Dr George Du Toit Allergy Clinic Blog

Allergies, Asthma and Winter Holidays

2011-12-14T05:19:00.000-08:00

For sensible advice on managing your food allergies over the coming holidays see tips on the AAAAI websites, as well as other charities such as the UK Anaphylaxis Campaign

Causes of ant sting anaphylaxis

2011-12-14T05:15:00.001-08:00

This study determined the Australian native ant species associated with ant sting anaphylaxis, geographical distribution of allergic reactions, and feasibility of diagnostic venom-specific IgE (sIgE) testing. 376 participants reported 735 systemic reactions. Of 299 participants for whom a cause was determined, 265 had reacted clinically to Myrmecia species and 34 to green-head ant (Rhytidoponera metallica). Of those with reactions to Myrmecia species, 176 reacted to jack jumper ant (Myrmecia pilosula species complex), 18 to other jumper ants (15 to Myrmecia nigrocincta, three to Myrmecia ludlowi) and 56 to a variety of bulldog ants, with some participants reacting to more than one type of bulldog ant. Variable serological cross-reactivity between bulldog ant species was observed, and sera from patients with bulldog ant allergy were all positive to one or more venoms extracted from Myrmecia forficata, Myrmecia pyriformis and Myrmecia nigriceps. Therefore 4 main groups of Australian ants cause anaphylaxis. Ser um sIgE testing enhances the accuracy of diagnosis and is a prerequisite for administering species-specific venom immunotherapy.

Brown SG, van EP, Wiese MD, Mullins RJ, Solley GO, Puy R, Taylor RW, Heddle RJ.
Causes of ant sting anaphylaxis in Australia: the Australian Ant Venom Allergy Study.
Med J Aust 2011 Jul 18;195(2):69-73

Spice allergy. A review

2011-12-14T05:13:00.000-08:00

Spice allergy seems to be rare, reportedly affecting between 4 and 13 of 10,000 adults and occurring more often in women because of cosmetic use. No figures were available on children.

Most spice allergens are degraded by digestion; therefore, IgE sensitization is mostly through inhalation of cross-reacting pollens, particularly mugwort and birch. The symptoms are more likely to be respiratory when exposure is by inhalation and cutaneous if by contact. Studies on skin testing and specific IgE assays are limited and showed low reliability.

The diagnosis primarily depends on a good history taking and confirmation with oral challenge. The common use of spice blends makes identifying the particular offending component difficult, particularly because their components are inconsistent.

Chen JL, Bahna SL.
Spice allergy.
Ann Allergy Asthma Immunol 2011 Sep;107(3):191-199

Allergy Food Labelling

2011-07-12T11:49:00.000-07:00

The current legislation on general food labelling dates back to 1978 and nutrition labelling rules were adopted in 1990. Consumer demands and marketing practices have changed significantly since then. EU consumers want to be better informed when purchasing food and to have labels that are simple, legible, understandable and not misleading. PLease see link below for updated that will hopefully assist food allergic patients and their families in making informed decisions on the food they buy within the EU

Questions and Answers on the Food Information regulation

The Prevalence, Severity, and Distribution of Childhood Food Allergy in the US

2011-06-23T14:48:00.000-07:00

Pediatrics. 2011 Jun 20. The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States.
Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, Holl JL.

Objective: The goal of this study was to better estimate the prevalence and severity of childhood food allergy in the United States. Methods: A randomized, cross-sectional survey was administered electronically to a representative sample of US households with children from June 2009 to February 2010. Eligible participants included adults (aged 18 years or older) able to complete the survey in Spanish or English who resided in a household with at least 1 child younger than 18 years. Data were adjusted using both base and poststratification weights to account for potential biases from sampling design and nonresponse. Data were analyzed as weighted proportions to estimate prevalence and severity of food allergy. Multiple logistic regression models were constructed to identify characteristics significantly associated with outcomes. Results: Data were collected for 40 104 children; incomplete responses for 1624 children were excluded, which yielded a final sample of 38 480. Food allergy prevalence was 8.0% (95% confidence interval [CI]: 7.6-8.3). Among children with food allergy, 38.7% had a history of severe reactions, and 30.4% had multiple food allergies. Prevalence according to allergen among food-allergic children was highest for peanut (25.2% [95% CI: 23.3-27.1]), followed by milk (21.1% [95% CI: 19.4-22.8]) and shellfish (17.2% [95% CI: 15.6-18.9]). Odds of food allergy were significantly associated with race, age, income, and geographic region. Disparities in food allergy diagnosis according to race and income were observed. Conclusions: Findings suggest that the prevalence and severity of childhood food allergy is greater than previously reported. Data suggest that disparities exist in the clinical diagnosis of disease.

Dietary baked milk accelerates the resolution of cow's milk allergy in children.

2011-06-21T07:03:00.001-07:00

Dietary baked milk accelerates the resolution of cow's milk allergy in children.
The majority (approximately 75%) of children with cow's milk allergy tolerate extensively heated (baked) milk products. This study reports on the outcomes of children who incorporated baked milk products into their diets. Children evaluated for tolerance to baked milk (muffin) underwent sequential food challenges to baked cheese (pizza) followed by unheated milk. Over a median of 37 months (range, 8-75 months), 88 children underwent challenges at varying intervals. Among 65 subjects initially tolerant to baked milk, 39 (60%) now tolerate unheated milk, 18 (28%) tolerate baked milk/baked cheese, and 8 (12%) chose to avoid milk strictly. Among the baked milk-reactive subgroup (n = 23), 2 (9%) tolerate unheated milk, and 3 (13%) tolerate baked milk/baked cheese, whereas the majority (78%) avoid milk strictly. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk-reactive subjects. Subjects who incorporated dietary baked milk were 1 6 times more likely than the comparison group to become unheated milk tolerant. Median casein IgG(4) levels in the baked milk-tolerant group increased significantly; median milk IgE values did not change significantly. Tolerance of baked milk is a marker of transient IgE-mediated cow's milk allergy, whereas reactivity to baked milk portends a more persistent phenotype.

