The Online Allergist

Swimming Pool Allergy

Every allergist has heard patients say that their allergies become worse at the swimming pool.  We usually respond that one cannot be allergic to the environs of the swimming pool, but not so fast.  Recent evidence has shown that chlorinated pool exposure interacts with one’s allergic predisposition to potentially increase the nasal congestion, runny nose and sneezing of allergic rhinitis, and the coughing and wheezing of asthma.

Swimming pools are commonly disinfected through chlorination of the water. Chlorine, when added to the water, releases hypochlorous acid, the active ingredient which oxidizes and inactivates a wide variety of waterborne pathogens. While advantageous in eliminated bacteria in the water, this chemical, especially in high concentrations, can at the same time be an irritant to the skin, eyes, nose, throat, and lungs.

It has been observed that swimmers have a higher prevalence of respiratory symptoms than other athletes. Researchers suggest that these respiratory issues may, in part, be the result of the repeated and frequent exposure to the chlorine used to disinfect the pool water. Recent studies have also documented a higher incidence of respiratory symptoms including allergic rhinitis and asthma in allergic children, suggesting an exacerbating or additive effect. So, the evidence is mounting that chlorine exposure in and around the pool can indeed make susceptible individuals more symptomatic.

Swimming is a wonderful activity, especially during these very hot summer days. TheOnlineAllergist recommends that those with allergies and asthma swim in outdoor pools and in pools where the chlorine levels are continuously monitored. Have fun, but be careful out there.

Volcanic Ash and Asthma - 10 Steps To Protect Yourself

It is hard to believe, but the Eyjafjallajokull Volcano in Iceland is still erupting. Tons and tons of volcanic ash are being released daily into the atmosphere and it is being carried by the wind across the Atlantic, threatening not only air travel for Europeans, but posing potential health hazard for those with respiratory diseases including asthma, emphysema or bronchitis.

Even though the majority of ash is at least 10,000 feet high in the atmosphere, significant quantities of ash and dust eventually falls to earth. This volcanic ash is composed of fine particles of fragmented volcanic rock. According to the World Health Organization (WHO), it is the ‘fine particulate matter’ measuring less than 10 microns that has the potential to create respiratory symptoms. The WHO estimates that about 25% of the particles are less than 10 microns in size, which would mean that people with asthma, emphysema or bronchitis may be susceptible to irritation if and when these minute ash particles are inhaled.

The WHO says in a statement that the plume itself does not pose a health threat as long as the ash particles remain in the upper atmosphere. “However, when it reaches ground level, and if it is in high concentration, the ash may cause health effects - but these are likely to be minimal.” it adds.

Respiratory symptoms from the inhalation of volcanic ash depend on a number of factors. These include airborne concentration of total suspended particles, proportion of small, breathable particles in the ash, frequency and duration of exposure, presence of free crystalline silica and volcanic gases or aerosols mixed with the ash, meteorological conditions, preexisting health conditions, and the use of respiratory protective equipment.

Acute respiratory symptoms upon inhalation of volcanic ash may include:

  -  nasal irritation and discharge

  -  throat irritation and sore throat

  -  dry coughing

  -  bronchitis symptoms, including cough, increased sputum production, wheezing, or shortness of breath

  -  airway irritation of people with asthma or bronchitis with subsequent shortness of breath, wheezing, and coughing

  -  difficulty breathing

These short-term effects are not considered harmful for people without existing respiratory conditions, however these symptoms can be quite severe in those with asthma, chronic bronchitis, emphysema, or other preexisting lung conditions.

The American Lung Association has published the following guidelines for those potentially exposed to volcanic ash or dust:

  10.  Close doors, windows and dampers. Place damp towels at door thresholds and other draft sources; tape drafty windows.

While these suggestions are intended especially for persons suffering from respiratory conditions (asthma, emphysema, bronchitis), they are also useful for normally healthy people during episodes of volcanic haze.

New Breakthrough for Severe Asthma: But, Don’t Get Too Excited

The FDA has approved the first medical device that uses radio-frequency energy for the treatment of severe persistent asthma in 18-year-olds and older.

All patients with severe persistent asthma share one thing:  the common finding of inflammation and swelling of the lining of the bronchial tubes. The subsequent reduction in the diameter of the breathing tubes leads to difficulty breathing and shortness of breath that is experienced with asthma.

This new device, called the Alair Bronchial Thermoplasty System, treats asthma symptoms by using radio-frequency energy to heat the lung tissue in a controlled manner.This attempts to reduce the thickness of the airway mucosa and the surrounding smooth muscle. To benefit from this treatment, patients require multiple sessions targeting different areas in the lungs. The device is composed of a catheter with an electrode tip that delivers a controlled amount of radiofrequency energy, directly to the airways. A controller unit, operated by the physician, generates and controls the energy.

The FDA based its approval on data from a clinical trial of 297 patients with severe and persistent asthma. The trial showed a reduction of severe asthma attacks in those treated with the device. The FDA is requiring a five-year post-approval study of the device to study its long-term safety and effectiveness.

It should be noted that this procedure, like all medical procedures, is not without risks. And, it will not be appropriate therapy for all severe asthmatics. This is a very exciting breakthrough in the treatment of refractory and severe asthma, but much more study and research is needed before allergists and pulmonologists will be referring their patients for this procedure.

Sesame Allergy: This seed packs a powerful punch!

The sesame seed, tiny in size, represents a growing danger as a food that can cause severe allergic reactions.  Sesame is in a family of seeds that also includes poppy seed, flax seed, sunflower seed, buckwheat, mustard, and pine nut. In the entire family of seeds however, sesame causes majority of allergic reactions. And, the incidence of sesame allergy is on the rise.  This is likely due to the increase in popularity in the use of seeds, especially sesame, in the Mediterranean diet.

Sesame allergy shares many similar properties to peanuts and tree nuts in terms of its clinical allergy symptoms, severity, and persistence in symptoms.  Despite these similar characteristics, sesame is not considered one of the “big 8” food allergens, although it is now the second most common food allergen in Israel. Sesame allergy often presents by age two, but this is highly variable and is influenced by countries that feed their young a sesame rich diet.

Sesame is associated with life-threatening anaphylaxis in susceptible individuals.  Again, this is very similar to tree nut and peanut allergy, and sesame sensitive individuals are recommended to avoid any amount of contact, even one tiny seed.

