Food Allergy Center of Connecticut

Oral peanut immunotherapy - promising, but not ready for clinical use

The only treatment for peanut allergy, or any food allergy, is strict avoidance. However, accidental ingestion can lead to reactions, sometimes serious. In the July issue of the Journal of Allergy and Clinical Immunology, Blumchen et al reported a study of oral immunotherapy to peanut and children with a history of peanut induced anaphylaxis.Children underwent a rapid build-up protocol, and then a longer protocol with biweekly dose increases. Eventually, 14 of 23 patients tolerated a protective dose of at least 500 mg of peanut. However, mild to moderate side effects were common, and several reactions occurred. An editorial in the same journal issue, written by some of the most prominent food allergy researchers in the the country, stated the following: "Although everyone involved in patient care and in novel therapeutic research would like a treatment option to offer individuals with food allergy, now is not the right time. Further studies are needed to address...outstanding issues to determine whether this type of therapy is appropriate for clinical use." Some of the outstanding issues raised by the editorialists included the appropriate dosing and dose frequency, the safety of the treatment, and the fact that most studies have excluded those patients with a history of very severe reactions.

Allergy & Asthma Care of Fairfield County points out that, at this time, no type of oral immunotherapy is approved in the United States. All oral or sublingual immunotherapy, whether to foods or environmental allergens, is currently investigational and not proven safe or effective.  If and when these treatments are truly proven safe and effective, and are FDA approved for use in patients, Allergy & Asthma Care will be thrilled to offer them.

Can you outgrow a shrimp allergy?

Shellfish allergies are responsible for most emergency room department visits in food-allergic adults, and have generally been thought to be life-long.  But a new study, conducted by Rosalia Ayuso, MD, and colleagues at Mount Sinai, has found that sufferers may build up a tolerance to shrimp as they grow older.  This is the first study to show that sensitization to shrimp allergens is greater in children than in adults, and that it may decrease with age.  This study was sponsored by the Food Allergy Initiative, and more information about it can be found at the following link.
Read more.

Peanut allergy on the rise

The prevalence of peanut allergy among children tripled between 1997 and 2008, researchers found.Respondents to a telephone survey reported that 1.4% of children had peanut allergies, up from just 0.4% a decade earlier, Scott Sicherer, MD, of Mount Sinai School of Medicine in New York City, and colleagues reported in the May 12 issue of the Journal of Allergy and Clinical Immunology."Although the total population prevalence of self-reported peanut and/or tree nut allergy did not increase among adults since 1997, there was a significant rise in self-reported allergies among children," the researchers wrote.They conducted the phone survey in 2008 and compared those results with two prior surveys they had done -- one in 2002 and the other in 1997.

Peanut and tree nut allergies are the leading causes of fatal allergic reactions and are not typically outgrown, the researchers noted.In 2008, the researchers surveyed 5,300 homes, which included a total of 13,534 individuals.They found that the prevalence of combined peanut and tree allergies among children was 2.1%, compared with 0.6% in 1997.For peanut allergy alone, prevalence was 1.4%, compared with just 0.4% in 1997.Allergies to tree nuts alone increased to 1.1% in 2008, up from 0.2% in 1997.Tree and peanut allergies remained steady among adults, at a rate of 1.3%.The researchers also noted that the prevalence of peanut allergy among U.S. children is similar to estimates from Canada, Australia, and the U.K.

Its increase could be attributable to the "hygiene hypothesis" -- the idea that less exposure to allergens and bacteria in childhood leave the immune system underdeveloped and vulnerable, the researchers speculated.Or it could be the timing of when the food is introduced, or how the food is prepared, the researchers said. Roasted peanuts, for instance, have increased allergenicity because cooking changes the nature of the proteins in the nut.Either way, the prevalence "represents a significant health burden," and the researchers called for better strategies for prevention and treatment, "particularly if we will be seeing a significant increase of these persistent allergies with time."

The study was limited by self-report and problems with identifying "true" allergy.

Food Allergy Awareness Week

This is Food Allergy Awareness Week, and many food allergy support organizations have special programs this week. The Food Allergy Initiative e-mailed the following about their "Give it Up" campaign:

It's Food Allergy Awareness Week, and FAI's new "Give It Up" national advocacy campaign is off to a great start!  Read on to find out how you can help get the word out...join our new online support community...participate in local events...even win an iPad!    