Kim JS, Nowak-Wegrzyn A, Sicherer SH, Noone S, Moshier EL, Sampson HA.
Dietary baked milk accelerates the resolution of cow's milk allergy in children.
J Allergy Clin Immunol 2011 May 20;

Surrey Allergy Clinics

2011-04-15T05:44:00.000-07:00

Dr Du Toit is delighted to announce that he has - in addition to clinics at The Portland Hospital - now commenced clinics in the Harley Street Clinic at The Groves. This clinic will offer easy transport links to areas such as Wimbledon, Kingston, Teddington, Esher, Walton, Weybridge, Cobham....

For diagnosis and management of: Food Allergy, Weaning difficulties, Asthma, Eczema, Allergic Rhinitis, Allergic Conjunctivitis, Antibiotic Allergy, Urticaria, Chronic Urticaria

Immunotherapy

Appointments

Pollen aggravates atopic dermatitis in patients with allergic rhino conjunctivitis.

2011-04-04T08:40:00.001-07:00

It is not uncommon for eczematous skin to 'flare' during the high pollen season. This is nicely demonstrated in the presentation below.

Cedar pollen aggravates atopic dermatitis in patients with allergic rhino conjunctivitis. A 7-year-old monozygotic twin patients with atopic dermatitis. Both serum IgE levels and cedar pollen RAST scores were high in the twins (elder/younger sister: IgE: 5170/3980IU/ml and Japanese cedar pollen: >100/64.0) in contrast to low mite and food RAST scores. The patients showed positive immediate (20 min in both sisters) and delayed (24 hours in elder sister, 24, 48, 72 hours in younger sister) reactions to a scratch test with Japanese cedar pollen. Skin lesions on the face were aggravated and extended to the trunk and extremities during the Japanese cedar pollen season and gradually subsided in summer. Oral provocation with egg white or cow milk showed no exacerbations, and topical corticosteroid did not improve the eczema. In contrast, successful protection from severe scratching behaviors was achieved by use of topical anti-allergic eye drops and wearing nightgowns made by the mother.

Murakami Y, Matsui S, Kijima A, Kitaba S, Murota H, Katayama I.
Cedar pollen aggravates atopic dermatitis in childhood monozygotic twin patients with allergic rhino conjunctivitis.
Allergol Int 2011 Mar 25;

Tomato allergy and tomato skin irritation

2011-04-04T08:39:00.001-07:00

Patients who are sensitive to tomato usually experience variable symptoms/irritation depending on the tomato variety and/or the processing of the food e.g. cooked, refrigerated... These differences are nicely described in the publication below.

Tomato allergens of six different varieties. The prevalence of sensitization to tomato has been estimated in 6.5% in a Mediterranean population. This study characterized the allergenic profile of 6 commonly ingested varieties of tomato and identified and quantified the most representative allergens. Rama, Rambo, Canario, Kumato, Pera and Raf tomato varieties were carefully peeled and extracts from peel and pulp prepared. Lyc e 3 and osmotin-like protein (OLP) were identified. Protein content and allergen concentration (Lyc e 3 and PG2A) were measured. Of 191 patients enrolled 80 (41.7%) reported symptoms after contact/ingestion with tomato, most of them oral symptoms. Protein profile and allergen quantification of the 6 varieties showed differences in the allergen composition. Lyc e 3 was found in all extracts, being the most abundant in all cases. PG2A and OLP were identified in all peel extracts and in some pulp extracts. Higher specific IgE values were obtained for the Kumato variety. Immunoblot showed the existence of several bands with IgE-bindi ng capacity, especially at 12 and 45-50 kDa. Therefore differences in the antigenic and allergenic profiles of the analyzed varieties and variations in their allergenic composition will affect the diagnostic capacity. LTP and PG2A are important tomato allergens in this population but other IgE-binding capacity proteins were also involved.

Lopez-Matas MA, Larramendi CH, Ferrer A, Huertas AJ, Pagan JA, Garcia-Abujeta JL, Bartra J, Andreu C, Lavin JR, Carnes J.
Identification and quantification of tomato allergens: in vitro characterization of six different varieties.
Ann Allergy Asthma Immunol 2011 Mar;106(3):230-238

Joint statement on the timing of introduction of gluten into the infant diet and the subsequent risk of developing coeliac disease and/or diabet

2011-03-11T02:48:00.000-08:00

The SACN/COT have just published their joint statement on the timing of introduction of gluten into the infant diet and the subsequent risk of developing coeliac disease and/or type 1 diabetes.A full version of the statement can be found on the COT or SACN website: -

In addition the FSA has published a news story to highlight the publication of this statement and the Government advice to consumers

'Tree pollen season' is upon us

2011-03-04T05:47:00.000-08:00

The tree pollen season is already upon us with many patients experiencing early symptoms. You may wish to keep an 'eye' on local pollen reports, most of which only start reporting from later on in March. Anticipate more severe symptoms when levels are higher and ensure medications such as non-sedating antihistamines are taken in advance. Immunotherapy is available as a curative approach for those with moderate to severe grass and/or tree pollen allergies.