Four Myths About Dust Mites

Myth # 1: Air purifiers can trap and kill dust mites - A number of air purifier companies have gone on record saying that HEPA room air cleaners are effective at catching and trapping dust mites. The truth is that dust mites do not fly and are unlikely to even come into contact with a HEPA air cleaner. Even their allergenic waste particles are largely unaffected by HEPA air cleaners, because even when they become temporarily airborne, they settle back down quickly. Although these air cleaners are minimally effective against dust mites, they can play a very important role in eliminating other allergens like mold, pollen and animal dander from our homes. On the other hand, mattress encasings and pillow encasings can create an important barrier between you or your child and dust mite allergens, thereby removing a major source of exposure.

Myth # 2: Dust mites live in air ducts - This untruth is sometimes perpetuated by companies that want to sell you their duct cleaning service. A small amount of dust mite allergen that becomes airborne could settle in your ductwork, but ducts are far from the humid, fibrous environments where the dust mites live and produce their allergenic waste.

Myth # 3: Dust mites bite - Dust mites are far too small to bite humans, but skin reactions to dust mite allergen may be the cause of this myth. Dust mite waste and other allergens can trigger a skin reaction known as eczema or atopic dermatitis.

Myth # 4: Dust mites live in all dust - You will not find live dust mites living in the dust on your bookshelf or in that dust “bunny” that skitters across your hard surface floor. Nor will you find dust mites in outdoor dust. They just cannot survive on the surface of things; they need to burrow deep into bedding, carpeting and upholstery, making these environments the perfect homes for dust mites.

Is one Epipen enough? Be prepared!

A recent study assessing emergency room records confirms the fact that a significant number of patients with anaphylactic reactions to food needed more than one injection of epinephrine. The data from this study revealed that 16% of patients presenting with food induced anaphylaxis required two injections.  Previous data showed that as many as 25% of reactions required multiple doses.  Multiple doses of epinephrine appeared to be more likely in those with reactions to peanuts and tree nuts and those presenting with hypotension (low blood pressure).

Additionally, many patients, even after observing a demonstration on the proper use of an auto-injector, are not able to use it properly, especially in an emergency situation. Please watch The Online Allergist’s video presentations on How to use an Epipen and insist that all members of the family watch the video and know how to use this device as well.

The message is clear: Those with a history of anaphylaxis and those highly allergic to foods, medicines, or insect stings should be prepared to treat anaphylaxis with multiple injections of epinephrine until medical assistance arrives. One injection may not be enough!

Help!  Seasonal Allergies Are Here!

With spring here, many children and adults will soon begin to have allergy symptoms due to exposure to tree and grass pollens. We all know people who suffer from allergic rhinitis, or “hay fever”. You can spot them from across the room - tissue in hand, sneezing, sniffling, blowing their nose, tearing, and rubbing their eyes and nose. If fortunate, these symptoms are but a minor inconvenience, but, if severe, they can significantly severely affect one’s quality of life.

Symptoms

Symptoms of allergic rhinitis are usually acute or intermittent, presenting only when one is exposed to the relevant allergen.  Seasonal allergic rhinitis, as its name implies, will manifest itself during the pollen seasons, most typically in the spring and fall.  Exposure to tree pollens is generally responsible for late winter and springtime symptoms and grass pollens are generally the cause of late springtime and early summer symptoms.  Flare ups in the fall are typically due to weed pollens and high mold spore exposure.  Symptoms of seasonal allergic rhinitis and allergic conjunctivitis can be quite intense, and can last for weeks to months, if not treated.

Diagnosis

Allergic rhinitis is actually one of the easiest diagnoses for an allergist to make. If the medical history suggests allergic rhinitis, an allergist will likely perform allergy testing in order to confirm the diagnosis, identify the offending allergen(s), and ascertain the severity of the allergy. The preferable and simplest testing method is skin testing. This method allows the testing of multiple allergens with the results being available immediately. Alternatively, similar results can be obtained through a blood test called RAST or ImmunoCap.

Treatment

Once the relevant allergens have been identified, an allergist will recommend a comprehensive treatment plan to eliminate the existing symptoms and hopefully reduce or prevent symptoms in the future.  Treatment options fall into three categories: environmental control, pharmacotherapy, and/or immunotherapy.  One, two, or all three of these options may be recommended, depending on multiple factors such as the severity and chronicity of symptoms, results of past treatment, and the effect that the symptoms have on one’s quality of life.

Theoretically,  environmental control is quite simple: one needs to minimize exposure to all relevant allergens.  As simple as this is conceptually, it may be quite difficult, if not impossible, to implement in many cases.  This is especially true when one is exposed to pollen, as these pollens are light and microscopic, traveling for tens to hundreds of miles in a gentle breeze.  Once the pollinating season starts, it is virtually impossible to avoid exposure to airborne pollen while outdoors.  If possible, one should stay indoors with air conditioning on high pollen days and the windows should remain closed.  It may also be helpful to wear a mask when outdoors for long periods of time.

In the arena of pharmacotherapy, there are many medicines available which are quite safe and effective in minimizing or eliminating the symptoms of seasonal allergic rhinitis.  These generally fall into the categories of antihistamines, steroid nasal sprays, and other non-steroidal blockers of inflammation.  Your allergist can recommend the best ones for you, and you can find money-saving coupons for many of them here.

As important as environmental control and pharmacotherapy are, neither of these approaches can offer a “cure” for the cause of the problem, e.g.,the immune system’s over-response to things (allergens) that it should be able to tolerate without inducing symptoms. The third treatment option, immunotherapy, or desensitization, is the only treatment option that addresses the actual cause of the immune system’s abnormal over-response.

For those who suffer from seasonal allergies, help is available from a board certified allergist in your area. And, The Online Allergist stands ready to provide you with more information on seasonal allergies and many other allergy and asthma related subjects.

Milk and Phlegm: A Relationship?

There is a wide-spread and accepted notion that there is a cause and effect relationship between the ingestion of milk and increased phlegm production.  But, the truth is that there is absolutely no scientific evidence to support such a claim.  And, there is no truth to the notion that milk makes asthma worse, unless one is truly allergic to milk protein.

Yet, despite the lack of evidence, many people claim such a relationship, especially during an upper respiratory virus or when they are having allergy symptoms.  This claim is so pervasive that many physicians recommend stopping milk during these episodes.  Even though such anecdotal evidence does not stand up to the scrutiny of scientific trials, The Online Allergist does not rule out the possibility that there is a subset of susceptible individuals who may indeed have increased mucus production when exposed to milk.  This is clearly not an allergic reaction, but other immunologic or contact responses may be operative.  There is even a recent article that suggests that some milk from certain breeds of cows contains a protein that causes the mucus glands of the gastrointestinal tract to over-react on contact.

Fact or old wives’ tale?  It is difficult to say.  Regardless, if you are one who believes that milk increases the amount or thickness of phlegm during an upper respiratory infection or allergies, there is certainly no harm in stopping milk during that episode.

