As a follow up to our previous post, the NBC Nightly News aired a story on food allergies on Sunday May 8, 2011. The first is the link to the original story and the other two links are to web only segments.
http://www.aascare.com/
Monday, May 9, 2011
Sunday, April 10, 2011
Food Allergies
These days, most everyone knows someone with a food allergy, defined as an abnormal immune response to a food. This is not surprising, as the prevalence of food allergies seems to be increasing. A recent abstract (Dr. Warrier, one of co-authors of this publication, practices at the Allergy, Asthma & Sinus Care Center in St. Louis) presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology in San Francisco on March 19, 2011, reported that food allergies affect 8% of children (Gupta RS, Springston EE, Warrier M, Smith B, Kumar R, Wang X, Joll J, Pongracic J. J Allergy Clin Immunol 2011; 127:SAB33). This is on the upper end of previous estimates. Food allergies are a significant problem, not only for those individuals who are affected, but also for their friends and family. One good resource (among several) for information on food allergies is a website from the National Institute of Allergy and Infectious Diseases: http://www.niaid.nih.gov/topics/foodallergy/Pages/default.aspx
"The Prevalence of Childhood Food Allergy in the United States."
If you are looking for a board certified adult and pediatric allergy/asthma specialist in St. Louis, Missouri, schedule an appointment with one of our physicians at the Allergy, Asthma & Sinus Care Center. More information is available on our website: http://www.aascare.com/
"The Prevalence of Childhood Food Allergy in the United States."
RATIONALE: The heterogeneity of available data on childhood food allergy
(FA) necessitates further study.
METHODS: Apopulation-based cross-sectional survey was administered from June 2009-February 2010 to determine the prevalence of childhood FA. Eligible participants were >18 years residing in a U.S. household
with children and able to complete the survey in Spanish/English. Primary outcome measures included report and severity of current FA. Report of FA was categorized as perceived (participant report), probable (participant report/consistent reaction history), or confirmed (participant report of physician diagnosis/test history and consistent reaction history). Probable/confirmed FA were further categorized as mild/moderate or severe based on reaction history. Data were weighted using study-specific post-stratification benchmarks to adjust for sample design and nonresponse. Data were analyzed to estimate the prevalence of perceived, probable and confirmed FA.
RESULTS: Data were analyzed for 38,480 children, with demographic characteristics representative of the U.S. population. FA was reported for 9.92% of children (95%CI59.56-10.28), with 1.96% perceived (95% CI51.81-2.13), 4.76% probable (95%CI54.51-5.02), and 3.20% confirmed
(95%CI53.00-3.42). Prevalence by allergen varied by age. 3.08% of all children reported a probable or confirmed food allergy subsequently categorized as severe (95%CI52.88-3.30). Reaction severity varied by allergenic
food. Odds of confirmed vs. no food allergy was significantly associated with race, age, income, and geographic region. In a model of confirmed vs. probable food allergy, only race and income remained
significant.
CONCLUSIONS: Findings suggest the extent of childhood food allergy is greater than previously reported. Disparities were observed in both the pathophysiology of disease and in current clinical practices.
New guidelines for the diagnosis and management of food allergies were released earlier this year. What's in it for people who are affected by food allergies? Check out this link:
If you are looking for a board certified adult and pediatric allergy/asthma specialist in St. Louis, Missouri, schedule an appointment with one of our physicians at the Allergy, Asthma & Sinus Care Center. More information is available on our website: http://www.aascare.com/
Wednesday, January 19, 2011
Allergen Immunotherapy (Allergy Shots)- still working after 100 years
"Immunotherapy treatment (allergy shots) is based on a century-old concept that the immune system can be desensitized to specific allergens that trigger allergy symptoms. These symptoms may be caused by allergic respiratory conditions such as allergic rhinitis (hay fever) and asthma. While common allergy medications often control symptoms; if you stop taking the medication(s), your allergy symptoms return shortly afterward. Allergy shots can potentially lead to lasting remission of allergy symptoms, and it may play a preventive role in terms of development of asthma and new allergies.
The Process
Treatment involves injecting the allergen(s), causing the allergy symptoms. These allergens are identified by a combination of a medical evaluation performed by a trained allergist/immunologist and allergy skin or allergy blood tests.