 

The "Give It Up" campaign encourages children, parents, families and friends to show their support for the millions of Americans with food allergies by abstaining from eating a favorite food during the entire week.  As part of the campaign, we invite you to join FAI's Facebook community and write your elected officials in an effort to raise more awareness about the need to find a cure for food allergies.  With the help of friends like you, we've succeeded in raising federal funds for research from $4 million to over $26 million in just six years - but that's far less than the government allocates to other important diseases.  Please write your legislators-it only takes a minute and it will make a huge difference!

The Food Allergy and Anaphylaxis Network has activities for Food Allergy Awareness Week listed on their website at http://www.foodallergy.org/section/food-allergy-awareness-week1.

For further information, or for evaluation or management of food allergies, call the Food Allergy Center of Connecticut at Allergy & Asthma Care of Fairfield County, (203)259-7070.

Zyrtec syrup, Benadryl syrup, and other McNeil products recalled

Zyrtec, Benadryl, and other liquid formulations of McNeil products have been recalled. Attached is a WebMD article about the recall:

May 2, 2010 -- Manufacturing defects have led to the recall of 43 child and infant liquid formulations of Tylenol, Motrin, Zyrtec, and Benadryl by McNeil, a division of Johnson & Johnson. No injuries or deaths have yet been reported.  The voluntary recall follows an April 19 FDA inspection of a McNeil plant in Fort Washington, Pa. that uncovered "manufacturing deficiencies," the Washington Post reports. The company says the chances of injury from one of the recalled products are "remote." Yet consumers are warned not to use the recalled products." Some of the products included in the recall may contain a higher concentration of active ingredient than is specified; others may contain inactive ingredients that may not meet internal testing requirements; and others may contain tiny particles," a company news release states. If children who have taken the recalled products have unusual symptoms, parents are urged to contact a health care professional.

Parents should not give children adult formulation of the medications. Alternative brands of the products, including generic medications, are available. Parents who have questions about alternative treatments should consult their child's pediatrician or other health care professional. Recalled products may be returned for a refund or exchanged for a fresh product once manufacturing issues have been resolved.

Please see this link for further information about the recall: www.mcneilproductrecall.com/

The doctors at Allergy & Asthma Care can assist in choosing appropriate medications for your child. Call (203) 259-7070 to schedule an appointment.

Oral immunotherapy to peanut looks promising

Early results of an ongoing research study were presented at the American Academy of Allergy, Asthma, and Immunology conference last month. In all, 39 children have participated in the ongoing study, which Dr. Burks characterized as an open-label pilot trial. The ongoing study protocol -- with 33 currently enrolled -- began when children were two to five years old. They initially received tiny doses of peanut flour, less than one milligram. The children took steadily increasing amounts of peanut until, eight to ten months later, they could tolerate up to 15 peanuts per day. Treatment continued at that level, Dr. Burks said, with periodic challenges to confirm the youngsters' ability to tolerate peanut products. The researchers -- including scientists at the University of Arkansas in Little Rock -- have determined that children successfully treated showed significantly decreased serum levels of peanut-specific immunoglobulin E. Withdrawal of the immunotherapy has now begun to be tested in participants with very low peanut IgE, less than 2 kU/L. Five of nine children who had been on treatment for at least 2.5 years passed an oral food challenge test. Researchers then stopped their immunotherapy for a month, followed by a second challenge test.  It was successful in all cases, Dr. Burks said, and the children now are under no diet restrictions and eat peanut-containing foods daily. "They are months out and they are doing fine," he said.

Dr. Burks emphasized that this study was small and the technique used remains experimental. Dr Kenneth Backman, of Allergy & Asthma Care of Fairfield County, states "these results are very exciting, and we are hopeful that this may lead to treatments in the future." However, he points out that "this procedure is still experimental, the risks are not fully known, and there remains the risk of a severe, possibly fatal reaction. This should not be performed outside a research setting."

