Is Tomato a fruit or vegetable?

Click the link below for a message from Dr. Wiens himself!

https://www.youtube.com/shorts/dBWo3TZcHK8

https://allergylosangeles.com/allergy-blog/tomato-allergy-can-come-in-many-flavors/

Dr. Alan Khadavi from southern California.

I appreciate the blog from Dr. Khadavi as the question of “citrus acid allergy” often comes up in my daily allergy practice here in Tulsa. Tomato is just one more food that can cause an intolerance that often is confused with a food allergy. As listed below, mucosal irritation is an intolerance, while oral allergy syndrome and anaphylaxis represent two examples of “IgE-mediated” or true allergy.

Tomato allergy is not commonly reported, but it can cause adverse reactions.  Hypersensitivity reactions to other fruits are commonly reported, particularly apples, stone fruits and bananas. Tomato (Solanum lycopersicum) is derived from two wild ancestor species, Solanum pimpinellifolium and Solanum cerasiforme. Tomato flavor is a balance of acid and sugar recognized by the tongue and the effect of volatile compounds within the fruit that cause aroma recognized by the nose. Tomato flavor is commonly described as sweet, tart, tangy or balanced.

Tomato is classified as a fruit because they contain seeds and grow from the flower of the tomato plant. But many people still classify it as a vegetable based on its culinary applications. (how we cook with it!)

Credits to Dr. Alan Khadavi

Types of reactions to Tomato:

  1. Mucosal irritation-Tomato has been implicated in an array of adverse reactions, including uncomfortable mucosal irritation due to acidic pH. The tomato plant can also cause itching of the skin when touched which is a form of allergic contact dermatitis.
  2. Oral allergy syndrome-symptoms typically occur with mouth itching and swelling of lips and tongue.  Patients allergic to grass pollen can describe symptoms of oral allergy syndrome to tomato.  This is not a true tomato allergy, but a cross reactivity of the proteins to the grass pollen.  Treatment is heating the fruit or just avoiding it. Other foods in the same category are kiwi, melon, peach and celery.
  3. Anaphylaxis-symptoms that occur are hives, swelling, wheezing, coughing, vomiting, diarrhea and low blood pressure. This is from IgE mast cell degranulation. Allergy skin testing, specific IgE lab testing and fresh food skin testing with tomato all can be used to test for tomato allergy.

Reactions to tomato can thus come in different forms.  With a severe reaction to tomatoes, patients will often avoid altogether and the problematic reactions are usually the mucosal irritation or food intolerance. An allergy doctor can help decipher what type of reaction one is having to tomato and to do the appropriate tests for establishing or ruling out a diagnosis of clinical allergy.

In the news a couple of years ago, Ariana Grande was diagnosed with a true tomato allergy. She joked that there was “nothing more unfair than an Italian woman developing an allergy to tomatoes in her mid-twenties.” But food allergies are a serious matter and should be taken seriously.  All precautions should be taken place and patients should carry around an injectable epinephrine in case of an accidental exposure.

Not only should patients be aware of tomato allergy, but doctors should also recognize that rare food allergies aren’t so rare if you have the sensitivity. What to do?

  • Make sure you have injectable epinephrine
  • Skin testing or blood testing can be performed to many foods that cause rare allergies.
  • Even if you don’t perform testing, please avoid the food (s) that cause problems, as the reaction may get worse with subsequent exposures.

#tomato-allergy

Will peanut allergy always be with us?

https://www.usatoday.com/story/sponsor-story/aimmune-therapeutics/2021/09/13/back-school-peanut-allergy-6-steps-parents-consider/5459643001/?utm_source=taboola&utm_medium=exchange&tblci=GiArXsoPmR6TKXGp2LlCIMdXds8I3gAGYdlTYUi6Ch-OGSDqyz0o88jezYjn_fI2#tblciGiArXsoPmR6TKXGp2LlCIMdXds8I3gAGYdlTYUi6Ch-OGSDqyz0o88jezYjn_fI2

Back-to-school with peanut allergy: 6 steps for parents to consider

What families living with peanut allergy need to know to help care for their kids at school

Aimmune Therapeutics

Parents of children with peanut allergy can consider these 6 steps when returning to in-person learning.

For families living with peanut allergy, the most common food allergy among children in the U.S.1, managing the allergy can require constant vigilance and supervision. This includes diligently reading food labels and, for some, avoiding social gatherings, such as birthday parties and summer camp, in fear of accidental exposure. Practicing a strict peanut-free diet alone might not be enough, as even a small amount of exposure to the allergen can prompt an allergic reaction.2

With many schools reopening for in-person learning this fall, parents of children with peanut allergy may be feeling nervous to send their kids back to school. This may be particularly true for those with young children starting school in-person for the first time who are not accustomed to the independence and level of vigilance required. 