Parents: Stop poisoning your children!

Exposure to tobacco smoke has long been known to cause illness in children.  Widespread educational programs and public awareness campaigns have identified passive exposure to second-hand cigarette smoke as a major health risk.  Yet, despite this, children unfortunately continue to be exposed in great numbers, and the greatest source of exposure is in the home.  Alarmingly, one quarter of all children in the U.S. live in a home with at least one smoker.

Exposure levels are not theoretical, as exposure and its degree can now be objectively measured. One can detect the presence of cotinine, a nicotine metabolite, in the blood, urine, saliva, and hair of those individuals exposed to passive smoke. In a recent study of children 3-10 years of age in Rochester, N.Y., mean cotinine levels were significantly higher in children whose parents smoked (2.82 ng/ml) compared with those children who live with non-smoking parents (0.72 ng/ml).  And interestingly, measured exposure to cigarette smoke was higher in children whose mother smoked, compared to other members of the family.

The medical community is very aware of the harmful effects of passive exposure to cigarette smoke. Allergists and pediatric pulmonologists can attest to the deleterious effects of exposure in young children. They clearly recognize the increased frequency and severity of respiratory illnesses. Children with asthma or reactive airways are especially susceptible. There is evidence that smoke exposure can temporarily paralyze the hair-like structures called cilia which line the respiratory tract.  Well functioning cilia are a critical defense mechanism in promoting the movement of mucous and ridding the body of foreign respiratory pathogens, allergens and irritants. Dysfunctional or paralyzed cilia can lead to respiratory infections including pneumonia, bronchitis, sinusitis, and recurrent ear infections in children.

We must all do more to discourage cigarette smoking in teenagers and adults, and we must do a better job in educating the public about this preventable health crisis. Parents must stop turning a blind eye to the fact that they are poisoning their children.

Be careful with antihistamines!

For many years, physicians have recommended first generation H1-antihistamines to patients suffering from allergic reactions and itching.  These antihistamines, long recognized for their effectiveness in treating allergies, and available over-the-counter, include diphenhydramine (Benadryl), chlorpheniramine (Chlor-Trimeton, Piriton, Chlor-Tripolon, HISTA-12), clemastine (Allerhist-1, Contac 12-Hour Allergy, Dailyhist-1, Tavist, Vistamine), hydroxyzine (Vistaril, Atarax), or triprolidine (Actidil, Myidil, Actifed).

Despite their effectiveness, there has always been a drawback.  First generation H1-antihistamines are well known to cause drowsiness and sedation.  Studies have shown them to be associated with impaired learning, reduced work efficiency, and they have been implicated in car, boat, and aircraft accidents. They have also been responsible for deaths due to intentional as well as accidental overdosing.

A Global Allergy and Asthma European Network (GA2LEN) task force recently performed a large scale review of accidents and fatal adverse events which occurred in the United States from 1996-2008 in which these first generation H1-antihistamines were implicated. Their goal was to enhance consumer protection by highlighting the potential dangers of the indiscriminate use of first-generation H1-antihistamines purchased over-the counter in the absence of appropriate medical supervision. The task force recommended that older first-generation H1-antihistamines no longer be available over-the-counter for self-medication of allergies and other diseases.

Newer and safer antihistamines including Claritin, Clarinex, Zyrtec, and Xyzal (click for coupons) are now available at competitive prices.  These new antihistamines are just as effective in treating allergy symptoms as their predecessors, without the harmful and dangerous side effects, at least at normal dosage levels.  Some are available over-the-counter, while others are available only with a prescription.  The Online Allergist recommends that one consult their primary care physician or allergist about which antihistamine would be optimal, especially now at the onset to the spring allergy season.

MSG: It is not an Allergy!

Monosodium Glutamate, or MSG, is a white crystalline powder commonly used as a food additive for its unique flavor enhancing qualities. MSG is the sodium salt of the natural occurring non-essential amino acid called glutamic acid. It is manufactured through the fermentation of starch, sugar cane, sugar beets, or molasses.

Although once associated only with Chinese food, MSG is now widely used by fast food establishments and it is present in many foods such as soup bouillon cubes, barbecue sauces, salad dressings, flavored chips, canned, frozen, and dry prepared foods, processed meats, as well as seasoning mixes. Fermented products such as soy sauce, steak sauce, and Worcestershire sauce contain high levels of glutamate similar to foods with added MSG.  It is available commercially under the trade names Accent, Ajinomoto, and Vetsin.

MSG has been reported to be responsible for a variety of symptoms including headaches, flushing, sweating, facial pressure or tightness, numbness, heart palpitations, chest pain, nausea, and weakness. These symptoms were initially characterized as the “Chinese Restaurant Syndrome”, but have subsequently been described as the “monosodium glutamate symptom complex”. Despite reports suggesting a cause and effect relationship, decades of research have failed to demonstrate a clear and consistent relationship between the ingestion of MSG and these symptoms. In addition, symptom characteristics do not support an IgE mediated or allergic mechanism. In short, we are not exactly sure how, why or when MSG may cause symptoms in certain people, and MSG is certainly not an allergy.  However, anecdotal reports continue to suggest that MSG can produce symptoms in susceptible individuals, especially headaches, muscle tightness, numbness and tingling.

Because of anecdotal reports of MSG related symptoms, the FDA requires that it be listed on processed food labels and has classified MSG as a food which is “generally recognized as safe”.

For more information about MSG, allergies to spices and other food additives, read our article Food Additives and Spice Allergy.

Food Allergies: Prevention and Treatment - Fascinating New Research

Ask anyone who was raising children 25 years ago if they ever heard of food allergies. The likely answer would be no. Yet today, who doesn’t know someone, if not several people, with severe food allergies? Allergists and pediatricians are observing first hand that the incidence of food allergies in infants and children has increased to “epidemic” proportions over the last few decades. 

The good news is that we are now beginning to understand how food allergies are developed.  But more importantly, new strategies are being recommended for food allergy prevention in the newborn and infant, and in the treatment of the severely food allergic individual.

Many theories have been presented to explain this disturbing trend. However, most research in the past has focused on breast feeding and its affect on the development of allergy. A close examination of the medical literature reveals that true scientific evidence about the timing of cows’ milk and solid food introduction into a child’s diet is scarce at best, and conflicting at worst. The time-honored and well established approach has been to delay the introduction of highly allergenic foods into the infant’s diet; solid foods until six months of age, cow’s milk until one year, eggs until two years, and peanuts, tree nuts and fish until three years. It is a generally accepted notion, although not necessarily valid, that breast feeding alone is the ideal diet for the first six months of life and that it can minimize or delay the onset of atopic dermatitis (eczema) and other allergic diseases, including asthma.

