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?
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!
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…
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
We all want to be realllllly healthy and it makes sense that what we eat is a place to start. Right? Well not so fast. Jenny (isn’t her real name to protect the innocent) went to her health club to lose some weight and get into shape. Jenny had always struggled with being overweight and was even laughed at in grade school because she was plump. (not funny if you’re one of those kids) Continue reading The Problem with Foods–foods that make me want to throw up→
From my colleague, Jeff Lewis: “The camp is called Camp Weekaneatit, it is July 13 to July 18, overnight camp, strictly gluten-free so the kids can eat what they want without having to worry. Its part of Camp Twin Lakes – an organization that hosts tons of medical camps. We have kids from all over – as far away as California the last two years. Scholarships are available.”
Anyone who tries to follow a strict gluten-free diet knows how difficult it can be to take a trip outside the home. This camp lets kids enjoy camp without the worry about the next meal or snack. Spread the word!
Seafood allergy is a major problem because as it worsens in someone’s life, the seafood allergy, actually, can become a problem that can be even life-threatening. Now, initially, people who have problems with seafood, actually, suffer difficulties which are more like stomach irritation, diarrhea, vomiting. But as the seafood allergy worsens, and as the symptoms start to get worse, what invariable happens is people start to have hives and even anaphylactic reactions.
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Food allergy is a constant source of anxiety to parents of children who could in fact die or suffer a severe reaction to foods. Believe it or not, the government has done a nice job with information pertaining to public safety, in this case, food allergy in schools. In case you think I’m kidding about the severity of food allergy, the YouTube link below should change your mind. The second link from the CDC is the “official word” on food allergy in schools.
With allergies, comes decision-making; should I eat this, should I go there, should I risk it? You need to remember to always do what is right for you! You know what situations may be dangerous for you and need to do what is best for your health and safety.
With the holidays quickly approaching, potlucks are upon us. Trusting other people with food allergies can often be a tricky thing to do. Last year I had a negative experience with a school potluck that is making me reconsider my decision to attend this year. Everyone was informed of the allergens that were not to be brought to the potluck, but people forgot and they were present. I was not comfortable eating any of the food and left the room, as there was food on most surfaces.
It was upsetting as I had been looking forward to the Christmas party and…
This question comes up in my office almost everyday….should I do skin testing or blood work? As you can see from the response of national experts, it depends. There is NO test that can boast 100% accuracy to predict whether or not you will react to a food. In fact, the gold standard if you will, is still the oral food challenge. Here is some food for thought (really, do you have to pun)
Clinical history is very important in determining food allergy. If you can eat a food without difficulty breathing, rash, or hives, you are most likely not allergic. You may have a positive test, but that only means you’ve had previous exposure to the food.
I will often obtain both skin testing and ImmunoCap (blood work) to clarify the presence of IgE-mediated allergy. If both tests are negative, you may have an adverse reaction to a food, not the severe life-threatening anaphylaxis. Very important distinction!
If in doubt, a food challenge is always a procedure to consider. Here’s why.
Sometimes the food in question just isn’t worth the trouble to challenge. No one says you have to eat strawberries!
If you challenge peanutsfor example, in the doctor’s office and experience anaphylaxis, better there than at home. Epinephrine is more readily available and in many cases, IV access and full resuscitation is available within minutes of your reaction.
This is another reason why a single test or treating allergy without experience is not a good idea. Read the link below and tell me just how complicated things can become!
An apple a day might keep the doctor away, but what is modern hospital medicine really like? Follow Dr. Benjamin Kirkland - a Doctor working in Australia - through the pinnacles and pitfalls of everyday hospital medicine!