Here are six proactive steps that parents can take when sending children with peanut allergy back into the classroom: 

1. Speak to the child’s allergist

Before the school year begins, parents should make an appointment to speak to their child’s allergist. At this time, parents can work with the allergist to update their Emergency Care Plan, which details the child’s allergies and what to do in case of an allergic reaction. During this appointment, parents can also discuss treatment options with their allergist.

2. Inform the school

Parents should share their Emergency Care Plan with school administrators and explain how they can help prevent accidental exposure to peanut. Many schools have protocols in place, but it’s important to have open conversations to ensure comfort with those protocols and to put other protocols in place as needed. The school may even have information about a food allergy support group for parents whose children attend local schools, which could offer useful tips.

Parents should make a complete list of the foods their child is allergic to and share emergency contact information, along with how and where their child’s medication will be stored. Additionally, they should confirm that the school staff is trained to administer injectable epinephrine.

3. Educate, educate, educate

Parents may want to meet with teachers, health professionals, cafeteria staff and other parents to educate them about the child’s peanut allergy and what to do in case of an allergic reaction. An educational session, in collaboration with the child’s teacher, could be offered to classmates during which students can ask questions and better understand what it means to avoid even the tiniest traces of peanut.

4. Reduce transportation concerns

Because of the exposure risk posed by school buses, it’s important to understand the schools' transportation protocols for food allergy management.

The school bus may pose a risk for accidental peanut exposure as buses are used for daily transportation and for class field trips. Parents should talk to their child’s school to understand school bus rules and protocols for food allergy management.

5. Prepare lunch or learn about substitute meal options

Preparing lunch at home may offer some parents assurance, while others may prefer that their child uses the school cafeteria. The U.S. Department of Agriculture (USDA) requires schools to offer substitute meals for students with life-threatening food allergies. This may require written instructions from the child’s healthcare provider and is another reason that speaking with the school’s food service director in advance of the school year is suggested.

Once thought to be a permanent condition, peanut allergy is now a treatable condition with the use of Oral Immunotherapy or desensitization to peanuts. Granted, this article is sponsored by the maker of Palforzia, Aimmune, but it is a good option for kids with peanut allergy.

  • Why should I consider the use of an “expensive” protocol for peanut desensitization? (Palforzia)
  • Using a FDA approved protocol simply means that researchers have agreed upon the dose escalation that minimizes adverse reactions such as anaphylaxis during the procedure. After all, you are giving your child a food that they are allergic to!
  • The amount of peanut protein is standardized between doses, meaning during the “up-days” and escalation phase, your child will always get the anticipated dose, making anaphylaxis less likely to occur.
  • In order to start using “peanut desensitization”, parents and physicians must verify that they have completed the appropriate education on how to use Palforzia and not “shoot from the hip.” If it were my child, I would always want to use a product that’s been tested and standardized for best results done safely.

6. Find out if treatment could be the right option

Some families living with peanut allergy may not be aware that there is a U.S. Food and Drug Administration (FDA)-approved treatment for children aged 4 through 17 years with peanut allergy. This might be an option for families who want to help take the power back from peanuts.

PALFORZIA® [Peanut (Arachis hypogaea) Allergen Powder-dnfp] is intended to gradually decrease your child’s sensitivity to small amounts of peanuts that may be hidden in foods. As children go back to school, parents may want to speak to their child’s allergist to see if PALFORZIA may be the right choice for them.

WHAT IS PALFORZIA?

PALFORZIA is a treatment for people who are allergic to peanuts. PALFORZIA can help reduce the severity of allergic reactions, including anaphylaxis, that may occur with accidental exposure to peanut. PALFORZIA may be started in patients aged 4 through 17 years old. If you turn 18 years of age while on PALFORZIA treatment you should continue taking PALFORZIA unless otherwise instructed by your doctor.

#food-allergy, #food-desensitization, #peanut-allergy

Fishing for allergy

Who doesn’t like to fish during this time of the year? Doesn’t matter if it’s catfish on the local pond, or trout at Roaring River, there’s nothing like feeling the tug on your line before you set the hook. And I have relatives that are experts at catching any type of fish you want. Fish allergy can be divided into 2 groups: the white fish and shellfish. You are usually not allergic to both groups and testing for sensitivity can be very helpful to avoid anaphylaxis and give you the tools to avoid the wrong kind of fish. Shellfish allergy to shrimp, crab, and lobster isn’t the focus of this writing, so we’ll discuss only allergy to “white fish” today. At times, I enjoy searching the medical literature for other allergist’s opinions on food allergy and this is no exception. What is most important for the white fish allergy, is can you outgrow this condition?

