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 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:
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
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
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.
Food allergy is a very common and even popular disease to have. This results in some predictable patient behavior such as:
1. I have allergy based on a blood test only, and I tolerate this food all the time. This may not be allergy at all, but simply a condition called “asymptomatic hypersensitivity”. Relax, some foods you can eat without allergy symptoms even though a blood or skin test is positive.
2. It is fashionable nowadays to have gluten sensitivity. Many patients will perform gluten challenges at home to see if bread or starches make abdominal cramping, skin rashes, or even concentration problems improve or worsen with the offending food. This practice becomes a problem if you are concerned with anaphylaxis (difficulty breathing, low blood pressure) to foods such as peanut, milk, or eggs to name a few. It’s one thing to experience more abdominal bloating after a gluten challenge and a much more dangerous situation to lose consciousness after ingesting peanut.
3. I’m grateful to be a member of the American Academy of Allergy, Asthma, and Immunology (AAAAI) in part because they help me as an allergist to stay current of all the thousands of recommendations published every year on my specialty. One such service is “Ask the Expert” forum and I’d like to share a recent post with you about food challenges.
Here’s the take-home message and the full answer is available if you click on the link below:
1. Food anaphylaxis can be related to the total amount of food ingested. In other words, don’t assume that tolerating a very small amount of peanut will guarantee that you can tolerate peanuts ad lib! Food challenges are performed under close supervision in order to determine HOW sensitive you are.
2. Oral desensitization to foods is still in the research stage and the experts on treating food allergy do not recommend this procedure be performed outside of a research protocol. It only takes one bad outcome to taint any progress made with treatment of food anaphylaxis.
Anyway, it’s lunchtime, and talking about food does make me hungry!
Pork-cat syndrome a rare (but real!) allergy
Allergic to cats? Then beware of pigs — or at least, the meat that comes from these sty-dwelling swine. A small number of people who are sensitive to felines may also get allergic reactions to eating pork. Continue reading
I always enjoy National Medical Meetings….good food, meeting old friends, and yes, even learning something! The College of Allergy annual meeting was held in California just one week ago……and what are the hot topics this year?
Here’s an article and interview from Medscape about this year’s meeting. Why am I interested? Dr. Portnoy was my mentor (professor) during my fellowship training in allergy. Way to go Jay!
Here’s what he had to say–This international food allergy conference features the latest on eosinophilic esophagitis, unusual and “off the beaten track” food allergies, spice allergies, and developments in food immunotherapy.
“Food allergy is always something that people are interested in,” Jay Portnoy, MD, professor of pediatrics at the University of Missouri, Kansas City, and Mercy Children’s Hospital, told Medscape Medical News.
Dr. Portnoy, who chaired this year’s abstract committee, highlighted a few of the presentations on food allergy that he considers particularly noteworthy.
“Researchers at Northwestern University in Chicago have found that kids with egg and milk allergy are more likely to outgrow those allergies than if they have tree nut or shellfish allergy. So when the doctor says your child will probably outgrow their egg or milk allergy, they’re not too far off,” he said.
Another study examines how people who are allergic to hen eggs might be able to tolerate them when they are baked. “It turns out that baking the egg actually denatures or neutralizes the allergen, more so than if you just partially cook it. If you introduce cakes and cookies into your diet, you will be able to most likely broaden your diet and improve the quality of your life,” he said.
One presentation of definite note is on a newly identified and possibly life-threatening allergic reaction to mammalian meat. Researchers have determined that the lone star tick is the primary reason for meat-induced alpha-gal allergic reactions.
“This new food allergy, alpha-gal, is more common than we thought. There is a high prevalence in some areas of the country, particularly in the central and southern regions of the United States,” Dr. Portnoy explained.
Alpha-gal is a sugar found in red meats such as beef, pork, and lamb. In the study to be presented, positive alpha-gal rates were 32% higher in areas with a lone star tick population than in other areas of the United States.
Symptoms of alpha-gal allergic reactions range from mild hives to potentially life-threatening anaphylaxis.
“The reaction is delayed. A lot of people have experienced this, and now we know what it is. This is why it is so important to come to the annual meeting and learn about these unusual allergic reactions,” he said.
The topic of spice allergies is also on the meeting agenda.
According to a statement issued by the ACAAI, spices are one of the most widely used products, and are found in foods, cosmetics, and dental products. The US Food and Drug Administration does not regulate spices, which means that they are often not noted on food labels.
As a result, they are one of the most difficult allergens to identify and avoid.
“While spice allergy seems to be rare, with the constantly increasing use of spices in the American diet and a variety of cosmetics, we anticipate that more and more Americans will develop this allergy,” said Sami Bahna, MD, DrPH, from the Louisiana State University Health Sciences Center in Shreveport.
“Food allergy is a very important topic for allergists because we need to understand the most current research; recently, the field has seen a lot of changes,” ACAAI President Stanley Fineman, MD, from the Atlanta Allergy and Asthma Clinic in Georgia, told Medscape Medical News.
“There is a lot of new understanding about food allergies, new diagnostic tools, and some potential treatments,” he said. “This is the place to find out the latest information; when you go back to your practice, you [will] be on the cutting edge.”
Back by popular demand is the annual literature review course, where experts present what they feel are the key articles of the year on topics such as immunology, allergic rhinitis, ocular allergies, and immunology. “We have almost 500 people already registered for this program. Some people look forward to this program all year long to catch up on the literature. It’s a very popular feature of the meeting,” Dr. Fineman said.
The slogan for this year’s meeting is “Over the Horizon: Expanding Expertise,” which captures the essence of what the conference is about, he noted.
“The program committee selected this theme to help us see what is going on in the future, to expand our expertise, to make sure that we are able to keep current, and to hone our skills so we can adapt to any changes in healthcare and any new research involved with treating our patients,” Dr. Fineman explained.
“Most allergists go to the meeting to find out what’s new in allergy, to keep their skills up, to interact with colleagues, and to validate what they do. Because, like most allergists and most physicians, if you are in practice and you don’t interact with other physicians, you can start to develop quirky styles of practice that may not be the best practices. It’s really a good idea to touch base with colleagues, interact, and hone your skills,” Dr. Portnoy added.
“At this meeting, allergists will hear about an unusual case and then remember a patient who had the same thing. That’s how advances in our field are made,” he said.
I could say it better. With all the controversy swirling around health care reform, it’s refreshing to learn about what really matters for taking care of patients….that’s why I keep going to work every day!
Schools are quite paranoid about giving any medication on their watch. The liability for giving sunscreen when you don’t need it? Zero. This is very similar to the use of epinephrine in a school aged child with food allergy. You certainly don’t want to withhold epi and risk anaphylaxis or death, when the risk of giving the EpiPen is negligible even if you don’t need the drug. Maybe our policies in schools will change after a large malpractice case gets media attention for NOT giving epinephrine at the appropriate time for peanut allergy.
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!”