rejection rate (1 percent), faster recovery, faster and more significant improvement in vision, and less reliance on long-term use of eye drops that can cause immunosuppressive side effects. Clear vision of many patients is restored in a few months.

What is the cornea and how does it get damaged?

The cornea is the clear outer layer of your eye that is directly in front of the iris (the colored part) and the pupil. It allows light to enter your eye. The cornea provides approximately 65 to 75 percent of the focusing power of the eye. It must remain clear for there to be good vision. If it is scarred or swollen, it may result in glare or blurry vision. Cornea damage may be caused by an infection, a medical condition that leads to a thinning cornea, such as keratoconus; chronic swelling following cataract surgery; or by Fuchs Dystrophy, a genetic disorder that causes swelling.

What happens during a DMEK corneal transplant?

During the DMEK procedure, the surgeon carefully strips out the damaged Descemet’s membrane and endothelium layer of the cornea and replaces it with donor tissue that has been thoroughly screened, processed, certified, and prepared by the eye bank. The surgeon replaces the damaged corneal layer with the new micro-thin tissue that, at 10 microns, is the thickness of a strand of hair. It is then secured with a gas bubble. The outpatient procedure typically lasts approximately 30-45 minutes. Although it is a highly effective procedure, it requires a steep learning curve for the surgeon to master who must work with tissue that is so thin and delicate. Consequently, only 30-40 percent of surgeons nationwide feel comfortable performing it.

Is anyone a candidate for DMEK?

Not all patients are candidates for DMEK, including those with complex anterior segment anatomy, a previous history of retinal detachment repair, or glaucoma surgeries. In these cases, a Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) may be a better option. Surgeons at New York Eye and Ear Infirmary are able to apply both the latest technologies of endothelial keratoplasties customized to patients’ individual anatomy and specific needs.

The changing seasons can bring on many changes in your health, including fatigue, seasonal depression, irritability, and colds. One of the more bothersome changes is seasonal hair loss. While it is normal to shed around 100 hairs a day, the loss of more hair can feel alarming.

However, seasonal hair loss shouldn’t be cause for alarm. In this Q&A, Brian Abittan, MD, Director of Skin and Hair Rejuvenation and Director of Hair Transplantation at the Kimberly and Eric J. Waldman Department of Dermatology at Mount Sinai, discusses seasonal hair loss and how to keep your hair healthy during changing weather conditions.

Brian Abittan, MD

What is seasonal hair loss? Is it a real thing?

Yes. Seasonal hair loss does appear to be a real thing. While we do not fully understand why it happens, there are multiple theories that have been suggested. One theory is that seasonal changes, possibly due to hormonal fluctuations or variation in nutrition, can cause a spike in the resting phase of hair growth, also known as the telogen phase. Shortly after, many of these hairs will shed. Additionally, seasonal stresses in patient’s lives may cause a hair shedding, called telogen effluvium.

How does seasonal hair loss differ from traditional hair loss?

Seasonal hair loss is different from other causes of hair loss. Patients can have medical hair loss disorders, like alopecia areata, which is a completely different form of hair loss. Also, patients can have a component of androgenetic alopecia, known as pattern hair loss, which generally develops over time. This, when accompanied with a seasonal hair loss or a telogen effluvium, can make the hair shedding appear to be worse. It is important to first identify the type of hair loss you are dealing with. Each specific type of hair loss can have a variety of unique treatments.

Is there a way to prevent temporary hair loss?

The best way to try to avoid seasonal hair loss is to maintain healthy, scalp and hair habits. Ensuring proper moisturizing during dryer months, using gentle grooming techniques, and maintaining a balanced nutrition are the most basic ways to help. If the seasonal hair loss becomes a consistent issue, more aggressive topical and oral medications can be considered as longer-term treatments.

Are there any lifestyle changes that help with retaining hair?

Balanced diets rich in vitamins, healthy lifestyle choices, and gentle hair practices are beneficial to hair health and growth.

Is vitamin D and biotin effective in helping to retain hair?

There is evidence that vitamin supplements, such as vitamin D and biotin, a water-soluble B vitamin, can be helpful in hair growth and maintaining healthy hair. Certainly, if someone has a vitamin deficiency, that can affect hair growth as well. More, in-depth studies are needed to fully understand the impact of vitamins on hair growth.