The data of whether someone can outgrow fish allergy is scarce. Fish allergy is one of the most common causes of food allergy, especially in children and young adults, with rates from 0.1 to 0.5%. The major fish allergen identified is beta-parvalbumin, it is resistant to heat and digestion. Many patients with an allergic reaction to one fish will also react upon ingestion of other fish. Sharks and rays mainly contain alpha-parvalbumin which has been shown to be less allergic.

Journal of Allergy and Clinical Immunology: In Practice.

Previous studies have shown that 15% of children can outgrow fish allergy within a period of 2-5 years, whereas telephone studies have shown it to be 3.5% in the United States.

A recent study called “Natural History of IgE-Mediated Fish Allergy in Children” published in The Journal of Allergy and Clinical Immmunology: In Practice, aimed to describe the natural history of fish allergy.

Children in the study ranged from 4 to 18 years who were previously diagnosed with fish allergy. The results showed:

  • 22% of children tolerated all fish tested, the average timeframe was 8 years after their first reaction.
  • Complete tolerance to fish increased with age, from 3.4% in preschool children to over 45% in adolescents.
  • Most children were able to tolerate swordfish (94%) and tuna (95%).
  • The best predictor of fish allergy was the IgE test to cod greater than 4.87 kUA/L.

The study has shown that fish allergy in children starts early, mostly during the first 2 years of life and a considerable proportion of children will outgrow fish allergy.  Particularly those with less sever reactions and a lower level of sensitization (skin prick and IgE testing). Those who continue being allergic may still tolerate several fish species, such as tuna and swordfish. This probably is a reflection of their parvalbumin content and/or composition.

Tolerance to at least 1 fish can be important for allergic children because fish has beneficial effects on health owing to the high omega-3 content and it is associated with a lower risk of coronary heart disease.

  • So what’s the take away from fish allergy, so you can fantasize what the “big fish” is doing underwater before you set the hook?
  • Most children will outgrow fish allergy and this applies particularly to swordfish and tuna. A definite must is to have testing performed to determine the level of IgE (or skin testing) to white fish that will prevent an allergic reaction that can spoil your next great fishing trip.
  • Tolerating fish to include at least one species can have clinical benefit due to omega-3 content to reduce heart disease and stroke.

#allergy, #fish-allergy, #food-allergy

It’s a scam to our patients

Much of my medical office day is explaining to patients what they DON’T have rather than treating #allergy. Allergy has become the explanation for all medical disease. For instance, it’s rare for allergy to cause lack of attention, abdominal cramping (because of food allergy), or even constipation, but patients want allergy testing nonetheless. What are some “non-allergy” conditions that you’re likely to spend money you don’t need because of excessive testing?

Continue reading

#allergy-shots-2, #food-allergy, #myths, #sinus-infections

Peanut allergy treatment is finally here!

#peanut-allergy

Do I really want that? Shared decision making and how this applies to allergy.

As #Christmas time approaches, it’s clear that Americans want choice. When I ask patients what they would like for Christmas, “I don’t know” is usually not their answer. Children’s eyes filled with sparkles at Santa’s coming, parents’ smiling at me and thankful I haven’t ruined their stories about Santa dominate our discussions about the holidays. Of course, I’ll always review medications and made sure that #asthma won’t ruin a perfectly good Christmas.


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Myth-busters in Medicine

As an allergist  in Tulsa, the myths that surround asthma, food allergy, hives, hay fever abound and patients often come in to the office telling ME what they are allergic to or how to fix the problem. Let me give you some examples:

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#allergies, #asthma, #board-certified-allergist, #dave-stukus, #food-allergy, #lynn-wiens, #tulsa-oklahoma, #zdogg

Well, you don’t say?

The Fall cometh and we all have allergies (particularly #ragweed) to deal with. It always amazes me how much information about #fall allergies can be found on the internet–some true, but much isn’t close to giving you good information about how to treat your allergies.  In fact, if you’ll remember, I asked where  most of you get your medical information and 100% said “from a medical journal”. I’m not sure I believe that result or there wouldn’t be so many allergy myths in Tulsa! I’ve often wondered, why does it make any difference to have good medical information about how to best treat your allergies? Continue reading

Give Me Your Stories About Food Allergy

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. Continue reading

#american-academy-of-allergy-asthma-and-immunology, #do, #food-allergy, #food-and-drug-administration, #he, #tulsa-oklahoma

Eliminating FODMAP foods temporarily can be helpful.

This web site has a very simple method for food elimination/challenge diet that can be applied to ANY #food intolerance.

#elimination-challenge-diet