But, new medical evidence has shown that the recommendations to delay the introduction of foods to infants as a means of preventing food allergies may be the wrong approach altogether!

Recent studies have revealed very credible scientific evidence to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk for developing food allergies. And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food.

A landmark study published within the last year demonstrated that children in England were ten times more likely to be allergic to peanuts than children in Israel. One very strong hypothesis to explain this finding is the fact that most Israeli infants have been exposed to soft peanut snacks by six months of age. On the other hand, children in England are not introduced to peanuts in any form until approximately three years of age. This study is just one of many which strongly suggested that the decreased risk for the development of allergy by the early introduction of food is due to the induction of “oral tolerance”, i.e., the induction of a systemic immunologic hypo-responsiveness to a dietary protein.

Our entire approach to feeding newborns and infants may be “turned on its head” in the coming months to years. It is difficult to change one’s opinion and behavior about well accepted dogma; however, very exciting medical research may cause us to rethink the current approach which has resulted in an 18% increase in food allergies over the last 10 years.

There is also good reason to be very optimistic about the treatment of severe food allergies. Historically, the treatment of food allergies has consisted of avoiding exposure and ingestion of the allergenic food, and the immediate availability of antihistamines and epinephrine for the treatment of an allergic reaction. Avoidance of exposure is indeed difficult, as evidenced by the large number of accidental ingestions and allergic reactions with resulting emergency room visits. But even with strict avoidance measures, the potential for sudden and life-threatening reactions leads to extreme anxiety in both the allergic individual and his or her family. Fortunately, medical research has now proven that orally administered immunotherapy can result in a significant degree of desensitization, or tolerance, to a given food in most allergic patients.

Food Oral Immunotherapy is a process whereby a food allergic individual is given small amounts of the allergenic food daily and for long periods of time in order to induce a state of oral “tolerance”. It is often possible to increase the dose tolerated over time, leading to even greater protection. In the classic sense, this is not a cure. Rather, it is a method to desensitize the highly allergic individual to a given food in order to decrease, and sometimes eliminate, the likelihood of a severe allergic reaction upon ingestion. This method has been proven successful with milk, eggs, peanuts, and some tree nuts. But, do not try this at home! The desensitization process is associated with a small degree of risk and therefore should be performed only by an experienced allergist and in a controlled setting.

We are on the brink of some very exciting breakthroughs in both the prevention and treatment of food allergies. We are hopeful that one day soon, such treatment will significantly improve the quality of life for those individuals in whom avoidance of food either limits or controls their daily activities.

Can bleach remove mold and mildew?

There is now additional scientific evidence that the allergenic potential of environmental mold and mildew can be effectively eliminated by the use of common household bleach.

Investigators have found that the allergen epitopes (the part of the molecule that is recognized by the immune system, specifically allergy antibodies) that are present in the common outdoor and indoor mold spores Alternaria and Cladosporium are denatured when treated with sodium hypochlorite, the active ingredient in bleach. They also showed that treatment with hypochlorite was effective at concentrations commonly used for household cleaning.

Sodium hypochlorite solution is frequently used as a bleaching agent or disinfectant. Household bleach used in laundering clothes is sold as a 3-6 % solution of sodium hypochlorite. A 1 to 5 dilution of household bleach with water (1 part bleach and 4 parts water) is effective against many bacteria and some viruses, and is frequently used in hospitals as the disinfectant of choice, due to its effectiveness and relative low cost.

The Online Allergist recommends aggressive environmental control to minimize the exposure to allergenic mold spores. If mold and mildew can be seen in the home, particularly in damp, moist areas such as bathrooms, it should be treated aggressively with diluted bleach. Such treatment should also be done periodically to prevent the reemergence of the mold and mildew.

Into health food?  Watch out for lupine allergy

Lupines, or lupins, are common garden plants found commonly in South America, western North America, in the Mediterranean area, and in Africa. The seeds produced on the lupine plant are members of the legume family and therefore related to peanuts, soy, and peas.

In the last few years, lupine ingestion has been recognized as a cause of allergic reactions, including anaphylaxis. In the occupational setting, inhalation of lupine flour may also produce rhinitis and asthma symptoms. Cross-reactivity between foods in the legume family is rare, but several studies have demonstrated significant cross-reactivity between peanut and lupine.

Lupinus albus is the species most widely cultivated for food. In some Mediterranean countries, dried lupine is a traditional snack. In Europe, lupine is manufactured as a flour and bran, or is used as an additive to wheat flour. It is commonly used in the preparation breads, pasta, and other bakery products. Lupine is also used as an alternative to soy flour. It is said to boost protein and fiber in food. Lupine can be found in health food stores.

Although not a frequent cause of severe allergic reactions in the U.S., lupine does have the potential for mild or severe allergic reactions in susceptible individuals.

Preventing food allergies in babies and infants: Do we have it all wrong?

Allergists and primary care physicians, especially pediatricians, have observed first hand that the incidence of food allergies in infants and children has increased dramatically over the last few decades to “epidemic” proportions. Many theories have been presented to explain this disturbing trend; however most research in the past has focused on breast feeding and its affect on the development of allergy. A close examination of the medical literature reveals that true scientific evidence about the timing of solid food introduction is scarce at best, and conflicting at worst. The time-honored and well established approach has been to delay the introduction of highly allergenic foods into the infant’s diet; solid foods until six months of age, milk until 12 months, eggs until 2 years, and peanuts, tree nuts and fish until 3 years. It is a generally accepted notion, although not necessarily valid, that breast feeding alone is the ideal diet for the first six months of life and that it can minimize or delay the onset of atopic dermatitis (eczema) and other allergic diseases, including asthma.

But, new medical evidence has shown that the recommendations to delay the introduction of foods to infants as a means of preventing food allergies may the wrong approach altogether!

Recent studies have revealed very credible scientific evidence (and more is on the way) to suggest that the common practice of delaying the introduction of cow’s milk, eggs, peanuts, and other foods may actually increase the child’s risk for developing food allergies. And, even more importantly, there is evidence to suggest that the early introduction of allergenic foods may actually prevent the development of the allergy to that food. It is thought that the decreased risk for the development of allergy by the early introduction of food is due to the induction of “oral tolerance”, i.e., the induction of a systemic immunologic hypo-responsiveness to a dietary protein.

Our entire approach to feeding newborns and infants may be “turned on its head” in the coming months to years. It is difficult to change one’s opinion and behavior about well accepted dogma; however, very exciting medical research may cause us to rethink the current approach which has resulted in an 18% increase in food allergies over the last 10 years.

In the opinion of TheOnlineAllergist, we are on the brink of some very exciting breakthroughs in both the prevention and treatment of food allergies. Stay tuned for more encouraging news soon.