Barcode Scanning App for those with Food Allergies/Intolerances

2011-03-04T05:33:00.000-08:00

You may wish to trial this new App designed to scan barcodes on foods in order to assess for allergen constituents. Early observations are that it takes longer to scan and await the result than simply reading the label; nonetheless it is an important advance towards assisting safe shopping for those with food allergies.

Dr Du Toit has no COI or commercial link with this product.

London Easter Treasure Hunt for Allergic Children

2011-03-01T02:09:00.001-08:00

3 April, 10am-1pm - London Easter Treasure Hunt for Allergic Children. This event will be held in a non-food environment and is open to the entire family, but best suited for children aged five years and younger. Please visit the UK Anaphlaxis Campagn website for the poster with more details.

NICE guidelines for diagnosing and treating food allergy in children and young people

2011-02-23T06:29:00.000-08:00

The National Institute for Health and Clinical Excellence (NICE) has released guidelines for diagnosing and treating food allergy in children and young people.

These guidelines stress that a clinical history of the food allergy taken by a competent practitioner is most important in diagnosing an allergy and that allergy tests, done in isolation, can be misleading. Skin Prick tests and specific IgE testing on a blood sample are the most reliable food allergy tests available. Diagnosing food allergies and intolerances using Vega testing, applied kinesiology, hair analysis, leucocytotoxic testing and IgG blood tests are inaccurate and should be discouraged.

Food allergies are adverse immune responses to food allergens and are among the most common of the allergic disorders and are recognised as a major paediatric health problem in western countries. Reactions can be extremely severe; hospital admissions in the UK for food allergies have increased by 500%since 1990, and there has been a dramatic increase in prevalence in the last twenty years, ranging from 6% to 8% in children up to the age of 3 years across Europe and North America. The most common foods to which children and young people are allergic include cow's milk; fish and shellfish; hen's eggs; peanuts, tree nuts and sesame; soy; wheat and kiwi fruit.

Food allergies in children can result in a number of symptoms, therefore the guideline recommends that the condition should be considered if the child has one or a combination of the following, including:

skin conditions such as eczema or acute urticaria (itchy rash)
respiratory complaints such as sneezing or shortness of breath
gastrointestinal problems such as vomiting, difficulty swallowing or constipation
anaphylaxis (severe, hyper-sensitive reaction) and other allergic reactions.
Food allergies should also be considered in children who are not adequately responding to treatment for atopic (allergic) eczema, gastro-oesophageal reflux disease (where stomach contents leak out of the stomach and into the oesophagus), and chronic constipation.

If a food allergy is suspected, the GP or other healthcare professional should take an allergy-focused clinical history, tailored to the presenting symptoms and age of the child or young person. This should include a family history of allergies, an assessment of the symptoms, and feeding history as an infant. A physical examination should pay particular attention to growth, and physical signs of malnutrition.

The guideline also recommends offering the appropriate information based on the type of allergy suspected, the risk of allergic reaction, and the diagnostic process which may include excluding specific foods from the diet, reintroducing these foods with reoccurrence of the allergic reaction confirming diagnosis. Diagnosis may also include skin prick and blood tests for IgE (immunoglobulin) antibodies; specific antibodies suggest particular allergic reactions. Alternative methods of diagnosis such as hair analysis and kinesiology are not recommended. Referral to secondary care should be considered if the child has ongoing problems including faltering growth, vomiting, abdominal pain, loose or frequent stools, or constipation.

December 13, 2010 — Sublingual immunotherapy may be safe and effective for allergic rhinitis, according to an updated review reported online December

2011-01-11T03:50:00.000-08:00

Allergic rhinitis has been reported in up to 40% of people worldwide. According to the 2008 guidelines on Allergic Rhinitis and its Impact on Asthma (ARIA), published in the April 2008 supplemental issue of Allergy, specific immunotherapy is recommended for patients with severe allergic rhinitis who do not respond to allergen avoidance and pharmacotherapy.

The 2003 Cochrane Review of sublingual immunotherapy for allergic rhinitis by Wilson and colleagues, published in the 2003 issue of the Cochrane Database of Systematic Reviews, included 22 randomized, placebo-controlled trials. Sublingual immunotherapy was noted to be effective and was not associated with systemic reactions.

This update of the 2003 Cochrane Review evaluates the efficacy and safety of sublingual immunotherapy for allergic rhinitis in adults and children.

