Tag Archives: sunlight

Birth Season and Vitamin D Levels as Adults

By Marc Sorenson, EdD, Sunlight Institute…

We all know that high sunlight exposure in adults leads to higher vitamin D levels. However, a most interesting piece of research also shows that your birth month has a considerable influence on vitamin D levels. In an Italian study, it was found that those who were born in winter, rather than spring and summer, were 11% more likely to develop vitamin D deficiency later in life.[i] This is an important finding, since many diseases are related in one way or another to season of birth. For example, a greater risk of obesity risk is observed in Canadians born in winter. Nevertheless, other factors such as inactivity are more important than season of birth.[ii]

This is another study that ties sunlight to vitamin D. But the question may still be asked: Is the relationship of birth seasonality to disease due to vitamin D or sunlight, or both? Whatever the answer, sunlight is the factor that makes vitamin D, so safely soak up the sun whenever you have the opportunity, and when it is too cold or overcast, safely use a sun lamp or tanning bed.

[i] Lippi G, Bonelli P, Buonocore R, Aloe R. Birth season and vitamin D concentration in adulthood. Ann Transl Med. 2015 Sep;3(16):231.

[ii] Wattie N1, Ardern CI, Baker J. Season of birth and prevalence of overweight and obesity in Canada. Early Hum Dev. 2008 Aug;84(8):539-47.

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Are they Sun Smart in China?

By Marc Sorenson, EdD, Sunlight Institute

Perhaps the Chinese people are smarter about sunlight than people in the U.S.  A real-estate developer there had to pay a family the equivalent of $15,650.00 for robbing them of their sunlight. One of the developer’s skyscrapers exceeded legal height and partially blocked the sun that enabled the family to obtain their government-mandated sunlight allotment during the coldest time of the year. The allotment was two hours per day, but the skyscraper reduced that allotment. The skyscraper allowed only 1-2 hours of sunlight.

The Judge in the case said, “We can’t live without sunshine” and told the developers that they had to respect the rights of the people to enjoy the sun. We need more judges like that in the U.S.!

What a contrast to the Dermatologists’ societies in the U.S.! In the 1990s, a president of the American Academy of Dermatology (AAD) stated that she lived for the day when everyone would move underground! She also said that melanoma would cause more cancer deaths than any other cancer by about 2010. Fortunately, we are not yet living underground, and melanoma is nowhere near the top of the cancer-deaths charts.

It appears that the Chinese are a whole lot smarter than the AAD! The AAD’s insistence that people avoid the sunlight is much more likely to destroy the health of the American public than soaking up some unobstructed sunshine. So enjoy some safe, non-burning sunlight, winter and summer while you improve your health!

To read the article, click here: http://www.shanghaidaily.com/national/Sunlight-suit-Family-wins-payout/shdaily.shtml

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Erectile Dysfunction (ED), Vitamin D, Sunlight and Nitric Oxide

By Marc Sorenson, EdD

A new article on November 30, 2015, from the Daily Mail, discusses breaking research on the association between ED and vitamin D.[1] The research from Johns Hopkins University, by Dr. Erin Michos and her colleagues, was conducted on 3,400 men over age 20, 30% of whom were vitamin D deficient, and 16% of whom reported symptoms of ED. Men with Vitamin D deficiency were 32% more likely to suffer ED than those whose levels were sufficient.

Although I, along with Dr. Grant, were the first to hypothesize that vitamin D deficiency could lead to ED,[2] I have moderated my opinion somewhat. It is entirely possible that higher vitamin D levels are really a surrogate measurement for sunlight exposure. Although vitamin D probably has a positive affect on ED, the UVA portion of sunlight has a nearly immediate effect in dilating the blood vessels[3] through the production of nitric oxide (NO), which is absolutely necessary for producing an erection.[4] Viagra and other ED drugs work by inhibiting the breakdown of NO, which keeps NO in circulation for a longer period.[5] But, they don’t always work and can have many deleterious side effects.[6]

My hope is that research will be done to determine the effectiveness of sunlight exposure in alleviating the condition. Of course, the underlying cause of ED is consuming foods that occlude the arteries. Sunlight and/or vitamin D serve as palliatives to that occlusion, as do the ED drugs. A nutrition program filled with colorful fruits and vegetables,[i] along with ample sunlight exposure, would, in my opinion, produce the very best results in mitigating or perhaps reversing the disease.