The treatment begins with a build-up phase. Injections containing increasing amounts of the allergens are given 1 to 2 times a week until the target dose is reached. This target dose varies from person to person. The target dose may be reached in 3 to 6 months with a conventional schedule (one dose increase per visit) but may be achieved in shorter period of time with less visits with accelerated schedules such as cluster that administers 2-3 dose increases per visit. The maintenance phase begins when the target dose is reached. Once the maintenance dose is reached, the time between the allergy injections can be increased and generally range from every 2 to every 4 weeks. Maintenance immunotherapy treatment is generally continued for 3 to 5 years. Some people have lasting remission of their allergy symptoms but others may relapse after discontinuing immunotherapy, so the duration of allergen immunotherapy varies from person to person.
Risks involved with the immunotherapy approach are rare, but may include serious lifethreatening anaphylaxis. For that reason, immunotherapy should only be given under the supervision of a physician or qualified physician extender (nurse practitioner or physician assistant) in a facility equipped with proper staff and equipment to identify and treat adverse reactions to allergy injections.
The decision to begin immunotherapy will be based on several factors:
- Length of allergy season and severity of symptoms
- How well medications and avoiding allergens control allergy symptoms
- Desire to avoid long-term medication use
- Time. Immunotherapy will require a significant time commitment during the build-up
- phase, and a less frequent commitment during the maintenance phase
- Costs may vary depending on region and insurance coverage. Yet, allergy shots can
- be a cost-effective approach to managing allergy symptoms.
In 1911, both allergen immunotherapy and the electrical ignition system for cars were introduced. Although unrelated, these events share a common outcome. One paved the way for advances in transportation, the other led to advances in the treatment of allergies. The earliest published successes for allergen immunotherapy were based on the work of two English scientists, Leonard Noon and John Freeman. Recognizing that pollen was the cause of hay fever, these scientists thought that they could induce immunity and tolerance by injecting hay fever patients with the pollen to which they were allergic. This idea was based on the positive results of vaccines that produced protection against infectious disease such as small pox. Over the years, we’ve learned much more about allergen immunotherapy including long-term benefits and what protocols are needed to make it very beneficial. Among the most important findings are that immunotherapy can provide long-term symptom relief for years after treatment is discontinued, and that it is a cost-effective approach to treating many allergies.
Research has demonstrated that allergy immunotherapy can be effective in treating:Allergic asthma
Allergic rhinitis and conjunctivitis
Stinging insect allergy
Atopic dermatitis
New frontierCurrently, immunotherapy for food allergies is not recommended and strict avoidance of the food is advised although investigations with oral desensitization for food allergies are in progress in the United States."
The information above is from the American Academy of Allergy, Asthma & Immunology http://www.aaaai.org/
Thursday, December 23, 2010
FLU, ASTHMA AND ALLERGIES
We are in Flu season, and people with allergies and asthma should take prevention measures to avoid getting sick.
ASTHMA’S AFFECT
Adults and children with asthma, especially when poorly controlled, are more likely to have significant breathing issues if they get the Flu compared to individuals without asthma or other chronic diseases.
IS IT AN ALLERGY OR IS IT THE FLU?
Some allergy symptoms may be confused for flu symptoms. For parents of children with asthma or allergies, telling the difference between allergic disease symptoms and the flu may be a bit difficult.
Itchy eyes, a scratchy nose or sneezing are symptoms of allergies, but if your child suffers from asthma and develops a fever or nausea and vomiting, consult your physician.”
Here’s how to tell if you are suffering from allergies or something more severe
Allergy Symptoms
Runny Nose
Sneezing
Stuffiness
Itchy, watery eyes
Itchiness in the nose, mouth or throat
Flu Symptoms
Runny Nose
Coughing
Sore throat
Tiredness
Fever
Nausea or vomiting
Diarrhea
Lack of appetite
FOOD ALLERGIES AND VACCINES
Vaccination for the flu is among the best prevention tools available to prevent complications from the flu. But what if you are allergic to a substance in the vaccines?
“Individuals with egg allergy may be at risk for an allergic reaction to ... influenza vaccines due to the egg content in the vaccine preparations,” reports Dr. Casale. “Before getting vaccinated, review the information posted on www.aaaai.org and consult with your health care provider. In most cases, vaccination can be tolerated if done according to ... recommendations.”
IF YOU DO GET SICK
The Centers for Disease Control and Prevention recommends that people with flu-like symptoms stay home for at least 24 hours after they are free of fever.
