Food Allergy Center of Connecticut

Epipen cap warning issued by distributor

Taking the cap off an EpiPen incorrectly when treating a severe allergic reaction could potentially result in failure to deliver the drug, the distributor of the device says.

Health Canada said Friday that Pfizer Canada, distributor of the EpiPen and EpiPen Jr autoinjectors, says the blue safety cap on the device should be removed by pulling the cap straight up while holding the orange tip downward.

"It has recently come to our attention that removal of the blue safety cap the wrong way by pulling it sideways or bending and twisting it off may prevent the device from working properly and potentially result in failure to deliver the drug," the company said in a release Thursday.

The company also said patients should:

• Continue to carry their EpiPen or EpiPen Jr at all times.
• The blue safety cap should not be removed until you need to use the medication.

Patients are advised to review the safety information regularly and check that the device hasn’t been unintentionally activated, Health Canada said

New research suggests possible means for turning off peanut allergy

Researchers at Northwestern University Feinberg School of Medicine have turned off a life-threatening allergic response to peanuts in mice by tricking the immune system into thinking the nut proteins aren't a threat to the body, according to a new preclinical study that was funded by the Food Allergy Initiative and the National Institutes of Health. The peanut tolerance was achieved by attaching peanut proteins onto blood cells and reintroducing them to the body -- an approach that ultimately may be able to target more than one food allergy at a time.

"We think we've found a way to safely and rapidly turn off the allergic response to food allergies," said Paul Bryce, an assistant professor of medicine in the division of allergy-immunology at Northwestern University Feinberg School of Medicine. Bryce and Stephen Miller, professor of microbiology-immunology at Feinberg, are co-senior authors of a paper published in the Journal of Immunology.

When an allergic person eats a peanut, the proteins are absorbed through the intestine and can activate a life-threatening, full-body immune response. Using a mouse model that mimics a life-threatening peanut allergy (which the Northwestern team developed several years ago), researchers attached peanut proteins onto white blood cells called leukocytes and infused those back into the mice. After two treatments, the mice were fed a peanut extract. They did not have the life-threatening allergic reaction because their immune system now recognized the protein as safe.

"Their immune system saw the peanut protein as perfectly normal because it was already presented on the white blood cells," Bryce said. "Without the treatment, these animals would have gone into anaphylactic shock." Bryce thinks that more than one protein can be attached to the surface of the cell and, thus, target multiple food allergies at one time.

"This is an exciting new way in which we can regulate specific allergic diseases and may eventually be used in a clinical setting for patients," said Miller, the Judy Guggenheim Research Professor at the Feinberg School. In an interview with the Chicago Sun-Times, Bryce cautioned that, while the researchers are excited about their progress, "this is not the cure for peanut allergies. We know there's children and parents living with life-threatening peanut allergies, and I'd love to be able to say that. But this is a preclinical study establishing on a mechanistic level something that could be applied to humans."

Dr. Irena Veksler of Allergy & Asthma Care of Fairfield County points out:"This is exciting new research, and represents one of many possible treatments for food allergy on the horizon. Research in humans is needed before we can conclude that this will be effective. For now, the only treatment for food allergy is avoidance."

Allergy & Asthma Care walks in the FAAN food allergy walk

The staff of Allergy & Asthma Care of Fairfield County walked in the FAAN food allergy walk in Milford, CT on Sunday, October 2. There was a great turnout at the event, which raised money for food allergy education and awareness. FAAN is the premier food allergy support and education organization in the country, and can be found at www.foodallergy.org.

Prevalence and severity of food allergies in the US

Previous attempts at quantifying the scope of food allergies among U.S. children have produced a wide range of estimates, from 2% to 8%. From a public health standpoint, getting more details on the main causes of causes of food allergies, and precise demographics of those afflicted, is crucial. A 2011 study published in the journal Pediatrics, “The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States,” analyzed data collected on nearly 40,000 children, as reported by adults in their households. Both unconfirmed cases of allergies that were reported along with convincing evidence and cases confirmed by a medical professional were counted and analyzed.

The study’s findings include:

• 8% of children had at least one food allergy, a projected total of 5.9 million children across the U.S. population
• 2.4% of the children in the study had multiple food allergies, nearly one-third of those with allergies.
• The prevalence of severe food allergies among the children studied was 3.1%, or 38.7% of the children with allergies.
• Peanut allergies were the most common at 2% of the children in the study. The next most prevalent were milk and shellfish, with rates of 1.7% and 1.4%, respectively.
• The likelihood of food allergies among Asian and black children was higher than that for white children. The odds of having a food allergy were “significantly lower” among children in households with annual incomes below $50,000.
• The chances of a confirmed food allergy were lower for black, Hispanic and Asian children compared to white children.
• Severe food allergies were more prevalent among male children and those who had multiple allergies.