Study Highlights
•A search of the literature included the Cochrane ENT Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, CINAHL, LILACS, KoreaMed, IndMed, PakMediNet, CAB Abstracts, Web of Science, BIOSIS Previews, China National Knowledge Infrastructure, Current Controlled Trials, International Clinical Trials Registry Platform, Google, reference lists, and other sources for published and unpublished data through August 14, 2009.
•Inclusion criteria were randomized, double-blind, placebo-controlled clinical trials that assessed the efficacy and safety of sublingual immunotherapy in adults and children with allergic rhinitis and a Jadad score greater than 3 of 5.
•60 studies were identified.
•49 studies were included in the efficacy meta-analysis.
•11 studies lacked efficacy data but had adverse event data.
•Subjects had allergic rhinitis with or without allergic conjunctivitis or allergic asthma.
•Allergens were identified by skin prick tests or high specific immunoglobulin E results.
•34 studies had adult participants, and 15 studies had children as participants.
•The primary outcome measures were symptom scores and medication scores.
•Symptom scores were assessed by diaries, visual analog scales, number of well days, or overall assessment.
•Medication scores assessed the use of antihistamine tablets, nasal sprays, and eye drops.
•Secondary outcome measures were serum immunoglobulin E and immunoglobulin G levels; allergen sensitivity of the eye, nose, or skin; and reports of adverse events.
•Subgroup analysis was conducted for seasonal vs perennial allergens, children vs adults, major allergen dose (< 5 μg vs 5 to 20 μg vs > 20 μg), duration of immunotherapy (< 6 months vs 6 - 12 months vs 12 months), individual allergens (house dust mite, grass pollen, Parietaria, ragweed, tree), sublingual spit vs swallow, and sublingual drops vs tablets.
•Symptom scores improved more in 2333 patients receiving sublingual immunotherapy vs 2256 patients receiving placebo. The SMD was −0.49 (P < .00001), based on 49 studies.
•Medication scores improved more in 1737 patients receiving sublingual immunotherapy vs 1642 patients receiving placebo (SMD, −0.32; P < .00001), based on 38 studies.
•Serum-specific immunoglobulin E levels increased in 675 patients receiving sublingual immunotherapy vs 659 patients receiving placebo (SMD, 0.27; P = .05), based on 14 studies.
•Total serum-specific immunoglobulin G levels increased in 286 patients receiving sublingual immunotherapy vs 304 patients receiving placebo (SMD, 0.95; P < .00001), based on 3 studies.
•Serum-specific immunoglobulin G4 levels increased in 588 patients receiving sublingual immunotherapy vs 599 patients receiving placebo (SMD, 0.46; P < .00001).
•Allergen sensitivity, measured by skin prick test results and nasal reactivity, did not significantly differ between the sublingual immunotherapy group and the placebo group.
•25 studies could not be included in adverse event analysis.
•Local adverse events, including labial edema, buccal pruritus, buccal or lingual edema, and throat irritation, were more common in the sublingual immunotherapy group vs the placebo group.
•Adverse events leading to treatment discontinuation occurred in 41 of 824 patients in the sublingual immunotherapy group and 12 of 861 patients in the placebo group, with local reactions occurring more than systemic reactions.
•No adverse events required adrenaline use.
•No fatalities occurred.
•Systemic adverse events were mild or moderate.
•No severe systemic adverse events or anaphylaxis events occurred.
•Subgroup analysis of symptom scores showed more improvement in the sublingual immunotherapy group vs the placebo group for all subgroups except for a major allergen content of less than 5 μg.
•Subgroup analysis of medication scores showed more improvement in the sublingual immunotherapy group vs the placebo group for all subgroups except for perennial allergens, children, house dust mite allergen, and sublingual drops.

Clinical Implications
•In adults and children with allergic rhinitis, sublingual immunotherapy is effective in reducing symptoms and the need for medication.
•In adults and children who receive sublingual immunotherapy for allergic rhinitis, reported adverse events include local and systemic mild and moderate events, but no severe systemic reactions, anaphylaxis, or the need for adrenaline.

Characterizing the relationship between sesame, coconut, and nut allergy in children.

2011-01-07T05:02:00.000-08:00

This study examined whether children allergic to peanuts and tree nuts are at increased risk of having an allergy to sesame or coconut. A retrospective chart review of children who underwent skin prick testing (SPT) to sesame and coconut was performed and 191 children identified who underwent SPT to sesame and 40 to coconut. Sensitization to sesame was more likely in children with positive SPT to peanuts (OR = 6.7) and tree nuts (OR = 10.5). Children with histories of both peanut and tree nut reaction were more likely to have a history of sesame reaction (OR = 10.2). Children with sensitization or allergy to peanuts or tree nuts were not more likely to be sensitized or allergic to coconut. In conclusion, children with peanut or tree nut sensitization were more likely to be sensitized to sesame but not coconut.

Stutius LM, Sheehan WJ, Rangsithienchai P, Bharmanee A, Scott JE, Young MC, Dioun AF, Schneider LC, Phipatanakul W.
Characterizing the relationship between sesame, coconut, and nut allergy in children.
Pediatr Allergy Immunol 2010 Dec;21(8):1114-1118

The role of shellfish proteases in allergic diseases and inflammation

2011-01-07T04:58:00.000-08:00

"This review outlines the different roles of proteases in allergic and inflammatory reactions. Preliminary data from our group demonstrate for the first time the presence of four types of proteases in rock lobster and two shrimp species. Trypsin-like activity seems to be the major enzyme action in all three shellfish species, with the highest proteolytic activity occurring under physiological conditions similar to those of the lung environment. This study is the foundation for further investigations into the role of proteases in allergic and inflammatory reactions towards exposure to shellfish allergens in the occupational and domestic environment."

S Sun, A.L Lopata
The role of shellfish proteases in allergic diseases and inflammation.
Current Allergy and Clinical Immunology 2010;23(4):174-179

Celiac disease (CD) is a gluten-dependent immune-mediated disease with a prevalence in the general population estimated between 0.3% and 1.2%.

2011-01-07T04:56:00.000-08:00

Cutting-edge issues in celiac disease and in gluten intolerance.
"Celiac disease (CD) is a gluten-dependent immune-mediated disease with a prevalence in the general population estimated between 0.3% and 1.2%. Large-scale epidemiological studies have shown that only 10-20% of cases of CD are identified on the basis of clinical findings and that laboratory tests are crucial to identify subjects with subtle or atypical symptoms. The correct choice and clinical use of these diagnostic tools may enable accurate diagnosis and early recognition of silent CD cases. In this review, we have considered some relevant aspects related to the laboratory diagnosis of CD and, more extensively, of gluten intolerance, such as the best combination of tests for early and accurate diagnosis, the diagnostic role of new tests for detecting antibodies against neoepitopes produced by the transglutaminase-gliadin complex, the forms of non-celiac gluten intolerance (gluten sensitivity), and the use and significance of measuring cytokines in CD."