If you experience severe symptoms, including difficulty breathing, chest pain/pressure, dizziness or persistent vomiting, seek emergency medical care.
AVOID CONTRACTING OR SPREADING THE FLU
• Wash your hands frequently with soap and warm water
• Hand sanitizers may also be effective
• Use a tissue to cover your coughs and sneezes
• Avoid touching your eyes, nose and mouth
• Stay home if you feel ill
• When possible, avoid close contact with sick people
• Obey school/business closures and other public health advisories
Adults and children with asthma, especially when poorly controlled, are more likely to have significant breathing issues if they get the Flu compared to individuals without asthma or other chronic diseases.
IS IT AN ALLERGY OR IS IT THE FLU?
Some allergy symptoms may be confused for flu symptoms. For parents of children with asthma or allergies, telling the difference between allergic disease symptoms and the flu may be a bit difficult.
Itchy eyes, a scratchy nose or sneezing are symptoms of allergies, but if your child suffers from asthma and develops a fever or nausea and vomiting, consult your physician.”
Here’s how to tell if you are suffering from allergies or something more severe
Allergy Symptoms
Runny Nose
Sneezing
Stuffiness
Itchy, watery eyes
Itchiness in the nose, mouth or throat
Flu Symptoms
Runny Nose
Coughing
Sore throat
Tiredness
Fever
Nausea or vomiting
Diarrhea
Lack of appetite
FOOD ALLERGIES AND VACCINES
Vaccination for the flu is among the best prevention tools available to prevent complications from the flu. But what if you are allergic to a substance in the vaccines?
“Individuals with egg allergy may be at risk for an allergic reaction to ... influenza vaccines due to the egg content in the vaccine preparations,” reports Dr. Casale. “Before getting vaccinated, review the information posted on www.aaaai.org and consult with your health care provider. In most cases, vaccination can be tolerated if done according to ... recommendations.”
IF YOU DO GET SICK
The Centers for Disease Control and Prevention recommends that people with flu-like symptoms stay home for at least 24 hours after they are free of fever.
If you experience severe symptoms, including difficulty breathing, chest pain/pressure, dizziness or persistent vomiting, seek emergency medical care.
AVOID CONTRACTING OR SPREADING THE FLU
• Wash your hands frequently with soap and warm water
• Hand sanitizers may also be effective
• Use a tissue to cover your coughs and sneezes
• Avoid touching your eyes, nose and mouth
• Stay home if you feel ill
• When possible, avoid close contact with sick people
• Obey school/business closures and other public health advisories
Avoid Allergy and Asthma Triggers and Keep the “Bah Humbug” Out of Your Holidays
Thanksgiving, Hanukah, Christmas, Kwanzaa and New Year’s — the fall and winter holidays bring festive times and seasonal activities that can trigger allergies and asthma. Allergists suggest the following tips to steer clear of potential culprits and enjoy healthy holiday cheer this season.
- Identify the Source of Your Suffering: Finding out what triggers your allergy and asthma symptoms is an essential first step. If you’re not sure, make an appointment to see an allergist, who can identify the source of your suffering and help stop it.
- Wash the Tree Before Trimming: Terpene is a potential allergen found in the oil or sap of live Christmas trees, evergreen wreaths and garlands. Mold also can reside on trees, and pollen is commonly found on junipers and cedar evergreens. Use a leaf blower in a well-ventilated area to remove some of the pollen from live trees and decorations. Wash the tree, especially the trunk, outdoors with a garden hose and leave in a bucket of water in the garage or on a covered porch to dry. Wear gloves when handling the tree to avoid contact with sap.Artificial trees also may harbor dust and mold. Wash them outside as well to help remove allergy triggers. When storing an artificial tree and decorations for next year, place them in airtight bags or containers.
- Let it Snow… Outside: While the artificial snow contained in aerosol cans helps bring the outdoor ambience in, these sprays can trigger asthma and allergy symptoms. Also be wary of scented candles, scented items including potpourri and wood-burning fireplaces. Your best bet is to avoid using these items if they trigger symptoms.
- Deck the Halls… After a Good Dusting: Menorahs, ornaments and other holiday decorations stored in attics and basements during the off-season often gather dust and mold that can cause an allergic reaction when they are removed from storage and readied for use. Clean each item thoroughly before decking the halls, dining room or tree. When packing these items away, store them in airtight containers to minimize dust and reduce your prep time next year.
