Ok, another study about the dangers of food allergy (yesterday in USA Today). You would think the occurrence of food allergy to KNOWN allergens (peanut & milk) would decrease given all the attention given to accidental ingestion. Evidently, this is not the case. Explanations? Maybe we’re afraid of giving epinephrine. In my personal experience, giving epinephrine is analogous to “waving the white flag.” It doesn’t have to be nor should it be when treating children with suspected food allergy. As I tell my nurses, “give the epi, then call the doctor!”
Think you can be allergic to your spouse? Just this week in the clinic, a middle-aged woman presents with a rash found only when she wears her wedding ring. No other jewellery gives her problems except for the ring when worn > 2-3 days. Although nickel allergy can cause this scenario, this woman probably has occlusion dermatitis or “wedding ring allergy.” Any accumulation of soap and water underneath the ring will cause this type of dermatitis in sensitive individuals. Want to learn more?
Insurance is now a part of our lives, especially health care providers. Expensive medications such as omalizumab (Xolair™) are rarely approved for use unless patients and physicians complete an extensive application for benefits. Here is a list of medical articles that support the use of Omalizumab in the treatment of asthma:
1. Storms, W, et al. Omalizumab and asthma control in patients with moderate-to-severe allergic asthma: A 6-year pragmatic data review. Allergy and Asthma Proceedings 2012 33:172-177.
- Proven fewer symptoms of asthma
- Less need for rescue medication
- Burst of steroids decreased from 5.1 to 1.1 in the 12 months of the study
- ACT scores improved by 58% in the first year
- Fewer hospitalizations
What other medication do we have available that produces these results without the use of oral steroids? But don’t take it from me, see for yourself.
My transcriptionists are not only good at what they do, but when they hear me talk as much as I do, it’s almost family.
I am reading a book called, Don’t Kill the Birthday Girl by Sandra Beasley, and I thought of you.
- It’s a memoir about the author’s life with food allergies, what it was like growing up with allergies, etc. She has a variety of food allergies along with environmental allergies.
- It’s not very long but it seemed like a book parents who have kids with allergies or individuals suffering from allergies in general would really be able to relate to. Good advice Stephanie!
- The author is really honest about what it’s like living with allergies but she’s humorous about it at the same time.
- The one thing that shocked me is that when the author was a teenager she thought about overdosing on Benadryl because she was tired of living with allergies. Don’t kid yourself, the quality of life in patients with allergy isn’t very good….much worse than heart disease or even diabetes.
- I think this book could help people with allergies, so they don’t feel alone. I don’t feel alone but I know I’m the only one in my family with allergies and none of them get what an allergic reaction is really like so I’m really enjoying this book.
Stephanie, thanks for the suggestion and I’m sure many of our readers will also enjoy the book. You’ll have to ask her permission to “friend”, but here’s her link—>profile.php?id=1192230038&sk=photos
Here’s the link from Amazon about further information on the book: Book on Allergies from Amazon
The Academy website is www.aaaai.org. Over 6,000+ attendees from all over the world to present the most recent advances in allergy and asthma. Yours truly even has an abstract on the correlation between BMI and FEV1. Yes I know, if you understood that we might all be in trouble!
Monday, I’ll start with a case report on a teenager that can’t swallow….are you sure you have the right specialty? How does this have anything to do with allergy/asthma? Stay tuned.
Sublingual and Oral Immunotherapy Shows Promise for Milk Allergy
I’ll summarize the most recent advances in treating milk allergy from the article below. Why is our current therapy not enough? Guess what happens when a patient allergic to milk suffers from accidental ingestion? Anaphylaxis! Why not cure the disease–Johns Hopkins is a long way from Oklahoma, but patients have access to this same research here in the Midwest.
NEW YORK (Reuters Health) Jan 02 – Sublingual and oral immunotherapy may help some children with milk allergy, but clinical desensitization is quickly lost and systemic reactions occur with oral therapy, a new study shows.
“We found that both sublingual and oral immunotherapy benefited children with cow’s milk allergy in that they were able to consume much more milk without symptoms at the end of the study than they could at the beginning of the study,” said Dr. Corinne A. Keet from Johns Hopkins University School of Medicine in Baltimore.
“However, oral immunotherapy, which used higher doses, was more effective,” she told Reuters Health by email.
The new findings appeared online November 30 in the Journal of Allergy and Clinical Immunology.
All children started out on sublingual therapy, with dose escalation over six weeks. Then they were randomized to either sublingual maintenance therapy (goal dose, 7 mg) or one of two doses of oral maintenance therapy (goal dose, 1 g and 2 g). The maintenance periods lasted 60 weeks each.
“One result that surprised us was how quickly children could lose desensitization,” Dr. Keet said. “This is another reason for caution with these methods.”
“These methods are far from perfect, and I think are not ready for general use in allergy practices,” Dr. Keet concluded. “They show a lot of promise, but many aspects, including both safety and efficacy, need to be improved before widespread adoption of this method.”