Dr. Katherine Bloom of the Food Allergy Center of Connecticut and Allergy & Asthma Care of Fairfield County comments: "We have known for some time that food allergies are on the rise. This study quantifies the significant increases in food allergy that we have been seeing for over a decade."

Peanut reaction due to transfusion

NEW YORK (Reuters Health) - A Sunday night custom of eating peanuts while watching soccer has led to the discovery that what you eat before you give blood can have an impact on the people who receive that blood. A report in the May 19 New England Journal of Medicine concludes that a 6-year-old boy who received a transfusion of platelets suffered a severe allergic reaction because three of the five donors had eaten peanuts the night before their donation.

The researchers said that, for the moment, they are not recommending any changes in blood donation practices.Yet they also cautioned that similar cases may have occurred and gone unreported. The child received the transfusion as part of his treatment for acute lymphoblastic leukemia. He experienced a rash, hypotension, angioedema and difficulty breathing, but recovered from the anaphylactic reaction following resuscitation with adrenaline.

The mother of the boy recalled that he had had a similar reaction after eating peanuts when he was one year old.At that point, investigators went back and interviewed the five donors. Coauthor Dr. Joannes Jacobs of the Radboud University Nijmegen Medical Center in Nijmegen, the Netherlands, told Reuters Health in that three reported eating several handful of peanuts the evening before the donation. One of the three provided the plasma portion of the transfusion, he said.

Why did the three remember when they had eaten peanuts? Coauthor Dr. Elisabeth van Pampus said in an e-mail that the transfusion came only four days after the donation. In addition, said Dr. Jacobs, "On Sunday evening in the Netherlands, the big thing is to watch soccer on the couch, and some people consume peanuts," so they recalled what they had been snacking on.The allergic reaction happened, the researchers said, because the major peanut allergen, known as Ara h2, resists digestion, and it creates a peptide that gets into the blood, detectable for up to 24 hours. The boy had antibodies to both.

Dr. Jacobs said the theoretical possibility of this happening was suggested in 2003, but "this is the first clinical report of this." "It is possible that allergens transferred in blood products to other patients have led to reactions that have gone unexplained and unreported," the researchers warned."We must analyze when this happens and how often it happens," Dr. Jacobs said. "We must create awareness that this phenomenon can take place."Dr. Dan Waxman, president of America's Blood Centers and chief medical officer at the Indiana Blood Center, agreed that in the United States as well, there is a need for a national system to record how often these types of reactions occur.He suspects that a peanut allergy-related reaction is extremely rare. What may be more of a worry, and what blood banks are addressing, he said, is the case of a patient who is allergic to penicillin, for example, getting a transfusion from someone who was taking the drug.

SOURCE: http://bit.ly/jO1EOz

N Engl J Med 2011.

Oral immunotherapy not ready for prime time

From the 2011 Annual meeting of the Academy of Allergy, Asthma, and Immunology(AAAAI):

Immunotherapy may hold the edge for treating children's food allergies but it isn't ready for prime time yet, as presented at the recent AAAAI meeting. In oral immunotherapy, small doses of the allergy-causing food progressively raised to boost immune tolerance can take the form of either a liquid held under the tongue and then swallowed -- sublingual immunotherapy -- or solid forms taken orally.

The oral form is furthest along in clinical studies and also appears more promising for efficacy, leading allergist A. Wesley Burks, MD, of Duke University Medical Center explained to MedPage Today Senior Staff Writer Crystal Phend.His group presented results from the first head-to-head comparison of the two forms of immunotherapy, which suggested oral immunotherapy desensitizes children's milk allergies better than sublingual immunotherapy. But both forms remain experimental for food allergies, Burks said.

The risk of serious reactions when giving children doses of the foods they are allergic to means that these treatments need to be carried out only under careful medical supervision, Burks said. Further study is also needed before widespread use in clinical practice, he warned.

Dr. Kenneth Backman of Allergy & Asthma care points out that immunotherapy to foods is still investigational and requires additional study. "While some studies have been promising, all studies have been small. Much larger studies need to be performed to confirm safety and efficacy before this treatment should be offered outside controlled clinical trials at academic centers. There may be significant risks of side effects, including dangerous allergic reactions and possible new-onset allergic diseases of the gastrointestinal tract, such as eosinophilic esophagitis."

Food allergies cause an ER visit every 3 minutes

Food allergies may cause many more visits to the emergency room than previously believed, according to a new study published in the  Journal of Allergy and Clinical Immunology. The research team, led by Sunday Clark, MPH, of the University of Pittsburgh, found that food-allergic reactions caused more than 7 million ER visits from 2001 to 2005-an average of 203,000 visits each year. Anaphylaxis, a potentially life-threatening reaction, accounted for some 90,000 visits annually. This means that every three minutes, a food-allergic reaction sends an American adult or child to the ER, while an emergency room visit for food-related anaphylaxis occurs every six minutes. A 1999 study estimated that food-induced anaphylaxis resulted in some 30,000 ER visits each year-a third of the number reported in the current study. 