Help Prevent Allergy Attacks Using Your Iphone

With all of the technology at the grasp of your hands today, why not use it to help prevent allergic reactions?  Our friends over at the Pollen Blog have done just that.

The name of the Iphone App. is “Allergy Alert” by SDI Health LLC, and it’s a 4-in-one tool for those who suffer from Allergies.  Using you zip code information, this App. can be used to set up alerts, pull forecast information (pertaining to allergies, asthma, coughing, and ultraviolet rays), and give you allergy index levels.  Best of all it’s free!

To download this Iphone App. for free, either search for “Allergy Alert” on Itunes, or in the App. store on your Iphone.

Thanksgiving - The “Perfect (Asthma) Storm” is here!

Ask any allergist or pediatrician.  Or, hang around the emergency room of any pediatric hospital. From Halloween until Thanksgiving, you can bet that many asthmatics, especially children, will begin to exhibit asthma symptoms or will become more symptomatic. And, many young people who have never been diagnosed with asthma will begin to cough, wheeze, or develop difficulty breathing for the first time during this time of year.

The autumn season constitutes the “perfect storm” for asthmatic individuals. Both allergenic and non-allergenic factors converge this time of year to tickle the airway. As far as allergies are concerned, fall is the time for ragweed and other weed pollens, and in some parts of the country, mold spores are abundant. A seasonal activity which is classic for eliciting asthmatic symptoms is the hay ride. Hay, itself a grass and highly allergenic, is often loaded with mold and mildew. For some children, the final destination for this exciting adventure is a visit to the doctor or the emergency room that night or the next day.

Potent non-allergic triggers also contribute to asthma flare ups in the fall. The cool, moist air can excite an already sensitive airway.  Another potential trigger is vigorous physical activity. What child does not want to spend time outdoors riding bikes or playing football during the glorious days of autumn? And, don’t forget respiratory viruses which abound this time of year. Colds and flu are among the most common triggers for asthma symptoms in children.

Being aware of asthma exposure risks this time of year may result in one’s pediatrician or allergist prescribing preventative asthma medication during, and preferably, prior to the arrival of fall. These medications are highly effective, but they must be taken daily throughout the season. All in all, seasonal asthma can be prevented in most cases and even children with known asthma can enjoy a symptom-free fall holiday season.

Are you allergic to your cell phone?

There have been a “rash” of reports linking allergic contact dermatitis to the use of cell phones, especially among teenagers.

Allergy to the nickel alloy found in most metals is the most common cause of contact allergy. Nickel allergy has been estimated to occur in 18.8% of all individuals, and 17-33% in the pediatric population. Nickel alloy can be found many metal objects in which we come in contact with on a daily basis, including metal jewelry, zippers, belt buckles, musical instruments and, yes,  cell phones. Cell phones with fashionable designs are commonly manufactured with metallic accents containing nickel.

Contact of the metal to the skin can cause allergic sensitization and the development of a rash which is typically red and very itchy. The resultant facial or auricular dermatitis most commonly presents on one side of the face, typically on the cheek or ear. Treatment includes covering the cell phone to prevent direct content of the metal to the skin and the use of hydrocortisone cream.

Dust Mites for Breakfast?

Dust mites are one of the most common allergens known to be responsible for upper and lower respiratory symptoms such as nasal congestion,  runny nose, sneezing, coughing, and wheezing.  House dust mites are found in highest concentrations in our bedding (mattresses and pillows) and carpets, and allergists are constantly working with patients on ways to minimize or avoid exposure to this very problematic allergen.

But interestingly, over the past few years, house dust mites and their cousin, the storage mite, have been recognized to be the cause of severe allergic reactions when eaten in foods contaminated with high concentrations of mites.  Dust mites have been found to contaminate pancake and flour mixes and when ingested, can cause severe allergic reactions, including anaphylaxis,  in sensitized individuals.  This has most commonly been reported with pancake mixes but has also been seen with cake mixes, and in beignet mixes from New Orleans. This allergy to ingested mites has been appropriately named Oral Mite Anaphylaxis or “Pancake Syndrome”.

Interestingly, cooking these foods at high temperatures did not get rid of the allergen. This is not surprising as mite allergen tends to be quite heat resistant. To eliminate mite allergen from your bedding you must wash the sheets in 120 degree water!

The risk of finding mites in flour increases in tropical and humid climates.  To decrease the chances of having mites contaminate foods, it is recommended that flour be stored in an airtight containers in the refrigerator or freezer.
 

Foods can make you sick!

Even though food allergies seem to be constantly in the news, there are actually more common and preventable food related illnesses. These illnesses are caused by eating unwashed and/or poorly cooked common foods contaminated with dangerous bacteria and other pathogens. According to a recently released study from The Center for Science in the Public Interest, “millions of consumers are being made ill, hundreds of thousands hospitalized and thousands are dying each year from preventable foodborne illnesses.” The top ten riskiest foods in terms of outbreaks were identified as leafy greens, eggs, tuna, oysters, potatoes, cheese, ice cream, tomatoes, sprouts and berries.

The top cause of illness in leafy greens such as lettuce are pathogens like E. coli, Norovirus and Salmonella. Salmonella was also a chief culprit in egg, cheese and tomato-related illnesses, the study said, in cases when eggs are undercooked and when cheese is not processed properly. The study also associated Salmonella and E. coli with potatoes. Proper washing and cooking are essential in reducing the risks of eating contaminated foods, in many cases.

The top 10 affected foods resulted in more than 1,500 outbreaks, totaling nearly 50,000 reported illnesses, according to the center, which added that most food-related illnesses don’t get treated or reported, so the real total is likely much larger.

Swine Flu (H1N1) Vaccine and Egg Allergy

It appears that the Swine Flu (H1N1) vaccine will be made by some manufacturers using a cell-based system which would be safe for egg allergic individuals. However, indications are that some will be manufactured in egg cultures. Therefore, if one is not certain as to the manufacturing process,  it is strongly recommended that they be allergy tested to the vaccine by a board certified allergist prior to its administration.

The Flu Vaccine and Egg Allergy

Egg allergy is one of the most common food allergies in children, affecting an estimated 1.5% of the pediatric population.  A diagnosis of egg allergy is based on a combination of clinical history and a positive allergy test .  It is important to know that egg allergens do not cross-react with chicken allergens, and therefore chicken does not need to be avoided if one is allergic to eggs.

If you or your child is allergic to eggs, you have probably wondered which vaccines contain egg protein. 

Injectable influenza vaccines are grown in chicken egg cultures and do contain measurable quantities of egg protein.  The intranasal influenza vaccine, FluMist, also contains egg protein and is currently not recommended in patients with severe egg allergy.