[i] Esposito K, Giugliano F, Maiorino MI, Giugliano D. Dietary factors, Mediterranean diet and erectile dysfunction. J Sex Med. 2010 Jul;7(7):2338-45.

To read the Daily Mail article, please click this link. http://www.dailymail.co.uk/health/article-3321000/Could-daily-dose-vitamin-D-cure-erectile-dysfunction-Deficiency-means-man-32-likely-impotent.html

[1] http://www.dailymail.co.uk/health/article-3321000/Could-daily-dose-vitamin-D-cure-erectile-dysfunction-Deficiency-means-man-32-likely-impotent.html

[2] Sorenson M, Grant WB. Does vitamin D deficiency contribute to erectile dysfunction? Dermato-Endocrinology 4;2:128–136.

[3] Opländer C, Volkmar CM, Paunel-Görgülü A, van Faassen EE, et al. Whole body UVA irradiation lowers systemic blood pressure by release of nitric oxide from intracutaneous photolabile nitric oxide derivates. Circ Res. 2009;105:1031–40.

[4] Burnett AL. The role of nitric oxide in erectile dysfunction: implications for medical therapy. J Clin Hypertens (Greenwich). 2006 Dec;8(12 Suppl 4):53-62

[5] Nitric Oxide and Viagra (no authors listed) Concepts in Biochemistry (accessed on November 30, 2015) at   http://www.wiley.com/college/boyer/0470003790/cutting_edge/viagra/viagra.htm.

[6] http://www.healthline.com/health-slideshow/erectile-dysfunction-medications-common-side-effects?stickyLb=true

 

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A vitally important Study on Sunlight and Multiple Sclerosis (MS)

By Marc Sorenson, EdD, Sunlight Institute

Drs. Robyn Lucas and Prue Hart are researchers from Australia whom I have followed for years. They speak the truth about the benefits of sunlight and present their research in a cogent and easily understandable manner. Their recent paper, written with other colleagues, is no exception.[i] They show evidence that beyond vitamin D, other photoproducts such as regulatory cells, dendritic cells, chemokines and cytokines,
released from the skin following exposure to ultraviolet radiation, may have protective and ameliorating affects against MS.

Here are the salient points in their report called Ultraviolet radiation, vitamin D and multiple sclerosis:

  • There is strong evidence from observational studies that low past sun exposure is associated with an increased risk of developing multiple sclerosis (MS).
  • Lower sun exposure or lower vitamin D status have been linked to more severe MS, that is, more frequent relapses and more rapid progression to disability.
  • Vitamin D supplementation trials for people with MS have shown improvement in immunological and MRI parameters, but with little convincing evidence of clinical benefit.
  • Higher levels of sun exposure may have benefits for MS-related immune parameters through both vitamin D and non-vitamin D pathways. (emphasis mine)
  • Exposure to ultraviolet radiation may result in immune tolerance that is beneficial for MS through upregulation of T and B regulatory cells, enhanced levels of cis-urocanic acid, alterations in dendritic cell trafficking as well as release of a range of other cytokines and chemokines.

This research is important because it shows that sunlight exposure works on MS in several different ways, one of which may be the stimulation of vitamin D production.

As the authors state: Recognition of multiple pathways whereby exposure to UVR may affect the development of MS could mark the beginning of prevention activities through modulation of an environment risk factor and the development of new therapeutic compounds. The vitamin D star seems to be waning, despite considerable genetic evidence that vitamin D has a role in MS risk. Perhaps it is only one part of a more complex picture. New intervention trials, undertaken in parallel, of vitamin D supplementation and UV-B phototherapy, should provide more definitive evidence – at least for the risk of MS following CIS. A finding that sun exposure, through the entirety of its effects, does have clinical significance as an immunomodulator for the development of MS, offers one of the few opportunities to modify disease risk for MS.”

I have posted other blogs regarding sunlight and MS, indicative that sunlight has protective effects against that malady, beyond its ability to stimulate vitamin D production in the skin. This research by Lucas and her colleagues is important in that it defines some of the other mechanisms of sunlight exposure that could lead to the prevention and potential cure of the disease.

[i] Robyn M Lucas, Scott N Byrne, Jorge Correale, Susanne Ilschner & Prue H Hart. Ultraviolet radiation, vitamin D and multiple sclerosis. Neurodegener. Dis. Manag 2015 (epub ahead of print).

 

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Lack of Sunlight may cause Females to become aggressive!