Bizzaro N, Tozzoli R, Villalta D, Fabris M, Tonutti E.
Cutting-edge issues in celiac disease and in gluten intolerance.
Clin Rev Allergy Immunol 2010 Dec 23;

Optimum duration of dust mite sublingual immunotherapy (SLIT).

2010-12-29T01:32:00.000-08:00

There is an increasing body of evidence to support the use of Sub Lingual Immunotherapy for the treatment of House Dust Mite Allergy, it may however be that a 4an style="font-weight:bold;">-year course of sublingual immunotherapy (SLIT) would be the optimum duration for allergic rhinitis patients sensitised to dust mite allergens.

Recently, Marogna M, Spadolini I, Massolo A et al. Long-lasting effects of sublingual immunotherapy according to its duration: A 15-year prospective study. Journal of Allergy and Clinical Immunology investigate the long-term effects of SLIT, and the optimal duration of treatment, by studying 78 patients aged 18-65 years, with allergic rhinitis (with or without asthma), who were monosensitized to dust mites.

The participants were divided into four groups to receive mite-specific SLIT plus drug therapy for 3 (n=19), 4 (n=21), or 5 years (n=17), or drug therapy alone (controls; n=21). Clinical benefit, based on the frequency and severity of symptoms, were assessed every year during the winter months over a follow-up period of 15 years. During this time, 10 patients receiving SLIT and nine controls dropped out of the study. There was no significant change in clinical scores among the 12 controls. In patients receiving SLIT, a significant clinical benefit was observed after just 1 year, which persisted for 7 years among patients who received SLIT for 3 years, and 8 years among those who received SLIT for 4 or 5 years. After loss of clinical benefit, patients in the SLIT groups received a second course of treatment, and this induced a benefit more rapidly than the first course. All patients in the control group developed a new skin sensitization during the follow-up period compared with just 21%, 12%, and 11% of patients who received SLIT for 3, 4, and 5 years, respectively.

They concluded that under the present conditions, it can be suggested that a 4-year duration of SLIT is the optimal choice because it induces a long-lasting clinical improvement similar to that seen with a 5-year course and greater than that of a 3-year vaccination.

Videos for teenagers with food allergies

2010-12-12T09:08:00.000-08:00

Anaphylaxis Canada has a new YouTube channel featuring a collection of five short clips dealing with common social situations faced by teens:

Dating with Food Allergies
Food Allergies and High School
Dining Out with Food Allergies
Eating Safely with Food Allergies
Travelling with Food Allergies

http://www.youtube.com/anaphylaxiscanada

These topics are sensitively and excellently covered in an age-appropriate manner, well worth a visit for the food-allergic teenager.

Eczema and allergies - New Website & Blog

2010-11-05T02:46:00.000-07:00

If your child has eczema and allergies you may wish to visit the recently launched Spottybaby.com - the aim of the site is to share a families experience and provide information and news about eczema and allergies through a blog and weekly podcast.

Spotty Baby is not intended to be a medical site or give any therapeutic advice but provide assistance to help parents as they address the issues that can arise on a day-to-day basis. The site aims to be personal, a little light-hearted and supportive.

Improving posture in young children - Physifun program

2010-11-02T08:22:00.000-07:00

You may wish to have a look at this exciting new Physiotherapy based program - www.physifun.co.uk. The possible benefits of the program are enormous and i believe a worthwhile undertaking, especially for sedentary children, or for children and young people with chronic asthma (were posture is not optimal).

Up to the age of 4, physiologically "good" posture, is present. Postural decline starts with entry to school. Most secondary school-aged children have poor posture (Fairbank et al, 1984; Nissien et al, 1994). Children sit for an average of 35-40 hours a week. After 15-25 minutes, children need a movement break, otherwise concentration suffers (due to muscle fatigue and or pain)(Breithecker, D – Teaching with exercise). Back problems and postural problems are on the increase (Gardner et al, 2005). Over 50% of 13-18 year olds suffer from LBP (Jones et al, 2001). Carrying 15% of body weight can cause spinal damage (Korovessis et al, 2004; Negrini et al, 1999). Evidence has shown that adolescents carry between 10% and 33% of their body weight in their school rucksacks (Forjuoh et al, 2003).

“Can early introduction of egg prevent egg allergy in infants? A population-based study”

2010-10-06T02:39:00.000-07:00

Early introduction of egg might protect against egg allergy. Until recently, international guidelines for infants from allergic families recommended delaying the introduction of allergenic foods, including egg and peanut, to prevent the development of allergies. Koplin et al, as reported in this issue of the JACI, studied more than 2500 infants recruited from the general population to assess whether timing of infant feeding milestones were associated with increased or decreased risk of egg allergy. The authors found that infants who introduced egg after 12 months of age were 3 times more likely to have challenge-proven egg allergy at 14-18 months of age than those who were introduced to egg at 4-6 months of age. This association occurred irrespectively of whether there was a personal history of eczema or family history of allergy. In particular, ingestion of cooked egg at 4-6 months demonstrated a more protective effect than first ingestion with egg in baked goods at this time. There was no association between duration of breast-feeding or timing of introduction of first solids and egg allergy. This study suggests that introduction of cooked egg at 4-6 months of age does not increase the risk of egg allergy and might even be protective against its development.

“Can early introduction of egg prevent egg allergy in infants? A population-based study” JACI October 2010 / Volume 126, No. 4

Food allergy in children and young people: scoping workshop, consultation and final scope

2010-09-05T06:01:00.000-07:00

You may be interested in reading through and commenting on these NICE recommendations; to do so feedback to Allergy stakeholders listed on the site

Parents warned to avoid 'alternative' allergy tests for children

2010-08-09T04:38:00.000-07:00

newspaper article

The NHS standards watchdog (NICE) say there is no evidence to support "alternative" tests to which many parents have turned in desperation, after their GPs failed to help.

