Tempted to get a tattoo? Today, people from all walks of life have tattoos, which might lead you to believe that tattoos are completely safe.

But there are health risks that can result in the need for medical care. The Food and Drug Administration (FDA) is particularly concerned about a family of bacteria called nontuberculous Mycobacteria (NTM) that has been found in a recent outbreak of illnesses linked to contaminated tattoo inks.

FDA also warns that tattoo inks, and the pigments used to color them, can become contaminated by other bacteria, mold and fungi. To raise awareness and make diagnoses more accurate, FDA strongly encourages reporting of tattoo-associated complications to its MedWatch program, says Linda Katz, M.D., M.P.H., director of FDA’s Office of Cosmetics and Colors.

How to Avoid Infection

Tattoo artists can minimize the risk of infection by using inks that have been formulated or processed to ensure they are free from disease-causing bacteria, and avoiding the use of non-sterile water to dilute the inks or wash the skin.  Non-sterile water includes tap, bottled, filtered or distilled water.

Consumers should know that the ointments often provided by tattoo parlors are not effective against these infections. NTM infections may look similar to allergic reactions, which means they might be easily misdiagnosed and treated ineffectively.

Once an infection is diagnosed, health care providers will prescribe appropriate antibiotic treatment according to Katz. Such treatment might have uncomfortable side effects, such as nausea or gastrointestinal problems. However, without prompt and proper treatment an infection could spread beyond the tattoo or become complicated by a secondary infection.

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Called neti pots, they are used to rinse the nasal passages with a saline (salt-based) solution, and have become popular as a treatment for congested sinuses, colds and allergies, and for moistening nasal passages exposed to dry indoor air.

However, the Food and Drug Administration (FDA) has concerns about the risk of infection tied to the improper use of neti pots and other nasal rinsing devices. The agency is informing consumers, manufacturers and health care professionals about safe practices for using all nasal rinsing devices, which include bulb syringes, squeeze bottles, and battery-operated pulsed water devices.

These devices are generally safe and useful products, says Steven Osborne, M.D., a medical officer in FDA’s Center for Devices and Radiological Health (CDRH). But they must be used and cleaned properly.

Most important is the source of water that is used with nasal rinsing devices. Tap water that is not filtered, treated, or processed in specific ways is not safe for use as a nasal rinse.

Some tap water contains low levels of organisms, such as bacteria and protozoa, including amoebas, which may be safe to swallow because stomach acid kills them.  But these “bugs” can stay alive in nasal passages and cause potentially serious infections, according to the Centers for Disease Control and Prevention (CDC).

Improper use of neti pots may have caused two deaths in 2011 in Louisiana from a rare brain infection that the state health department linked to tap water contaminated with an amoeba called Naegleria fowleri.

How to Rinse Your Nose?

The procedure for nasal rinsing may vary slightly by device, but generally involves these steps:

  • Leaning over a sink, tilt your head sideways with your forehead and chin roughly level to avoid liquid flowing into your mouth.
  • Breathing through your open mouth, insert the spout of the saline-filled container into your upper nostril so that the liquid drains through the lower nostril.
  • Clear your nostrils, then repeat the procedure, tilting your head sideways, on the other side.

Nasal rinsing can remove dirt, dust, pollen and other debris, as well as help to loosen thick mucus. It can also help relieve nasal symptoms of allergies, colds and flu.

“The nose is like a car filter or home air filter that traps debris. Rinsing the nose with saline solution is similar to using saline eye drops to rinse out pollen,” Osborne says. The saline, he adds, enables the water to pass through delicate nasal membranes with little or no burning or irritation.

FDA staff recommends that you consult a health care provider or pharmacist if the instructions do not clearly state how to use the device or the types of water to use, if instructions are missing, or if you have any questions.

What makes children asthma better? While asthma is never “cured,” a variety of FDA-approved medications can help manage symptoms.

  • For quick relief of severe symptoms, doctors will prescribe “rescue” medications, such as albuterol, which open up the bronchial tubes in the lungs. “The goal is not to use it, but have it available—at home, school, camp—just in case,” says Anthony Durmowicz, M.D., a medical officer in the FDA’s Center for Drug Evaluation and Research.
  • To stabilize chronic and persistent symptoms, doctors will prescribe “controller” medications. The most common, safe and effective controller medications are the inhaled corticosteroids (ICS). With regular treatment, they improve lung function and prevent symptoms and flare-ups, reducing the need for rescue medications, according to NHLBI.
  • Children whose asthma is triggered by airborne allergens (allergy-causing substances), or who cannot or will not use ICSs, might take a type of drug called a leukotriene modifier. These come in tablet and chewable forms, though for many people they tend to be less effective than ICSs, especially for more severe asthma, Ortiz says.
  • For more severe cases that are not controlled with ICSs or leukotriene modifiers alone, adding long-acting beta agonists (LABAs) such as salmeterol or formoterol might be recommended. FDA cautions against using LABAs alone without an ICS, and recommends that if one must be used, it should be for the shortest time possible.

Most asthma medications are inhaled. Babies and toddlers use a nebulizer, a machine that delivers liquid medication as a fine mist through a tube attached to a face mask. Older children can use a metered dose inhaler or dry-powder inhaler.

To ensure that the proper dose of medication gets into a child’s lungs, doctors might also prescribe a device called a spacer, or holding chamber which attaches to the inhaler. “There are practical advantages to using (spacers) in younger kids—the timing and coordination needed to use an inhaler is hard for them,” Durmowicz says. Once the child can use the inhaler comfortably, it’s no longer as critical, he adds. Clinical trials have shown that “the relative dose delivered to the lungs with and without the spacer is the same.”

Health care providers also might recommend the use of a peak-flow meter to check how well a child’s asthma is controlled by treatment over time. Peak flow meters measure the amount of air the child expels from the lungs.

The type and combination of medications and devices a doctor prescribes depends on severity, frequency of symptom flare-ups, the child’s age, activity schedule and sometimes cost.