By Marc Sorenson, EdD, Sunlight Institute

Serotonin is one of the most potent natural mood enhancers produced in the body. As previously mentioned in one of my blogs, men whose levels of serotonin were measured on a very bright day produced eight times more serotonin than those who were measured on a cloudy, dismal day. Serotonin levels were also seven times higher in summer than winter.[1] Serotonin works in concert with melatonin; serotonin keeps keeps us bright and happy during the sunny day and melatonin lets lets us sleep during the dark night. Unfortunately, lack of sunlight in winter may also lead to too much daytime melatonin production, which may lead to aggressive behavior.

A 2015 report from Proceedings of the Royal Academy B, demonstrated that female rats who had the least sunlight exposure per day displayed the most aggression.[2] A similar increase in aggression was not observed in male rats.

An increase in melatonin was given as the reason for the aggression, since when winter approaches, sunlight decreases and melatonin increases. (Of course, serotonin also decreases, as stated in the aforementioned research.) Melatonin increases aggression, according to this study, by acting on the adrenal glands, causing a release of a hormone called DHEA, which has been consistently been linked to aggression in both mammals and birds.

I’m not entirely convinced that that aggression was not caused more by the drop in serotonin than the increase in melatonin. Either way, you boyfriends and husbands should be sure that your lady love gets plenty of sunlight or other form of UV light every day of the year, or you may be in trouble!

[1] Lambert GW, Reid C, Kaye DM, Jennings GL, Esler MD. Effect of sunlight and season on serotonin turnover in the brain. Lancet. 2002 Dec 7;360(9348):1840-2.

[2] Proceedings of the Royal Academy B 2015. Reported by Carly St. James, Empire State News. http://www.empirestatenews.net/2015/11/19/a-spike-in-female-aggression-can-be-linked-to-this-seasonal-change/ [accessed November 19, 2015]}

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Lack of Sunlight may cause Females to become aggressive!

By Marc Sorenson, EdD, Sunlight Institute

Serotonin is one of the most potent natural mood enhancers produced in the body. As previously mentioned in one of my blogs, men whose levels of serotonin were measured on a very bright day produced eight times more serotonin than those who were measured on a cloudy, dismal day. Serotonin levels were also seven times higher in summer than winter.[1] Serotonin works in concert with melatonin; serotonin keeps keeps us bright and happy during the sunny day and melatonin lets lets us sleep during the dark night. Unfortunately, lack of sunlight in winter may also lead to too much daytime melatonin production, which may lead to aggressive behavior.

A 2015 report from Proceedings of the Royal Academy B, demonstrated that female rats who had the least sunlight exposure per day displayed the most aggression.[2] A similar increase in aggression was not observed in male rats.

An increase in melatonin was given as the reason for the aggression, since when winter approaches, sunlight decreases and melatonin increases. (Of course, serotonin also decreases, as stated in the aforementioned research.) Melatonin increases aggression, according to this study, by acting on the adrenal glands, causing a release of a hormone called DHEA, which has been consistently been linked to aggression in both mammals and birds.

I’m not entirely convinced that that aggression was not caused more by the drop in serotonin than the increase in melatonin. Either way, you boyfriends and husbands should be sure that your lady love gets plenty of sunlight or other form of UV light every day of the year, or you may be in trouble!

[1] Lambert GW, Reid C, Kaye DM, Jennings GL, Esler MD. Effect of sunlight and season on serotonin turnover in the brain. Lancet. 2002 Dec 7;360(9348):1840-2.

[2] Proceedings of the Royal Academy B 2015. Reported by Carly St. James, Empire State News. http://www.empirestatenews.net/2015/11/19/a-spike-in-female-aggression-can-be-linked-to-this-seasonal-change/ [accessed November 19, 2015]}

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The Latest on Sunlight and Asthma. Lack of Windows profoundly increases Risk.

By Marc Sorenson, EdD, Sunlight Institute…

Asthma is a disorder characterized by inflammation of the air passages, which cause narrowing of the airways that transport air from the nose and mouth to the lungs.[i]  The mechanism by which sunlight may reduce asthma and its symptoms could be the anti-inflammatory properties of the vitamin D production that it stimulates in the skin.  Inflammation is often caused by proteins called cytokines that are either pro-inflammatory or anti-inflammatory elements of the immune system.[ii]  Vitamin D has the ability to inhibit pro-inflammatory cytokine production while stimulating the production of anti-inflammatory cytokines.[iii] However, there are likely other attributes of sunlight, beyond stimulating vitamin D production in the skin, that have beneficial affects.