- Plan Ahead for Healthy Travel: Traveling for the holidays has its challenges, but there are several things you can do to keep asthma and allergies in control whether you’re on the road, on board or at your destination. Talk to an allergist before you depart to identify preventive and emergency relief strategies. Pack your medications in your carry-on bag so they’ll always be there for you at a moment’s notice. If you’re allergic to dust, consider bringing your own pillow and mattress covers. Early morning and late evening travel, when air quality is generally better and traffic is lighter, also may be helpful. When renting a car, be sure to request one in which no one has smoked.
- Chill Out: Stress makes it harder for your immune system to do its job. Take time to decompress and stay on schedule with any allergy and asthma medications to prevent symptoms from interfering with holiday fun.
- Guard Against Flu: When people gather, viral illnesses such as the flu are more likely to be passed around.
Skin Allergies
Skin allergies
Winter is often a time that people suffer with dry, red, itchy skin. Allergies may be responsible for the itching. The most common skin allergies include eczema, hives, and allergic contact dermatitis.
Eczema
Eczema (also commonly called atopic dermatitis) is more common in infants and small children, but can also affect older children and adults. In infants it often affects the face, the forearms and the thighs. In older children and adults the rash usually affects the crease behind the elbows and knees, but it can affect other areas as well.
Triggers can include allergens (like pets and dust mites), irritants (like wool), excessive dryness (like using deodorant soaps), overheating and sweating, and emotional stress.
Preventing the itch is one of the main goals in treatment. Lubrication of the skin is the most important treatment. Antihistamines are often used to suppress the itch, and topical medications such as topical steroids and other anti-inflammatory medications can be used. In severe cases, oral steroids like prednisone are needed.
Hives and angioedema
Hives are red, raised, and terribly itchy. They come and go in a matter of minutes to hours. They do not affect a single area of the skin—they move around! Although they can be caused by allergy to foods, medications, insect bites and stings, and even rarely airborne allergens, they most often occur for no particular reason at all. Even though a cause cannot always be found, we can always provide some degree of relief with treatment. And the best news is that they always eventually just go away.
Angioedema is a swelling that occurs in deeper layers of the skin. For that reason, it often feels different than the itch from hives. It often occurs with hives, but sometimes occurs alone. It often affects the eyelids, lips, face, tongue, hands or feet. It can also be triggered by allergies, but like hives, sometimes occurs randomly. Testing and treatment to provide relief is readily available.
Contact dermatitis
Contact dermatitis is often not only itchy, but sometimes painful. It is red, blistery, and fixed in one location where the responsible allergen came in contact with the skin. Because there is often a lag of one or two days between contact and the appearance of the rash, the cause is not always obvious. We can provide testing to try to find the culprit, and we can offer relief with treatment.
If you or someone you know has been suffering with skin allergies, please contact us. We would love to help.
Eczema
Eczema (also commonly called atopic dermatitis) is more common in infants and small children, but can also affect older children and adults. In infants it often affects the face, the forearms and the thighs. In older children and adults the rash usually affects the crease behind the elbows and knees, but it can affect other areas as well.
Triggers can include allergens (like pets and dust mites), irritants (like wool), excessive dryness (like using deodorant soaps), overheating and sweating, and emotional stress.
Preventing the itch is one of the main goals in treatment. Lubrication of the skin is the most important treatment. Antihistamines are often used to suppress the itch, and topical medications such as topical steroids and other anti-inflammatory medications can be used. In severe cases, oral steroids like prednisone are needed.
Hives and angioedema
Hives are red, raised, and terribly itchy. They come and go in a matter of minutes to hours. They do not affect a single area of the skin—they move around! Although they can be caused by allergy to foods, medications, insect bites and stings, and even rarely airborne allergens, they most often occur for no particular reason at all. Even though a cause cannot always be found, we can always provide some degree of relief with treatment. And the best news is that they always eventually just go away.
Angioedema is a swelling that occurs in deeper layers of the skin. For that reason, it often feels different than the itch from hives. It often occurs with hives, but sometimes occurs alone. It often affects the eyelids, lips, face, tongue, hands or feet. It can also be triggered by allergies, but like hives, sometimes occurs randomly. Testing and treatment to provide relief is readily available.
Contact dermatitis
Contact dermatitis is often not only itchy, but sometimes painful. It is red, blistery, and fixed in one location where the responsible allergen came in contact with the skin. Because there is often a lag of one or two days between contact and the appearance of the rash, the cause is not always obvious. We can provide testing to try to find the culprit, and we can offer relief with treatment.
