The year in review (2011)

Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2011.  J Allergy Clin Immunol 2012;129:76-85

So what’s new in allergy to foods, drugs, and insects?  I promise, I won’t bore you with basic science facts useful only for allergy boards, but here’s some facts for you to digest with the new year:

  • A US study estimates a food allergy emergency department visit every 3 minutes, on average.  This is a very remarkable statistic for a condition that was “trivial” during my allergy fellowship training.

  •  Food allergy health care costs are estimated at $500 million in 2007.  Ditto the above–now you know why so much research is focused on a permanent cure for food allergy.

  • Severity of peanut allergy varies regionally, likely based on the source of sensitization (pollen related vs oral).  Not only region variation, but also determined by culture.  For instance, infants in Israel who are fed peanut early in life have less allergy than their European counterparts that withhold peanut until age 2 or 3.

  •  Vitamin D deficiency is associated with increased risk for food sensitization (peanut).  Is there anything that Vitamin D doesn’t do?  Cod liver oil, here we come! 
  • Freezing fresh fruits for prick-prick testing does not result in a significant loss of potency.  Who cares?  Well, your doctor may want to test you by pricking a fresh fruit (say peaches) and then testing your skin.  Don’t worry about how you’re going to get the fruit to the appointment….just freeze it for later.

 Treatment Strategies:

  • Clinical studies of peanut oral and sublingual immunotherapy show promise.  Why not eat small amounts of peanut and develop tolerance to it?  It works and several studies are beginning in 2012 to find out more information about safety and who are the best candidates for this procedure.  Want to be involved in this type of study?  Call me for details.

  • Several studies support the use of Xolair™ for not only asthma, but also food allergy:  Milk and peanut to name two.  This treatment may also be useful for chronic urticaria refractory to antihistamines–>hives.

  • During a safety study of a food allergy herbal formula based on traditional Chinese medicine, a trend toward modulation of basophil responses was observed.  This means some science exists behind the nutritional and herbal medicine “craze.”

  • New insights into the use of vitamin D, phototherapy, methotrexate, azathioprine, and immunoadsorption in treating severe AD were shown.

 Several studies support the notion that egg content of seasonal influenza vaccines is low, that skin testing is not necessary, and that the vaccine can be safely administered to persons with egg allergy!! See my previous post on egg allergy and Flu vaccine.

  •  A Canadian study shows only 55% with diagnosed food allergy had selfinjectable epinephrine.  Folks, this is a life-threatening reaction and only 55% had the lifesaving treatment on hand?  
  • A clinical study of children with delayed urticarial and maculopapular rashes shows a low recurrence rate and efficacy of drug rechallenge.  If you’re faced with a rash occurring 4-6 hours after taking a medication, you probably won’t react with the second exposure

 Is this enough to absorb in one day?  Happy New Year!

 

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