One of the most recent studies on factors that contribute to asthma showed that living in a room without windows was associated with an increased the risk of asthma of 930%,  and living in an area without adequate sunlight was associated with an increased the risk of 220%.[iv] Considering that windows filter out the UVB light that stimulates the production of vitamin D, having windows could not have reduced asthma by vitamin D production—it had to be some other factor—something that entered the room through that window glass protected the people with windows from the remarkable increase in asthma they would have otherwise had. We know that UVA light, which does pass through windows, stimulates the production of nitric oxide, which is a potent vasodilator. Could it also be a bronchodilator? This explanation, of course, is theory.

Other research that indicates a direct influence of sunlight on asthma, is one by Hart and her colleagues, which showed that controlled exposure to ultraviolet light (UVR) in mice markedly limited the development, incidence and severity of asthma symptoms such as inflamed airways and lungs.[v] These researchers exposed mice to allergens that generally brought on asthma attacks and then exposed them to sun lamps for 30 minutes.   After the exposure, the allergens caused no attacks.  The researchers also stated that sunlamp exposure produced a cell type in mice, that when transferred into other mice, suppressed the immune reactions and halted symptoms. This is another indication that sunlight has a healthful effect on asthma beyond vitamin D production.

Dr. Litonjua and Dr. Weiss, noting that the prevalence of asthma and allergic diseases began to increase worldwide in 1960, hypothesized that since people have increasingly spent more time indoors, there has been less exposure to sunlight, which has led to decreased cutaneous vitamin D production.[vi] This could have further led to vitamin D deficiency in pregnant women, resulting in more asthma in their offspring. But was vitamin D deficiency the cause or was it simply sunlight deficiency? Or could it have been both?

At the health resort owned by the Sorensons, we often noticed that asthmatics ceased using their inhalers after a week or two of hiking in the sunshine. One of them decreased the dosage from 6 inhalers per day to zero in about a week. Could it have been sunlight? We believe that the combination of mostly plant-based nutrition, combined with sunlight, made the difference, and the aforementioned research provides reasonable support for that opinion.

[i] Asthma and Allergy Foundation of America: Asthma Facts and Figures.  Accessed 3-6-2010 http://www.aafa.org/display.cfm?id=8&sub=42

[ii] Kurtzke J. On the fine structure of the distribution of multiple sclerosis 1,25-Dihydroxyvitamin D3 inhibits cytokine production by human blood monocytes at the post-transcriptional level. Cytokine 1992;4:506-12.

[iii] Canning MO, Grotenhuis K, de Wit H, Ruwhof C, Drexhage HA.  I-alpha,25-Dihydroxyvitamin D3 (l,25(OH)(2)D(3)) hampers the maturation of fully active immature dendritic cells from monocytes. Eur J Endocrinol 2001;145:351-57.

[iv] Kamran A, Hanif S, Murtaza G. Risk factors of childhood asthma in children attending Lyari General Hospital. J Pak Med Assoc 2015 Jun;65(6):647-50.

[v] Hart, P.  Exposure to sunlight could reduce asthma.  Newsletter of the Telethon Institute for Child Health Research 2006;3:2

[vi] Litonjua AA, Weiss ST.  Is vitamin D deficiency to blame for the asthma epidemic?  J Allergy Clin Immunol 2007;120:1031-35.

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Can the Quantity of Sunlight in the Birth Month alter the Longevity of Diabetics?

By Marc Sorenson, EdD. Sunlight Institute

One of the more interesting research papers in recent memory demonstrates that the amount of sunlight during the month of birth may increase the life span of adult diabetics.[1] The researchers studied the death records of 829,000 diabetics, 90% of whom were type 2. Among the most interesting findings was that with rapidly decreasing ultraviolet radiation (UVR or sunlight) at the time of birth, lifespan decreased in better nourished, white female diabetic population.

Diabetic males, on the other hand, gained 6.1 years of life when exposure to sunlight was increasing at birth month, whereas females gained 2.3 years.

This all makes perfect sense, since fall weather is a time of rapidly decreasing sunlight intensity and a drop in temperature, which would decrease vitamin D and other photoproducts, and cause people to be outdoors less.