A common misconception is that the measles, mumps and rubella (MMR) vaccine should be avoided in those who are egg allergic.  However, doctors now know it is safe for patients with egg allergy to receive the MMR vaccine without any prior testing.  This is because the measles and mumps vaccines are not grown in egg cultures, but in chick embryo fibroblast cultures which contain negligible or no egg protein.

It is important to know that, in most cases, egg-allergic patients can safely receive the injectable influenza vaccine. Allergy skin testing to egg and the flu vaccine by a board certified allergist should be performed if one is highly allergic to eggs, and especially if one has had a previous anaphylactic reaction upon ingestion of eggs. Based on these results, the vaccine may be administered by a graded-dose or split-dose protocol.

Allergists specialize in making sure the influenza vaccine may be administered safely to both children and adults with egg allergy.  Receiving the flu vaccine decreases your or your child’s risk of serious illness or hospitalization due to influenza, allowing you to remain healthy and active. 

Alternative to Allergy Shots for Some Patients

Sublingual immunotherapy (SLIT), or allergy drops under the tongue,  may now be an alternative to allergy shots for some patients.This form of desensitization has been used successfully in Europe for decades and has proven to be safe and effective. Pending FDA approval, this form of treatment is considered “off label”, but ongoing clinical trials in the U.S. will likely remove the off-label indication. SLIT could become the immunotherapy of choice for many allergists and patients in the next few years as the results of the clinical trials become available.

EpiPen and Twinject: Don’t Leave Home Without Them

It is a sad fact, but most fatal allergic reactions could be prevented by the early recognition of allergic symptoms and the rapid self administration of epinephrine, in the form of an Epipen or Twinject auto-injector.

Most life threatening reactions are caused by food allergies, medication allergies, and stinging insect allergies. Essentially any food can trigger an allergic reaction, but the most common ones that cause severe anaphylaxis are: peanuts, tree nuts (e.g., walnut, pecan, almonds, cashew, Brazil nut), shellfish, fish, milk, and eggs.

The venom of stinging insects such as yellow jackets, honeybees, wasps, hornets are common causes of anaphylaxis, as is the biting fire ant in certain geographical areas of the U.S.

Virtually any medication can trigger an allergic reaction. Common categories of drugs that cause anaphylaxis are aspirin and other non-steroidal anti-inflammatory drugs (NSAIDS), antibiotics, and anti-seizure medicines.

Upon exposure in the allergic individual, these allergens can initiate a severe, total body allergic reaction called anaphylaxis, whose symptoms may include urticaria (hives), a generalized sensation of warmth, vomiting, abdominal cramping, difficulty breathing, and circulatory collapse resulting in a rapid decrease in blood pressure and shock. The rapid injection of an Epipen or Twinject can slow down or eliminate the allergic reaction, but it must be injected as quickly as possible. The earlier the injection in the course of a reaction, the more likely the epinephrine is to control and stop the serious effects of anaphylaxis. Approximately 20-30% of all reactions require a second or third dose of epinephrine.

For anyone who has experienced a systemic allergic reaction or who is recognized as being at high risk, it is imperative that they or their caregivers have at least two auto-injectors of epinephrine with them at all times. They should be at home, in the workplace, school, daycare, homes of relatives, or any environment where an allergic individual frequents. One should avoid exposure of these devices to extremes in temperatures, such as in automobile glove compartments, as they are temperature sensitive and can lose their potency. They also lose their potency with the passage of time and, therefore, should be constantly monitored for expiration dates.

It is also imperative that patients or caregivers understand both the indications for and the proper techniques for the administration of an Epipen or Twinject. Demonstration devices are available and health care professional should demonstrate technique when prescribing these auto-injectors. Easy to understand demonstration video can be accessed below.

Prevention of anaphylaxis is a public health responsibility which is shared by health care providers, patients, and care-givers, especially parents of young children. Education must be made available with regard to avoiding exposure to the allergic agent, recognition of an allergic reaction, and rapid treatment including the immediate administration of the Epipen or Twinject.

10 Helpful Hints For Coping With Food Allergies

Living with food allergies is a challenging reality for many individuals.  However, do not despair! As you navigate the sometimes stormy waters of food allergies, it is important to know that you are not alone.  And, more importantly, food allergies are manageable. Knowing this, the following are some tips and recommendations that will help you meet the challenges of living healthily with food allergies.

1)  You are not alone.

Although having a food allergy can be a challenge, it should not be perceived as a stigma. While only 4-8% of the population have proven food allergies, up to 25% of the population perceive that they are allergic to at least one food item.  As a result, it is likely that you already know someone who is dealing with similar issues and challenges.

Recommendations: Visit other websites of organizations that offer a wide variety of food allergy resources. Start with the following: The Food Allergy & Anaphylaxis Network, The Food Allergy Initiative, Kids With Food Allergies, Anaphylaxis Canada, and The Allergy & Asthma Network Mothers of Asthmatics.

Additionally, there may be food allergy support groups in your neighborhood or city. There are also support groups that can be found on the internet where you can discuss your food allergy with others who face similar challenges. Such online support groups can be found through internet providers such as Yahoo, AOL, and Google.

2)  Avoidance is the only treatment.

Simply put, if you do not eat or come into contact with the particular food(s) to which you are allergic, you will not have a reaction.

While it is possible that many individuals will “outgrow” their food allergy, it is very dangerous to experiment in order to see if one can eat a food to which they previously reacted.  Remember, in some circumstances, even the smallest amount of exposure can lead to a serious, life-threatening reaction. Your allergy specialist is the only person who should determine when it is safe to introduce such items in to one’s diet, and food challenges should only be done under the supervision of your allergist.

Recommendation: Never dabble or cheat with a food that your physician recommended that you avoid. Additionally, an individual should never try to “detoxify” , “desensitize”, or challenge oneself.

3)  Do not assume that a food item is safe.

Always check all ingredients to verify that a food product does not contain your particular allergen. In fact, one should approach all food items with some suspicion that there could be a hidden ingredient.  In particular,  be especially suspicious of pastries, sauces. Such foods commonly have multiple ingredients and the ingredients can change during the cooking, preparation, or manufacturing process. Additionally, it is important to remember that one can never assume that a restaurant or food service establishment properly labeled the ingredients on their menu.

Recommendation:  When possible, always ask how an item is prepared, and try to ascertain if there has been any contact with other items that may cause cross-contamination.  Be proactive when dining at a restaurant or food establishment by bringing cards that clearly list your particular food allergen and ask the wait staff to clarify the ingredients of each dish.  If you are served an item that you suspect contains your food allergen, do not eat it. If you cannot confirm that the food item is safe to eat, it is best to avoid eating it altogether.