Dr. Katherine Bloom of Allergy & Asthma Care of Fairfield County points out that "all allergic diseases are on the rise, and this is certainly true of food allergy. Whether this increase in ER visits is due to the overall increase in food allergies, or due to a worsening of the reactions that do occur, will require further study. The most important thing is for people to accurately identify their food allergies and carefully avoid those foods. Seeing an allergist is an essential part of this process."

Sesame and nut allergy often occur together

NEW YORK (Reuters Health) - Compared to children without peanut or tree nut allergies, kids who have both these allergies may also be more likely to develop an allergy to sesame seeds, a small study suggests.The researchers linked a history of dual allergic reactions to peanuts and tree nuts with a 10-fold higher risk of allergy to sesame seeds - the tiny seeds that are commonly found in hummus and on hamburger buns.The researchers also looked for a link between nut allergies and coconut allergies, but they did not find one. 

To help sort out these relationships, Dr. Wanda Phipatanakul, of Children's Hospital Boston, and her colleagues studied the medical records of 191 children who had skin prick tests for sesame allergy and 40 who had tests for coconut allergy.About 37 percent and 20 percent of the kids had positive test results to sesame and coconut, respectively, suggesting that their immune systems produced antibodies in reaction to the food. When the researchers looked only at the children who had already proved sensitive to peanuts or tree nuts, between 50 percent and 60 percent showed sensitivity to sesame. Overall, they had a 6- to 10-fold higher risk of sesame sensitivity compared to children who did not have peanut or tree nut sensitivity, the researchers report in the medical journal Pediatric Allergy and Immunology. But just because kids are "sensitized" doesn't mean they are truly allergic, Phipatanakul told Reuters Health in an e-mail. Between 13 percent and 15 percent of peanut and tree nut allergic children were actually allergic to sesame, which turned out to be about the same proportion as among kids who didn't have the nut allergies.The rate of sesame allergy jumped up to 50 percent for children allergic to both nuts, however.

Coconut sensitization or allergy, on the other hand, did not appear to be related to kids' reactions to peanut, tree nut or both." Most patients that are tree nut allergic don't really have to avoid coconut," noted Fleischer. The findings are also consistent with earlier research connecting peanut and sesame allergies, he said. However, both Fleischer and Phipatanakul pointed to limitations in the study, including its small size and lack of food challenges, the "gold standard" for diagnosing food allergies. They noted that more studies are needed to fully understand the relationships."We pretty much know that all food allergies are on the rise, particularly peanut. But this doesn't necessarily say that sesame seed allergy is an epidemic by itself," said Fleischer. "We just know it is associated with peanut, and we need to be aware that patients are at risk and should to be tested for it.""If someone has a concern about any allergy they should always see an allergist," he added. "Any person can react to any food."

SOURCE: http://bit.ly/fFJpbh Pediatric Allergy and Immunology, December 2010.

Reuters Health

New food allergy guidelines published

The National Institute for Allergy and Infectious Diseases (NIAID) has just released its Guidelines for the diagnosis and management of food allergy in the United States ,the much anticipated culmination of a 2-year effort on the part of medical organizations, federal agencies, and patient advocacy groups.

The real value of the guidelines is that they are written not just for allergy specialists, but also for general and specialty practitioners in other fields -- such as primary care, dermatology, gastroenterology or emergency medicine -- who often encounter patients with symptoms or claims of food allergy or food reaction. The guidelines define food allergy and distinguish it from other adverse food reactions, spell out the diagnostic process for potential food allergy (which tests are useful and which are not), and describe the "best practices" for management of food allergy and its symptoms, including anaphylaxis.

Dr. Kenneth Backman of Allergy & Asthma Care points out, "these guidelines will help standardize the approach to food allergy, and help keep all physicians on the same page. They help summarize the current state-of-the-art in food allergy."

Egg allergic patients can safely receive the influenza vaccine

It is influenza season, and current CDC guidelines recommend that all individuals over 6 months of age receive the influenza vaccine. In the past, it was advised that egg allergic patients either skip the vaccine, or be tested by an allergist to determine if they could safely receive the vaccine. Recent guidelines from the American Academy of Allergy, Asthma, and Immunology recommend a protocol whereby nearly all egg allergic patients can safely receive the influenza vaccine. Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County states, "with the recent guidelines, egg allergic patients no longer need worry about an allergic reaction to the influenza vaccine when administered appropriately." Allergy & Asthma Care currently has influenza vaccine available and can administer the vaccine using the latest protocol. Call (203) 259-7070 today.