The researchers concluded that “Rapidly changing UVR at the equinoxes modulates the expression of an epigenome involving the conservation of energy, a mechanism especially canalized in women. Decreasing UVR at conception and early gestation stimulates energy conservation in persons we consider ‘diabetic’ in today’s environment of caloric surfeit. In the late 19th and early 20th centuries ethnic minorities had poorer nutrition, laborious work, and leaner bodies, and in that environment a calorie-conserving epigenome was a survival advantage. Ethnic minorities with a similar epigenome lived long enough to express diabetes as we define it today and exceeded the lifespan of their nondiabetic contemporaries, while that epigenome in diabetics in the nutritional environment of today is detrimental to lifespan.”

So as I see it, those who are programmed genetically for diabetes can increase lifespan by being born at the right time of year. If only their parents had known!

[1] George E Davis Jr* and Walter E Lowell. Variation in ultraviolet radiation and diabetes: evidence of an epigenetic effect that modulates diabetics’ lifespan. Clinical Epigenetics 2013, 5:5.

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Sleep Deprivation, Metabolic Syndrome and Sunlight

By Marc Sorenson, EdD, Sunlight Institute

It is becoming increasingly obvious that lack of sleep is a major risk factor for human health. In a recent study reported in the journal Sleep Medicine,[i] 2579 adults without metabolic syndrome, were assessed for sleep habits for 2.6 years to determine their risk of developing metabolic syndrome, also known as Met S. Met S is a group of metabolic disorders (high blood pressure, abdominal obesity, high cholesterol, high triglyceride levels, low HDL levels and insulin resistance) that are linked to increased risk of cardiovascular disease and type 2 diabetes. The participants were aged between 40 and 70 years.

Those who slept and average of less than 6 hours daily were 41% more likely to develop Met S than those who slept 6-7.9 hours. Among the measurements that were particularly concerning, were a 30% increased risk of high blood glucose and excess belly fat (both indications of future diabetes), and a 56% higher risk of high blood pressure. The researchers concluded that “Short sleep duration is an independent risk factor for incident metabolic syndrome in a population-based longitudinal study.”

Indeed, Lack of sleep can be deadly. Forbes Magazine online ran an excellent article on sunlight and sleep,[ii] in which they stated the following statistics: “In 2012, 60 Million Americans filled prescriptions for sleeping pills, up from 46 million in 2006.” The article discusses the potential dangers of sleep medications, showing that those who take 18 pills per year have a tripling of the risk of death compared to those who take fewer than that 18. It then describes the results of research showing that people whose workplaces have windows are able to sleep about 46 minutes per night more than those who have no natural light access.  Those who had more exposure to sunlight also were generally happier, had fewer ailments and experienced better vitality than their counterparts without windows.

Many individuals have difficulty sleeping long and soundly enough to feel refreshed. A study by Dr. Julie Gammack exposed test subjects to 30-60 minutes per day of direct sunlight, and according to the Saint Louis University health web site, “Nursing home patients who were exposed to natural light had improved sleep quality, less difficulty falling asleep, fewer episodes of wakefulness during the night and greater satisfaction with the amount of sleep they got.”[iii] Other research by Dr. Ayoub and colleagues in Alexandria, Egypt demonstrated that there were several factors associated with insomnia among the elderly. [iv] Having five or more diseases was associated with a 7.5 times increased risk, anxiety was associated with a 1.9 times increased risk, and depression with a 1.74 times increased risk. There was only one factor that reduced risk. Sunlight exposure was associated with 43% reduced risk. Likely, this was due to the production of serotonin and melatonin due to sunlight exposure (see the last paragraph. Other research has shown that sleep disturbances are more common in sub-arctic areas during the dark time of the year.[v] The message? If one wants to sleep well, sunlight exposure during the day is imperative.

This research on windows is particularly interesting because the effects of sunlight in that case could have had nothing to do with vitamin D, since the sunlight exposure came through windows, which block the UVB light that produces vitamin D. It is likely that the positive effects of sunlight in this case were produced by increasing serotonin levels (a natural mood enhancer) in the brain during the sunlight exposure, and then allowing melatonin (a natural relaxer) during the night.

Lack of sleep is a common, and perhaps deadly, malady. The sun is not our enemy, but a vital friend. Embrace it, but do not burn.

[i] Jang-Young Kim, Dhananjay Yadav, Song Vogue Ahn, , Sang-Baek Koh. A prospective study of total sleep duration and incident metabolic syndrome: the ARIRANG study. Sleep Medicine 2015;16:1511-1515.

