Several months ago, I asked you what was missing from your treatment of #allergy. To my surprise, 50% of respondents wanted more information on food allergy, compared to only 36% who wanted cheaper medications for their #asthma. So I listened and here are some stories I find interesting about food allergy. Please share your stories with me by adding your comments at the end of this blog. Unfortunately, people don’t really think food allergy is a real health problem. I can tell you that many kids with food allergy get “challenged” by well-meaning grandmas who give them a cookie, just to see if they’re truly allergic. Probably not a good idea, but it can be very dangerous to #food allergic patients. I have several patients with banana allergy, and are also teachers, just like in this recent “prank” from Ohio. If your friend or co-worker says they have allergy, make sure a qualified professional confirms the allergy is real–don’t try it on your own.
OK, we have to have a little humor in medicine, or we all go crazy. While you may laugh at the drama below, patients with food allergy experience constant anxiety about the ramifications of accidental food ingestion: loss of work days, unscheduled emergency room visits, and disfiguring facial swelling, not to mention death from food anaphylaxis. One bright spot in food anaphylaxis is peanut oral immunotherapy, which is very effective and will probably soon be approved by the FDA for use in clinical practice. Call us if you’re interested in this newly approved treatment for #peanut allergy. In the meantime, enjoy the show!
McDonald’s introduced a spirit-lifting jingle in the 70’s: “Two all beef patties, special sauce, lettuce, cheese, pickles, onions, on a sesame-seed bun.” Who would’ve thought that 30 years later, sesame seed allergy would increase to half of that of persistent cow’s milk allergy? Guess we’ll have to limit our trips to McDonald’s or find out for sure if sesame seed allergy is contributing to allergy symptoms.
Sesame seed food allergy.
The number of reports regarding sesame seed food allergy (SFA) has increased significantly worldwide over the past two decades, either due to a genuine increase in SFA or merely an increase in its awareness. Its prevalence is difficult to estimate due to the lack of well designed prospective population-based studies. Based on the available data, we estimate that SFA affects 0.1-0.2 % of the population, in areas where the food is available. Albeit this prevalence appears to be relatively low, it is approximately one-half of that of persistent cow's milk allergy. While only one fatality has been reported, the significant number of SFA patients presenting as anaphylaxis indicates the potential risk. Many reports based the diagnosis of SFA on sensitization criteria alone, particularly amongst atopic dermatitis patients. Elimination of sesame from the diet of these children utilizing such criteria is not justified, and may even increase the risk for developing SFA.
Food allergy is more complicated than you might think. Don’t forget to remember:
- Food allergy is a trivial disease unless you have it! You can’t possibly understand the trauma food allergy patients live with everyday, but try and show some empathy when you’re around a discussion regarding food allergy.
- Don’t try on your own to “prove” a friend or relative doesn’t really have food allergy. Leave that to the professionals such as board-certified allergists. Not only do we test for IgE (that’s what causes anaphylaxis), but we are experienced in office food challenges to confirm or disprove the presence of life-threatening allergy.
- Food allergy is an ever changing specialty and will often require a change in medical practice/procedures. Testing for sesame seed allergy, and desensitization to peanut protein are just 2 examples of changing medical practice in the past 10 years. Others are sure to follow.
Last, but not least is the following article from The New York Times and Lisa Sanders, MD on anaphylaxis that wasn’t due to food allergy. There’s always a catch, and of course I won’t tell you what happened until you read the last paragraph!
‘‘Call 911,” the 21-year-old woman gasped to her older sister. “I’m having an attack.” The older sister looked over at the young woman. She looked scared, a thin layer of sweat glistening on her pale face. The older sister immediately picked up the phone and dialed. She’d heard about her sister’s strange attacks but had never seen one. Her younger sister had come to her bedroom earlier that evening, saying that the inside of her mouth was itchy and that she was worried this was an allergic reaction. She didn’t want to be alone, in case the two doses of Benadryl she’d already taken weren’t enough.
To prevent these attacks, the patient’s mast cells have to be controlled. Twice a day, she takes an antihistamine and an antacid — medications that block histamine, the primary actor in allergies. And once a day, she takes vitamin D to make her over excitable mast cells less likely to erupt into an allergic reaction. She recently added a new medication — a shot she gets every three weeks — to block mast-cell triggers. It’s a lot of medicine for someone who had never taken anything. But it’s much better than the alternative. And she hasn’t had another attack since.
Lisa Sanders, M.D., is a contributing writer for the magazine and the author of a new book, “Diagnosis: Solving the Most Baffling Medical Mysteries,” which will be published in August. If you have a solved case to share with Dr. Sanders, write her at Lisa.Sandersmd@gmail.com.