The National Institute for Health and Clinical Excellence (NICE)'s first guidance on children's food allergies will say GPs need to act much more quickly to investigate common childhood complaints which could be triggered by diet.

The watchdog describes a 500 per cent increase in hospital admissions for food allergies in the UK since 1990. Its guidelines will cite research showing that up to 8 per cent of children under the age of three now suffer from some kind of food complaint.

While immediate allergies can be shown by blood or skin prick tests, establishing a delayed allergic reaction is much more difficult.

NICE will say "alternative" tests such as hair analysis, kinesiology, which measures muscle strength as a person lies next to a suspected allergen, and "vega" tests which measure electrical activity should not be used. The guidelines will also warn against the use of 'IgG' antibody tests promoted by commercial firms in clinics and via the internet.

Experts who drew up the guidelines said desperate parents turned to such methods because they appeared to offer certainty in diagnosing delayed reactions to food, when the NHS could only offer "a slow and laborious process" of eliminating foods one by one until the culprit was identified.

The draft guidelines, being published for consultation, will say GPs need to start such investigations sooner, and that the "alternative" tests being offered for delayed reactions should not be used.

New pea bulking agent, beware if pea allergic

2010-05-05T09:30:00.000-07:00

If allergic to pea's you may wish to be made aware of a product designed as a 'bulking' ingredient, possibly at levels where it won't easily be tasted. Although it should be labelled as 'pea protein' or similar on the packet and in the 'contains' box, this may not be the case. Like lupin, it could be a beige flour which goes unrecognised by many and unlike lupin, the law won't require it to be identified as a major allergen.

Highate Allergy Support Group, London

2010-04-21T02:23:00.000-07:00

Herewith, notification of a support group, commencing in Highgate London, for parents of allergic children (Babies to under 5yr old's). If interested please email allergykidz@yahoo.co.uk

Allergy Alerts - Free service from FSA

2010-04-21T01:57:00.001-07:00

The FSA in the UK offers an excellent 'Allergy Alerts' service'

Sometimes foods have to be withdrawn or recalled if there is a risk to consumers because the allergy labelling is missing or incorrect or if there is any other food allergy risk.

In such situations, if you subscribe, the FSA will issue an Allergy Alert.

Allergen-free places to eat in UK

2010-04-21T01:41:00.000-07:00

If you live in the UK and are food allergic or have a child with food allergies you may find this new website of use to you. The site seeks to detail places to eat where meals are carefully prepared for those with gluten sensitivity or food allergies.

They invite you to rate, review and add new places as you find them to help the site become ever more detailed.

Enjoy

Pollen Season in the UK and pollution

2010-04-17T11:54:00.000-07:00

The birch pollen season is now well underway in the UK and there is a risk of of high birch and other tree pollen counts over the coming weeks prior to the grass pollen season commencing.

A lack of rain, strong winds and moderate temperatures will further increase pollen counts. As there is a synergistic allergic and 'irritative' effect between pollen and pollution so recent volcanic fallout may further increase the suffering of pollen allergic individuals. All should be sure too strictly take their 'preventer' and 'reliever' asthma and hayfever medications over the coming weeks.

Birch pollen affects about 25% of hay fever sufferers, and even low birch pollen counts may cause symptoms of hay fever in sensitive individuals. Birch pollen is also associated with the Oral Allergy Syndrome.

Campaign to Improve NHS Allergy Services

2010-04-14T05:06:00.001-07:00

Campaign to Improve NHS Allergy Services

Last chance to sign the petition! The National Allergy Strategy Group is campaigning for improved NHS allergy services and needs your support to petition the Prime Minister
for change.

If you feel this is a worthy cause, please visit http://petitions.number10.gov.uk/allergyservices/ and add your name to the growing list of people who are backing the campaign.

For more information on the work of the National Allergy Strategy Group and for details on how you can help further visit www.nasguk.org

The natural history of soy allergy.

2010-04-07T06:50:00.000-07:00

This article describes the natural history of soy allergy and identify predictors of oral tolerance/outgrowing soy allergy. One hundred thirty-three patients were studied. Eighty-five (64%) had asthma, 95 (71%) had allergic rhinitis, and 108 (85%) had atopic dermatitis. Eighty-eight percent had concomitant peanut allergy. The median age at the initial visit was 1 year (range, 2 months to 17.5 years). Kaplan-Meier analysis predicted resolution of soy allergy in 25% by age 4 years, 45% by age 6 years, and 69% by age 10 years. By age 6 years, 59% of children with a peak soy IgE level of less than 5 kU/L, 53% of children with a peak s-IgE level of 5 to 9.9 kU/L, 45% of children with a peak s-IgE level of 10 to 49.9 kU/L, and 18% of children with a peak s-IgE level of greater than 50 kU/L had outgrown soy allergy (P < .01 for trend). In this referral population approximately 50% of children with soy allergy outgrew their allergy by age 7 years. Absolute soy IgE levels were useful predictors of outgrowing soy allergy.

Savage JH, Kaeding AJ, Matsui EC, Wood RA.
The natural history of soy allergy.
J Allergy Clin Immunol 2010 Mar;125(3):683-686

Two available injectable adrenaline devices e.g. Epipen, should be available for food allergic children

2010-03-31T09:01:00.000-07:00

Many children with food allergies carry EpiPens, which are self-injectable doses of epinephrine that can halt a severe allergic reaction called anaphylaxis.