4) Read Labels Carefully.

Starting in 2006, the Federal Government mandated that all packaged goods containing milk, egg, wheat, soy, fish, shellfish, peanut or tree nut be labeled in plain English in order to alert potentially allergic consumers of their contents.

Recommendation: Make sure you read the labels of all packaged goods, even those very familiar to you, because manufacturers do change ingredients from time to time. Despite the 2006 labeling laws, it is still important to learn about the alternative ways that the food industry labels food products. This is a potentially life-saving skill to have. The Food Allergy & Anaphylaxis Network’s website provides a quick tutorial on the details of food labeling (Click here to download the PDF).

5) Always carry with you your emergency medications, especially self-injectable epinephrine (EpiPen or Twinject).

It is surprising that in nearly every study of known food allergic individuals, many allergic individuals simply do not comply with the recommendation to have epinephrine with them at all times.  Epinephrine is a drug that can rapidly reverse skin, cardiac, respiratory and gastrointestinal symptoms in an acute allergic reaction. As a result, Epinephrine is potentially lifesaving.  In fact, in studies of food allergy related fatalities, lack of available epinephrine was almost always associated with the fatality.  Moreover, lack of receiving any emergency medication has been associated with an increased severity of reaction.

Recommendation: Always have emergency medication, especially epinephrine, available in the event of a reaction.

6) Learn to use your Epinephrine device, use the device promptly after a reaction occurs, and teach others to use it.

Quite surprisingly, it is not uncommon for individuals to be given these devices without a demonstration of how to use them. It is important not only that the food allergic individual know how to use the device, but that the people who are in close daily contact with the food allergic individual be trained and comfortable with the use of the device as well.  This includes teachers, school administration, co-workers, and family members.

Knowing how to use the device, however, does not guarantee that the device is used in appropriate situations.  Unfortunately, there is much data that suggests that even when an auto-injecting epinephrine device is available, it is under-utilized.  Delay in receiving epinephrine has been shown to increase the potential for a life-threatening reaction, and has been associated with food allergy related fatalities.  Parents or other care providers of food allergic children should not be afraid of using the epinephrine device out of fear of having to give their child an injection. The risk of not administering epinephrine is much greater than the risk of giving it unnecessarily.

Recommendation: First, make sure you and those who are in close daily contact with the food allergic individual know how to use the Epinephrine device. Click on this link  to view a video demonstration of how to use both devices sold in the US, EpiPen and Twinject. Additionally, both companies provide free how-to-use DVD’s which are available from both the company and your allergist. Trainer devices, available from your allergy provider or in twin-pack devices of EpiPen and Twinject, closely mimic the actual devices and are a wonderful tool to practice with.

Finally, written “Food Allergy Action Plans” are highly recommended for school aged children, including those in child care, to clearly detail how a particular reaction should be treated. Such plans should be kept on file with the child’s particular institution as they will help ensure that your child receives proper treatment in the event of a reaction. Please remember, there is never a wrong time to use one’s epinephrine device to treat an allergic reaction, but there are, however, times when it is wrong to avoid using it.

7)  Be wary of cross-contamination.

Allergen-free food can be very easily contaminated accidentally. Utensils, pots, and pans that were used to prepared allergenic foods need to be thoroughly cleaned. In addition, preparation surfaces, such as tables and chairs, must be cleaned thoroughly with hot, soapy water after use.  Foods can spill, splatter, or rub against one another as an additional means of accidental contamination.

Recommendation: Call restaurants in advance to determine if one’s food allergy needs can be met.  Request that appropriate cleaning procedures be taken, and, if possible, attempt to arrange for the meal to be prepared with cooking items and surfaces that have not come into contact with the particular allergen.  If these requests cannot be met, it would be advisable not to risk potential exposure and to eat at an establishment that can provide such requests.  Bring clearly written instruction cards detailing one’s food allergies and the special preparation instructions required to help avoid potential inadvertent or unintentional contamination. A sample card is available at The Food Allergy & Anaphylaxis Network (Click here to begin PDF download).

8)  Learn to recognize and take appropriate precautions in situations that are likely to increase one’s risk for potential exposure.

Because it can be difficult to ascertain whether food being served in certain situations contains any allergens, a food allergic individual must take extra care at events such as birthday parties, company events, or even while attending a ballgame at a stadium. Bakeries, ethnic restaurants, and snack bars may be sources of potential exposure and cross-contamination.  Attending such locations can be dangerous because exposure is possible though direct ingestion, skin contact of a contaminated surface, and even through inhalation of allergen particles.

Recommendation: Whatever the situation, it is important to have a plan in place to avoid a potential reaction. Prior to eating anything, make an attempt to verify the ingredients and the potential for cross contamination in the food preparation.  If this cannot be done, avoid eating the food altogether, or avoid eating at the particular location if special requests cannot be met. Additionally, it is advisable to wash your hands several times a day to limit the potential for contact exposure. Be extra cautious when ordering food in situations where there is a language barrier between oneself and the person taking the order, or ordering from a menu not written in one’s primary language. Use of written cards again is highly advisable.

9) Never share food and encourage others to wash their hands after food contact.

Sharing of food is a very easy way to increase the likelihood of an accidental reaction, especially in younger food allergic individuals who may not be capable of distinguishing safe from non-safe foods.  Additionally, the person sharing the food may not have gone to the necessary lengths to ensure the food has not been contaminated.

Recommendation: Make sure everyone washes their hands after food contact as this is important to cut down on potential routes of cross-contamination.  This critical measure is also particularly recommended to be implemented in classrooms of food allergic children, especially those in schools where there is presence of the particular allergen in the classroom/eating area or where children with food allergies are not afforded a designated “safe” eating area.

10)  Feel empowered and be proactive—be your own advocate!

Having a food allergy may require a little more diligence in terms of awareness and recognition of certain situations, but it is entirely manageable and reactions are preventable.  At present, awareness of food allergy in the general community is increasing, but there is still much work to do.

Recommendation: Join a food allergy advocacy organization such as the The Food Allergy & Anaphylaxis Network, The Food Allergy Initiative, Kids With Food Allergies or other similar groups.  Contact your allergy provider for other recommendations.  Help bring food allergy awareness to the community by talking to local officials about how they can help advocate for healthy, safe eating.  Teach others how to maintain a safe environment for you or your child.  Our goal is for you to feel safe and be safe, both inside and outside the home.

5 Ways to Save on Allergy and Asthma Medication

Treating your allergies or asthma properly can be expensive.  Statistics from the American Academy of Allergy have estimated the cost of treating allergic rhinitis (seasonal allergies or hayfever) and asthma is on the order of many billions of dollars per year in the U.S.  The costs that patients face are both direct (medications, doctor visits, hospital stays etc) and indirect (missed work or school, decreased productivity on the job etc).

