The year in review (2011)

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.

 Treatment Strategies:

  • 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!

 

#allergen, #allergies, #allergy, #conditions-and-diseases, #food, #food-allergy, #health, #national-jewish-health

Cold, Flu, or Allergy–Take the challenge!

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.

#allergies, #allergy, #american-academy-of-allergy, #american-academy-of-allergy-asthma-and-immunology, #asthma, #conditions-and-diseases, #health, #immunology

Allergic to Antihistamines—really!

 

This is from Gary Stadtmauer, MD’s blog. 

How many times have we heard patients say they are “allergic” to drugs like antihistamines and corticosteroids?  Hypersenstivities to medications used to treat allergic diseases are fortunately uncommon. 

This is Dr. Stadtmauer’s experience with “allergy” to Benadryl….check the references below–it’s legit! 

“I have seen a couple of cases of drug exanthem from antihistamines but never immediate hypersensitivity…until now.  I recently saw a young woman who has had recurrent urticaria/angioedema of immediate onset due to Benadryl.  She had no associated symptoms.  Scratch testing to Benadryl 5mg/ml was negative but ID was positive at 0.5 mg/ml (W/F of 4/10) and 5 mg/ml (W/F o 5/10).  See image below.

One could question whether this is an IgE-mediated event.  Perhaps it is or perhaps in the occasional patient the antihistamine acts as an agonist, binding to the receptor instead of blocking it thereby triggering histamine release.  Anaphylactic shock caused by a challenge with 12.5 mg oral diphenhydramine has been reported and the authors of this case suggest the mechanism was IgE-mediated.

Benadryl Skin TestSo what?  Never say never when a patient comes in with a bizarre drug allergy or states that are allergic to Benadryl….you might be surprised!

Citations re:  Antihistamine Allergy
1. Barranco P, López-Serrano MC, Moreno-Ancillo A. Anaphylactic
reaction due to diphenhydramine. Allergy. 1998; 53: 814.
2. Weidinger S, Mempel M, Ollert M, Elser I, Rakoski J, Köhn FM,
Ring J. Anaphylaxis to mizolastine. J Allergy Clin Immunol.
2004; 114:979-81.
3. Rodríguez del Río P, González-Gutierrez ML, Sánchez-López J,
Núñez-Acevedo B, Bartolomé Álvarez JM, Martínez-Cócera C.
Urticaria caused by antihistamines: report of 5 cases. J Investig
Allergol Clin Immunol. 2009; 19 (4): 317-20.
4. Gonzalo-Garijo MA, Jiménez-Ferrera G, Bobadilla-González P,
Cordobés-Durán C. Hypersensitivity reaction to mizolastine:
study of cross reactions. J Investig Allergol Clin Immunol. 2006;
16 (6): 391-3.
5. Demoly P, Messaad D, Benahmed S, Sahla H, Bousquet J.
Hypersensitivity to H1-antihistamines. Allergy. 2000; 55: 679-80.
6. Aberer W, Bircher A, Romano A, Blanca M, Campi P, Fernandez
J, Brockow K, Pichler WJ, Demoly P for EDNA and the EAACI
interest group on drug hypersentitivity. Drug provocation
testing in the diagnosis of drug hypersensitivity reactions:
general considerations. Allergy. 2003; 58: 854-63.

#allergies, #allergy, #anaphylaxis, #benadryl, #drug-allergy-2, #histamine-antagonist, #immunoglobulin-e, #the-journal-of-allergy-and-clinical-immunology

The Holidays are Here–How about Allergy?

HoHoHo!  It’s Christmas time.  Holiday safety is especially important for patients with allergies. 

Regardless of whether you have asthma or food allergy, here is a great handout from the AAAAI about “Handling the Holidays!” Feel free to use this handout in your practice!

Allergy to Christmas….really? 

How about those Thanksgiving dinners? Any risk for allergy?

Enjoy and eat some for me.

#allergies, #allergy, #conditions-and-diseases, #food, #food-allergy, #health, #holiday, #thanksgiving