A study of emergency room treatment in children with these life-threatening reactions supports recommendations that children carry two EpiPens, not just one. Dr. Susan Rudders of Children’s Hospital Boston led a review of more than 1,200 medical charts over six years from the emergency departments at Children’s and Massachusetts General Hospital. A little over half of the children who were seen for allergic reactions to food were suffering from anaphylaxis, which can include low blood pressure, difficulty breathing, and gastrointestinal problems. Among the patients who were given epinephrine either before or during their ER visit, 12 percent received a second dose.

The researchers also found that guidelines for care were not always being followed by emergency rooms. More children were given antihistamines or corticosteroids than the recommended epinephrine. Fewer than half left the hospital with a prescription for an EpiPen and fewer than a quarter were referred to an allergist.

The authors go on to say “The results of our study indicate that food-related anaphylaxis continues to be underrecognized and inadequately treated in the [emergency department] setting"

Source Pediatrics Online March 22/2010

Commercial Pesto sauce in the UK often contains Cashew

2010-03-31T08:48:00.000-07:00

Dr George Du Toit would like to re-issue a warning to nut allergic people in the UK with respect to the many brands of commercial Pesto sauce that now containing Cashew as a substitute for pine nut. Pine nut tolerant cashew-allergic individuals are then innocently eating - and reacting to - these 'may contain nuts' labelled products in the belief that they are tolerant to pine nut and that the sauce only contains pine nut (actually a seed).

Tonsillar hypertrophy linked to childhood wheeze and snoring.

2010-03-31T01:14:00.000-07:00

Tonsillar hypertrophy linked to childhood wheeze and snoring.

In addition to airway inflammation, adenotonsillar hypertrophy is another factor that may increase upper airway resistance and predispose to sleep-disordered breathing (SDB) in childhood. The researchers studied 442 children (average 7.6 years old), who attended the ED for minor ailments or were referred for recurrent wheezing. They used parental questionnaires on symptoms of SDB (snoring), wheezing, use of inhaled bronchodilators or corticosteroids, tonsillectomy, and history of chronic disease. The children also underwent clinical examinations and the size of their tonsils was measured by inspection of the oropharynx. After accounting for factors such as age, gender, body mass index, and passive smoking, the researchers found that a history of wheezing was significantly associated with the presence of tonsillar hypertrophy and habitual snoring, at odds ratios (ORs) of 2.23 and 1.73, respectively. A history of wheezing was significantly associated with the presence of snoring in children with tonsillar hypertrophy (OR=2.76), but not in those without. The authors concluded that children with history of wheezing have more frequently tonsillar hypertrophy than those without wheezing.
Editor's comment: Children with a history of wheezing are more likely to have tonsillar hypertrophy which may partly explain the association between asthma and obstructive sleep-disordered breathing (SDB) in childhood.

Kaditis AG, Kalampouka E, Hatzinikolaou S et al. Associations of tonsillar hypertrophy and snoring with history of wheezing in childhood. Pediatric Pulmonology 2010; 45(3):275-280.

There is no rationale for sedating antihistamines as prescription-free drugs for self-medication

2010-03-31T01:13:00.000-07:00

Potential dangers of the indiscriminate use of first-generation H1-antihistamines.

A GA²LEN (Global Allergy and Asthma European Network) task force reviewed the literature (via Medline and Embase) and performed a media audit of coverage in the United States from 1996 to 2008 of accidents and fatal adverse events in which H1-antihistamines were implicated. The goal of the effort was to enhance consumer protection by bringing to the attention of regulatory authorities, physicians and the general public the potential dangers of the indiscriminate use of first-generation H1-antihistamines purchased over-the counter in the absence of appropriate medical supervision. They found that first-generation H1-antihistamines, all of which are sedating, are generally regarded as safe by laypersons and healthcare professionals because of their long-standing use. However, they reduce rapid eye movement (REM)-sleep, impair learning and reduce work efficiency. They have been implicated in civil aviation, motor vehicle and boating accidents. They have also been responsible for deaths as a result of accidental or intentional overdosing. In conclusion this review raises the issue of better consumer protection by recommending that older first-generation H1-antihistamines should no longer be available over-the-counter as prescription- free drugs for self-medication of allergic and other diseases now that newer second-generation non-sedating H1-antihistamines with superior risk/benefit ratios are widely available at competitive prices.

Church MK, Maurer M, Simons FER et al. Risk of first-generation H1-antihistamines: a GA²LEN position paper. Allergy 2010; 65(4):459-466.

Allergy to meat, novel findings

2010-03-19T13:53:00.000-07:00

An allergy to meat may be responsible for up to half of recurrent anaphylaxis cases without known cause, researchers said.

In three cohorts of idiopathic anaphylaxis patients, 20% to 50% tested positive for allergy to the sugar galactose-a-1,3-galactose (alpha-gal) found in beef, lamb, pork, and other mammalian meats, according to Scott Commins, MD, PhD, of the University of Virginia, and colleagues.

About 10% of all anaphylaxis patients at one of the participating clinics reacted to alpha-gal. The allergy may often go undetected and unsuspected because of its typically adult onset and because there's three to six hour delay in symptoms after eating meat. That's likely the time needed for digestion and absorption. Once affected patients are diagnosed, management is simple -- avoidance.

Nearly all common allergies are reactions to proteins, so severe allergy to a sugar is a novel finding.

Source: Abstract, ie not peer reviewed article, from American Academy of Allergy, Asthma & Immunology Commins SP, et al "Testing for IgE antibody to the carbohydrate galactose-a-1,3- galactose (alpha-gal) in Patients with recurrent, idiopathic anaphylaxis: How many cases are we missing?" AAAAI 2010; Abstract 471.