Allergy blood tests - easy to order, hard to interpret

The allergy blood test, often called the RAST, tests for the presence of allergic antibody, or IgE, in the blood. Over the past several years, this test has become increasingly popular. While the allergy blood test has become more accurate over the years, and can be useful in diagnosing allergies, particularly food allergies, it has its limitations. The blood test is often best used in conjunction with allergy skin testing, which is more sensitive. Contrary to what some people think, the allergy blood test does not give a yes or no answer about whether someone has an allergy. Rather, the blood test gives a statistical likelihood of whether or not an allergy exists, and falsely positive tests are common. Interpretation of allergy test results depends upon the medical history of the patient, and upon the experience and expertise of the physician who ordered the test. When the skin and blood test are inconclusive, oral challenges to foods can
help with diagnosis of food allergy. Board certified allergists have the best training and experience for interpreting allergy test results. A recent article in the Wall Street Journal discusses the limitations of food allergy testing and the importance of correct interpretation of the results. Please click here to see the full article.

Egg allergic patients can safely receive flu vaccine

Both the H1N1 and seasonal influenza vaccines are made using chicken eggs. Because of this, egg allergic patients are warned not to receive the vaccines. However, the amount of egg allergen in the vaccine varies from lot to lot, and egg allergic patients can be skin tested with the vaccine to determine whether it can safely be administered. Even patients who test positive to the vaccine can usually receive the vaccine safely, through a desensitization procedure. The Food Allergy Center of Fairfield, a division of Allergy & Asthma Care of Fairfield County, offers expertise in the area of food allergy, and we have safely vaccinated many hundreds of egg allergic patients. We currently have H1N1 vaccine in stock, and appointments are available at our Fairfield and Monroe offices. Call (203) 259-7070.

Food allergies on the rise in children

Food allergies in children, including peanut allergy, have increased by nearly 20% in the last 10 years, and certain ethnic groups may be harder hit than others.A new study shows reports of food allergies in children rose by 18% from 1997-2007 while ambulatory care visits to treat food-allergy-related illnesses have tripled in recent years.

Researchers say many reports have suggested that food allergies in children are on the rise, but few resources are available to make reliable estimates.In their study, published in Pediatrics, researchers analyzed information from national health surveys that included information on parent-reported children's food allergies, visits to ambulatory care clinics for treatment of allergies, and allergy-related health care usage from 1993 to 2007.

The results showed that in addition to an 18% increase in parent-reported food allergies among children under the age of 18, visits to ambulatory care clinics for allergy-related illnesses increased from an estimated 116,000 per year in 1993-1997 to an estimated 317,000 per year in 2003-2006.

"Reported food allergy is increasing among children of all ages, among boys and girls, and among children of different races/ethnicities," write researcher Amy M. Branum, MSPH, of National Center for Health Statistics at the CDC, and colleagues in the study."However, it cannot be determined how much of the increases in estimates are truly attributable to increases in clinical disease and how much are attributable to increased awareness by physicians, other health care providers, and parents."

The Food Allergy Center of Connecticut, a division of Allergy & Asthma Care of Fairfield County, offers comprehensive diagnosis and management of adults and children with Food Allergies. Call today for an appointment with Dr. Backman, Dr. Bloom, or Dr. Veksler.

Branum, A. Pediatrics, December 2009.

Food allergy awareness key to successful managment in schools

Food allergy is a growing safety concern across the United States and creates challenges for all educators and parents in our nation’s schools. As the State of Connecticut begins another school year, it is important to point out that public awareness about the seriousness of food allergies is growing. Connecticut is a national leader in developing food allergy management plans and State legislation to promote the safety and well-being of children with severe food allergy. By working collaboratively, with the school staff, other parents, students, and family physicians, parents of children with food allergy can promote a safe and successful school experience for every child.

In 2006, the Connecticut State Department of Education in conjunction with the State Department of Public Health has developed Guidelines for Managing Life-Threatening Food Allergies in Connecticut Schools to assist Connecticut schools in effectively managing the health and safety needs of children with life-threatening food allergies. Connecticut law requires each public school district to "implement a plan based on the guidelines for the management of students with life-threatening food allergies.” In 2009, Governor Rell signed into law legislation to further promote the safety of children with severe food allergy in Connecticut.  The legislation requires every Connecticut public school district to make its plan available on every School Board of Education’s or school’s Web site or publically available if no web sites exist, and it must provide annual notice of the plan’s implementation to the State Department of Education, as well as to parents and guardians.

The following are key links regarding the issues:

CT Guidelines:  http://www.sde.ct.gov/sde/lib/sde/PDF/deps/student/health/Food_Allergies.pdf

CT Act 09-155:  http://www.cga.ct.gov/2009/ACT/PA/2009PA-00155-R00SB-00755-PA.htm

The Food Allergy Initiative:  http://www.faiusa.org