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?

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#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

Dear Doctor…..

                             

Dear Doctor,

Thanks for all your help with my #allergies, but I have a bone to pick with you.  A few minutes into my visit and you’re talking about “rhinitis” and “IgE” and “desensitization”.  By the time my brain catches up with you, our visit is over and I don’t feel like I really understand what condition I  have.  Could you slow down and explain what you mean by all that medical riff-raff?

Signed,

Confused and a bit rushed Continue reading

#allergy-shots-2, #allergy-testing, #ige

Food allergy “testing” is usually a bad idea

Thanks Dr Benaroch for your insights from a pediatricians standpoint. We see patients everyday that have been told based on a “test” that their child has food allergy. The percentages vary, but a majority of children that are found to have a food allergy by testing, tolerate the food just fine after challenge. What are the exceptions? Peanut, tree nut, milk, and egg anaphylaxis should always be asked during patient histories. This is why meeting your patient and asking directed questions is so important!

The Pediatric Insider

The Pediatric Insider

© 2015 Roy Benaroch, MD

People like tests. You get numbers, and maybe a printout, and there’s science and blood and things just feels more… serious, when testing is done. You can picture Marcus Welby  (or perhaps a more modern physician), looking solemn, declaring “We’d better run some tests.”

Are medical tests magical and mysterious, and can they unlock the secrets of life? Usually, no. And among the worst and most misunderstood tests we do are food allergy tests.

A few recent studies illustrate this well. A review of about 800 patients referred to an allergy clinic found that almost 90% of children who had been told to avoid foods based on allergy testing could in fact eat them safely. The study, bluntly titled “Food allergen panel testing often results in misdiagnosis of food allergy” also found that the positive predictive value of food allergy blood…

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