Both add up rapidly to become a big part of health care costs for patients and insurance companies.  The following are suggestions for patients who are interested in saving money on their prescription medications.  Working with your doctor is the best way to find ways to control spiraling prescription medication costs.

1.  Take the medications as directed by your doctor.

This may seem obvious, but it is probably the best long term way to save money.  Many medications such as nasal steroid sprays (Flonase, Nasonex, Veramyst, Rhinocort AQ, Nasacort AQ) and inhaled steroids (Flovent, Asmanex, Qvar, Azmacort, Advair, Symbicort) and Leukotriene blockers (Singulair or Accolate) work best as “Controller Medications”. 

Controller means that taking the medicine daily prevents symptoms and illness. If you can prevent allergy symptoms, or a flare of asthma, you save health care dollars and money out of your pocket by not needing additional medications such as antibiotics, or incurring co-pays for sick visits.  You and your kids will also miss less work and school, which makes you more productive in the long run.

2.  Check with your insurance plan to see if ordering medication in bulk will be cheaper.

Many insurance plans come with pharmacy benefits that offer discounts if you order ninety day supplies of medications.  Since many allergy and asthma medications need to be taken on a preventative basis (“controller”), having several months supply of medication on hand makes sense, may allow for discounts, and will save you several trips to the pharmacy.

3.  Research which medications are covered best by your insurance plan.

Physicians have a difficult time keeping up with which medications are covered best by your insurance plan.  Do your homework to see if your insurance plan has a list of medications, or formulary, which outlines which medications they cover at lower, or generic, co-pays and discuss this with your physician during a visit.  Often times, physicians are happy to switch a patient to a medication that is covered well by their plan as long as it is safe and provides equal benefits.

4.  Don’t just ask for samples. Ask your doctor if his office has any coupons for you medications.

There is a trend now for pharmaceutical companies to provide fewer samples and more coupons or discount cards for their medications.  Often these coupons will lower or totally eliminate the entire co-pay.  Many coupon offers provide you a month’s free supply of medications and enroll you in future discount programs.

5.  Research on the internet discount offers for medications.

TheOnlineAllergist.com compiles many allergy and asthma medication coupon offers to help patients.  You can also Google coupons or discount offers for your allergy or asthma medications.  Another good resource is the website of the pharmaceutical company that makes your medication.  Often these coupons are not quite as good as what you can find at your doctor’s office, but they can save you a great deal of money and are easy to use.

Inhaler Technique is Critical

Most asthma patients are not using their inhalers and/or spacers correctly, and, therefore, are not getting the maximum benefit from these devices. All physicians caring for asthma patients will attest to the fact that even after demonstrating the proper technique for using a metered dose inhaler or spacer, “show and tell” on subsequent office visits proves that excellent technique is rarely observed, especially in children.

A recent study revealed that only 50% of those using an inhaler alone had good technique and only 29% of those using an inhaler with a spacer were using it adequately. For both groups and devices, breathing out before inhalation and breath holding was problematic. This study reinforces the need to demonstrate and observe the correct use of inhalation devices at each clinic visit.

Excellent technique is critical to good asthma control. Consult the “How to videos” page on this website for step by step instructions for inhalers, spacers, and other devices.

Beware of Peanut Allergies in Infants and Toddlers

Most allergists practicing for more than a decade have observed that the age of presentation of peanut allergy in infants is getting earlier and earlier. A recent article published in Pediatrics has proven that this is the case.

In 1995, the median ages of first peanut reaction was 24 months. Of those infants born after July, 2000 presenting to a major university allergy department, the median age of first peanut reaction was 14 months! The decline in the age of first peanut reaction seems to be attributable to earlier exposure. It is interesting to note that this study found that most patients (68%) who were peanut allergic demonstrated sensitization or clinical allergy to other foods (53% to eggs, 26% to cow’s milk, 20% to tree nuts, 11% to fish, 9% to shellfish, 7% to soy, 6% to wheat, and 6% to sesame seeds).

Peanut allergy represents one of the most potentially serious allergies in childhood. Do not introduce peanuts prior to three years of age. And, consult an allergist if you suspect a peanut allergy in your child.
Source:  PEDIATRICS Vol. 120 No. 6 December 2007, pp. 1304-1310(doi:10.1542/peds.2007-0350)

Are Creams and Moisturizers Containing Oats Safe For Children With Atopic Dermatitis?

It is interesting to note that some cream emollients and moisturizers that contain oats may actually be doing more harm than good in patients with atopic dermatitis (eczema). A recent study from France found an alarming rate of sensitization to oat protein among children using oat containing topical products. Sensitization rates were particularly high in children two years old and younger.

Oatmeal baths and oat creams have a reputation for soothing the angry, inflamed skin of those with atopic dermatitis or eczema. The evidence presented in this study raises questions about this claim, and caution is therefore warranted when using these products, especially if used regularly.

One EpiPen May Not Be Enough.  Be Prepared.

A recent study assessing emergency room records confirms the fact that a significant number of patients with anaphylactic reactions to food needed more than one injection of epinephrine. The data from this study revealed that 16% of patients presenting with food induced anaphylaxis required two injections. Previous data showed that as many as 25% of reactions required multiple doses. Multiple doses of epinephrine appeared to be more likely in those with reactions to peanuts and tree nuts and those presenting with hypotension.

The message is clear: Those with a history of anaphylaxis and those highly allergic to foods, medicines, or insect stings should be prepared to treat anaphylaxis with multiple injections of epinephrine until medical assistance arrives. One may not be enough!

There is no Relationship Between Seafood Allergy and Radiocontrast Media

How often do allergists hear: “I am allergic to fish and therefore I am allergic to the iodine in radiocontrast dye”?

The long-standing misconception that there is a higher incidence of allergic reactions to radiocontrast media (IVP dye) in those with seafood allergy is alive and well. And, this misunderstanding is pervasive among both physicians and patients.

In a survey of 231 faculty radiologist and interventional cardiologists at 6 midwest academic medical centers, sixty-nine percent of responders indicated that they inquire about a history of seafood allergy before radiocontrast media administration. Some 37.2% of responders replied that they would withhold radiocontrast media or recommend premedication on the basis of a history of seafood allergy.

Medical research has proven time and time again that there is no cross-reactivity between these substances. Physician education with respect to seafood allergy and radiocontrast media administration is vital to halting the persistence of this misconception.

Source:  The American Journal of Medicine
Volume 121, Issue 2, February 2008, Pages 158.e1-158.e4