“One alternative which is getting more attention recently is to use milk in baked goods to desensitize,” Dr. Keet added. “For some children, this is a good option, but some children are unable to tolerate even the small amounts of milk in baked goods needed to start desensitization. So, for many children with milk allergy there aren’t any good alternatives.”
J Allergy Clin Immunol 2011.
Here’s what you need to know:
1. DON’T try this at home
2. Milk allergy may be a “curable” disease, but we don’t know how long patients will have to ingest milk to become “desensitized”.
3. If you’re interested in participating in a clinical research trial here in the Midwest on milk allergy, please let me know.
So how much can we hear about food allergy? As unfortunate as it is to have a severe food allergy, what bothers patients most is lack of reliable information about their condition and the lack of concern about a potentially fatal reaction. Just look on Facebook to find hundreds of stories about the tragedy of food allergy or anaphylaxis. Here’s an example of the anxiety that results from a child with food allergy—>
If you’re going to treat food allergy, you have to know it’s there–duh. But not so fast….most kids never get the appropriate food challenges to make the diagnosis. Consider this:
- Oral food challenges are the gold standard for diagnosing food allergies in children, but only a small fraction of kids in the United States are getting them.
- At the American College of Allergy, Asthma & Immunology 2011 Annual Scientific Meeting Dr. Gupta reported from her study that oral food challenge was done in just 15.6% of children that really needed the test.
- As a result, it is likely that childhood food allergy is seriously underdiagnosed
“Food allergy guidelines just came out in March of this year from the National Institutes of Health NIAID [National Institute of Allergy and Infectious Diseases] stating that oral food challenge is the proper test to diagnose food allergy, along with medical history and positive skin and blood testing,” Dr. Gupta said.
In Dr Gupta’s study, only 47% had a skin test and 40% had a blood test for food allergy.
“Overall, what this tells us is that food allergy is not being diagnosed optimally and oral food challenges are definitely not being done enough,” she said.
What are your thoughts about food allergy? Have any readers experienced a “misdiagnosis” of food allergy? I’d love to hear from you!
Advances in allergic skin disease, anaphylaxis, and hypersensitivity reactions to foods, drugs, and insects in 2011. J Allergy Clin Immunol 2012;129:76-85
So what’s new in allergy to foods, drugs, and insects? I promise, I won’t bore you with basic science facts useful only for allergy boards, but here’s some facts for you to digest with the new year:
A US study estimates a food allergy emergency department visit every 3 minutes, on average. This is a very remarkable statistic for a condition that was “trivial” during my allergy fellowship training.
Food allergy health care costs are estimated at $500 million in 2007. Ditto the above–now you know why so much research is focused on a permanent cure for food allergy.
Severity of peanut allergy varies regionally, likely based on the source of sensitization (pollen related vs oral). Not only region variation, but also determined by culture. For instance, infants in Israel who are fed peanut early in life have less allergy than their European counterparts that withhold peanut until age 2 or 3.
Vitamin D deficiency is associated with increased risk for food sensitization (peanut). Is there anything that Vitamin D doesn’t do? Cod liver oil, here we come!
- Freezing fresh fruits for prick-prick testing does not result in a significant loss of potency. Who cares? Well, your doctor may want to test you by pricking a fresh fruit (say peaches) and then testing your skin. Don’t worry about how you’re going to get the fruit to the appointment….just freeze it for later.
Clinical studies of peanut oral and sublingual immunotherapy show promise. Why not eat small amounts of peanut and develop tolerance to it? It works and several studies are beginning in 2012 to find out more information about safety and who are the best candidates for this procedure. Want to be involved in this type of study? Call me for details.
Several studies support the use of Xolair™ for not only asthma, but also food allergy: Milk and peanut to name two. This treatment may also be useful for chronic urticaria refractory to antihistamines–>hives.
During a safety study of a food allergy herbal formula based on traditional Chinese medicine, a trend toward modulation of basophil responses was observed. This means some science exists behind the nutritional and herbal medicine “craze.”
New insights into the use of vitamin D, phototherapy, methotrexate, azathioprine, and immunoadsorption in treating severe AD were shown.
Several studies support the notion that egg content of seasonal influenza vaccines is low, that skin testing is not necessary, and that the vaccine can be safely administered to persons with egg allergy!! See my previous post on egg allergy and Flu vaccine.
A Canadian study shows only 55% with diagnosed food allergy had selfinjectable epinephrine. Folks, this is a life-threatening reaction and only 55% had the lifesaving treatment on hand?
A clinical study of children with delayed urticarial and maculopapular rashes shows a low recurrence rate and efficacy of drug rechallenge. If you’re faced with a rash occurring 4-6 hours after taking a medication, you probably won’t react with the second exposure
Is this enough to absorb in one day? Happy New Year!
At the bottom of this handout from the American Academy of Allergy, Asthma, and Immunology, you’ll find the table that should help you determine if you have a cold or allergies….call me if questions.