[ii] http://www.forbes.com/sites/daviddisalvo/2013/06/18/to-get-more-sleep-get-more-sunlight/

[iii] Gammack, J. Quoted in Medical News Today, April 10, 2005.

[iv] Ayoub AI, Attia M, El Kady HM, Ashour A. Insomnia among community dwelling elderly in Alexandria, Egypt. J Egypt Public Health Assoc. 2014 Dec;89(3):136-42.

[v] Bratlid T, Wahlund B. Alterations in serum melatonin and sleep in individuals in a sub-arctic region from winter to spring. Int J Circumpolar Health. 2003 Sep;62(3):242-54.

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Sunshine and Anaphylaxis—another Reason to Embrace the Sun.

By Marc Sorenson, EdD…

Anaphylaxis, or anaphylactic shock, is an extreme allergic reaction to a protein to which a person has been previously exposed.  It is characterized by a profound drop in blood pressure, severe itching and hives, and breathing difficulties. Untreated, it can be lethal.  A common cause is bee sting, although many drugs and foods trigger reactions in individuals.

Although anaphylaxis has many causes, one of the major associations with the reaction is sunlight, being much more prevalent in areas with less sunlight.[1] [2] [3] Interestingly, the frequency of hospital admissions for the condition has increased 5-7 fold in the last 10-15 years, although death from anaphylaxis has not increased.[4] That could be due to increasingly fast response to the condition by medical personnel.

Other research indicative of an association of sunlight deficiency to anaphylaxis involves the use of the anti-anaphylaxis drug, Epipen. When geographical location in the USA is compared to the number of prescriptions for the drug, a strong north-south gradient is apparent, [5] with the highest rates in Massachusetts and the lowest in Hawaii. People residing in southern states have about 25-30% of the risk of those residing in the New England. The same relationship is observed in Australia, where there EpiPen prescriptions are more frequent in the south than the north[6] as are hypoallergenic formula prescriptions.[7] (In Australia, the south is colder and has less sunlight, due to being in the southern hemisphere).

A similar relationship in the U.S. is shown with visits to the emergency room for acute allergic reactions, including anaphylaxis, especially food-induced anaphylaxis.[8] The northeast region had more visits than the South. These studies establish that sunlight is protective against this potent reaction. Other research shows a similar geographic gradient with higher frequencies recorded in areas of little sun exposure,[9] such as those in children residing in northern countries.[10]

Regular, non-burning sunlight is an essential ingredient in the vibrant-health recipe for ourselves and our children. Embrace the sun!

[1] Tejedor-Alonso M A, Moro-Moro M, Múgica-García MV. Epidemiology of Anaphylaxis: Contributions from the Last 10 Years. J Investig Allergol Clin Immunol. 2015;25(3):163-75.

[2] Mullins RJ, Camargo CA. Latitude, sunlight, vitamin D, and childhood food allergy/anaphylaxis. Curr Allergy Asthma Rep. 2012 Feb;12(1):64-71.

[3] Rudders SA, Camargo CA Jr. Sunlight, vitamin D and food allergy. Curr Opin Allergy Clin Immunol. 2015 Aug;15(4):350-7.

[4] Tejedor Alonso MA, Moro Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015 Jun;45(6):1027-39.

[5] Camargo, C. et al. Regional differences in EpiPen prescriptions in the United States: the potential role of vitamin D. J Allergy Clin Immunol 2007;120:128-30

[6] Mullins RJ, Clark S, Camargo CA Jr. Regional variation in epinephrine autoinjector prescriptions in Australia: more evidence for the vitamin D-anaphylaxis hypothesis. Ann Allergy Asthma Immunol. 2009 Dec;103(6):488-95.

[7] Mullins RJ, Clark S, Camargo CA Jr. Regional variation in infant hypoallergenic formula prescriptions in Australia. Pediatr Allergy Immunol. 2010 Mar;21(2 Pt 2):e413-20.

[8] Rudders SA, Espinola JA, Camargo CA Jr. North-south differences in US emergency department visits for acute allergic reactions. Ann Allergy Asthma Immunol. 2010 May;104(5):413-6.

[9] Tejedor Alonso MA, Moro M, Múgica García MV. Epidemiology of anaphylaxis. Clin Exp Allergy. 2015 Jun;45(6):1027-39.

[10] Mullins RJ, Camargo CA. Latitude, sunlight, vitamin D, and childhood food allergy/anaphylaxis. Curr Allergy Asthma Rep. 2012 Feb;12(1):64-71.

 

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