If you or someone you know has been suffering with skin allergies, please contact us. We would love to help.
Advair and Symbicort – “Black Box Warnings”
In 2003, the FDA required the manufacturer of Advair to include a “Black Box Warning” on the package insert of this medication. The reason for this was due to the finding in a large trial that some patients with asthma who were treated with the long-acting bronchodilator, salmeterol, had a higher incidence of asthma related death and other complications from asthma than the group who was not treated with salmeterol. Since 2003 there have been further analyses and studies regarding the use of salmeterol and another long-acting bronchodilator, formoterol. Formoterol is used in the medications Foradil and Symbicort.
Opinions among experts have been polarized. Some well-respected physicians have stopped using these drugs altogether in favor of using higher doses of steroids as well as older medications such as theophylline for treatment of moderate and severe asthma. Others who are equally well respected cite data referring to the overall safety of long-acting bronchodilators salmeterol and formoterol, and continue to use them.
The FDA has recently updated its labeling regarding the use of long-acting bronchodilators. They have concluded that the benefits of these drugs for asthma treatment outweigh the risks, when used appropriately, but that they should be used only in patients whose asthma cannot be controlled with controller medications such as inhaled corticosteroids alone. The new label stipulates that long-acting bronchodilators should only be used along with a concurrent controller medication. In other words, Serevent and Foradil should not be used alone to treat asthma. Once asthma control is achieved, it is recommended to try to reduce medication. If asthma can be controlled with a low or medium dose of inhaled corticosteroids, then long-acting bronchodilators should be avoided.
The safety of long-acting bronchodilators in adolescents has been questioned in the past. The FDA has recommended that products that contain long-acting bronchodilators such as Advair and Symbicort should be used in this age group because the ease of use has helped compliance. This results in improved symptom control and less risk of complications of uncontrolled asthma such as oral steroid use, ER visits and hospitalization.
A recent study published in February of this year in the Journal of Allergy and Clinical Immunology performed an analysis of the use of formoterol (an ingredient in Foradil and Symbicort), in over 23,000 subjects. There was no evidence of an increased risk for serious events, including hospitalization and death in the formoterol group.
We at the Allergy, Asthma & Sinus Care Center review the current safety data of all of the medications that we prescribe. We are often asked if it is necessary to use medications to treat asthma, and if the medications are safe. The “cure” for asthma has yet to be found, and every medication does carry at least some potential for side effects or risk. Overall, we feel that there is a place for medications such as Advair and Symbicort. These medications are a necessary tool in order to achieve control of asthma, but we do always look for opportunities to use less medication when possible.
The FDA has recently updated its labeling regarding the use of long-acting bronchodilators. They have concluded that the benefits of these drugs for asthma treatment outweigh the risks, when used appropriately, but that they should be used only in patients whose asthma cannot be controlled with controller medications such as inhaled corticosteroids alone. The new label stipulates that long-acting bronchodilators should only be used along with a concurrent controller medication. In other words, Serevent and Foradil should not be used alone to treat asthma. Once asthma control is achieved, it is recommended to try to reduce medication. If asthma can be controlled with a low or medium dose of inhaled corticosteroids, then long-acting bronchodilators should be avoided.
The safety of long-acting bronchodilators in adolescents has been questioned in the past. The FDA has recommended that products that contain long-acting bronchodilators such as Advair and Symbicort should be used in this age group because the ease of use has helped compliance. This results in improved symptom control and less risk of complications of uncontrolled asthma such as oral steroid use, ER visits and hospitalization.
A recent study published in February of this year in the Journal of Allergy and Clinical Immunology performed an analysis of the use of formoterol (an ingredient in Foradil and Symbicort), in over 23,000 subjects. There was no evidence of an increased risk for serious events, including hospitalization and death in the formoterol group.
We at the Allergy, Asthma & Sinus Care Center review the current safety data of all of the medications that we prescribe. We are often asked if it is necessary to use medications to treat asthma, and if the medications are safe. The “cure” for asthma has yet to be found, and every medication does carry at least some potential for side effects or risk. Overall, we feel that there is a place for medications such as Advair and Symbicort. These medications are a necessary tool in order to achieve control of asthma, but we do always look for opportunities to use less medication when possible.
Subscribe to:
Posts (Atom)