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
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.
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:
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
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
This web site has a very simple method for food elimination/challenge diet that can be applied to ANY #food intolerance.
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?
Confused and a bit rushed Continue reading
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!
© 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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This article is in press and will be published in Annals from the College of Allergy, Asthma, and Immunology next month. I thought the study is very interesting given the “push” for oral desensitization. I just returned from the AAAAI annual meeting and it appears that patients with food allergy can become “desensitized” or cured, however, that comes with a cost of potential anaphylaxis during treatment. Think of it like the use of allergy shots which are very effective, but you can develop anaphylaxis after an allergy shot that will need additional treatment such as epinephrine. The question I have is, “should this therapy with foods be used at home where parents and patients don’t know much about giving epi?”
Here’s the summary–>Asthma patients are at risk for more severe reactions and less likely to reach full desensitization during milk oral immunotherapy, according to a study in Annals of Allergy, Asthma and Immunology. Researchers in Israel studied 194 subjects 6 years and older with IgE-mediated cow’s milk allergy, with and without asthma, undergoing milk oral immunotherapy. Regardless of severity, subjects with asthma had more reactions and injectable epinephrine use during induction, and more home treatments with immunotherapy. Moderate to severe asthma also was associated with a lower likelihood of reaching full desensitization