Prevalence of Asthma

2010-02-14T09:24:00.000-08:00

Click here for the latest ISAAC Study data which seeks to answer if the prevalence of asthma increasing or decreasing?

Is wheat allergy outgrown?

2010-02-06T08:43:00.000-08:00

The prognosis of wheat hypersensitivity in children.

"The study was aimed to determine the natural history of wheat hypersensitivity, to define risk factors for persistent wheat hypersensitivity, and to evaluate the development of respiratory allergy in children with wheat hypersensitivity. The development and subsequent disappearance of wheat hypersensitivity, clinical findings, skin prick test (SPT) reactivity, and the development of allergic rhinoconjunctivitis and asthma were charted retrospectively in 28 children with wheat hypersensitivity proven by the open oral challenge at the median age of 21 months (range 6 to 75 months). Appearance of skin symptoms during the diagnostic wheat challenge was related to SPT-positive wheat hypersensitivity, while the appearance of gastrointestinal symptoms alone was associated with SPT-negative wheat hypersensitivity (p = 0.002). Wheat was tolerated by 59%, 69%, 84%, and 96%, by age 4, 6, 10, and 16, respectively. Sensitization to gliadin with a SPT wheal of >/=5 mm at the time of the diagnostic challenge was associate d with a slower course of recovery from wheat hypersensitivity (p = 0.019), and a SPT wheal of >/=3 mm to gliadin at any time was associated with the development of asthma (p = 0.022). SPT reactivity to wheat was associated with later SPT reactivity to birch pollen (p = 0.001), and the development of allergic rhinoconjunctivitis (p = 0.001). In conclusion, almost all children with wheat hypersensitivity can tolerate wheat by adolescence. Sensitization to gliadin is associated with a slower achievement of tolerance and an increased risk of asthma."

Kotaniemi-Syrjanen A, Palosuo K, Jartti T, Kuitunen M, Pelkonen AS, Makela MJ.
The prognosis of wheat hypersensitivity in children.
Pediatr Allergy Immunol 2009 Sep 30;

Peanut Allergy - is the epidemic stabalising in the UK?

2010-02-06T08:36:00.001-08:00

The prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK.

This article investigated the prevalence of peanut allergy in three cohorts of children (age 3-4 years) born on the Isle of Wight. Peanut sensitization increased significantly from 1.3% in Cohort A to 3.3% (P = 0.003) in Cohort B before falling back to 2.0% in Cohort C (P = 0.145). Similarly, clinical peanut allergy increased significantly from 0.5% in Cohort A to 1.4% (P = 0.023) in Cohort B, with a subsequent fall to 1.2% in Cohort C (P = 0.850). Data from three cohorts of 3- to 4-year-old children born in the same geographical area shows that peanut allergy prevalence has changed over time. Peanut sensitization and reported allergy in children born in 1994-1996 increased from 1989 but seems to have stabilized or slightly decreased since the late 1990s, although not significant.

Venter C, Hasan AS, Grundy J, Pereira B, Bernie CC, Voigt K, Higgins B, Dean T.
Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK. Allergy 2010 Jan;65(1):103-108

Website listing 'allergy friendly' accommodation

2010-02-03T02:41:00.000-08:00

A new potentially very helpful directory of hotel, B&B and self catering accommodation - suited to people who suffer from allergies including dust mite allergy, pet allergy, and food allergies - has been created. All the accommodation listed on the site offer rooms with anti-allergy features that will appeal to sufferers of asthma, rhinitis and sinus problems, and /or cater for people with food intolerance.

The web address is www.allergyfriendlyhotels.com.

Immunisation and later onset asthma - study shows no link

2010-01-27T10:24:00.001-08:00

Childhood immunization and atopic disease into middle-age - a prospective cohort study.

To address possible associations between childhood immunizations and asthma and allergies in middle-aged adults, the researchers assessed data from the Tasmanian Longitudinal Health Study on 5,729 participants who were followed-up from ages 7 to 44. Most of the participants (up to 90.7%) had undergone childhood immunization against diphtheria, tetanus, pertussis, polio, and/or smallpox. By the age of 44 years, 11.2% of the participants had been diagnosed with asthma; 11.1% had at least one food allergy; 37.0% had eczema; and 50.3% had hayfever. After accounting for confounders, multivariable regression analysis revealed no significant associations between any childhood immunization and asthma (odds ratios [ORs] ranging from 0.87 to 1.17), eczema (ORs=0.99-1.07), food allergy (ORs=0.97-1.11), and hayfever (ORs=1.02-1.05) at age 44 years. Cox regression analysis also revealed no significant associations between any childhood immunization and incident asthma after the age of 7 years (ORs=1.03-1.21).

Matheson MC, Walters EH, Burgess JA et al, Childhood immunization and atopic disease into middle-age - a prospective cohort study. Pediatric Allergy and Immunology,

Cost saving benefits of Immunotherapy

2010-01-20T13:20:00.000-08:00

January 12, 2010 — Use of immunotherapy in children with allergic rhinitis (AR) decreases their healthcare costs by one third and prescription costs were reduced by 16%, according to a study published in the January issue of the Annals of Allergy & Asthma Immunology.

"In addition to its long-term sustained efficacy, immunotherapy is the only treatment proved to alter the course of allergic disease as demonstrated by its association with significant reductions in the likelihood that children with AR will develop asthma and new sensitizations to aeroallergens," write Cheryl Hankin, PhD, from BioMedEcon LLC, Moss Beach, California, and colleagues. "Given these important benefits, immunotherapy is likely to be a cost-effective option for the management of AR."

The Joint Task Force on Practice parameters. Adverse reactions to vaccines

2010-01-13T04:38:00.000-08:00

Experts say that children who have an allergic reaction to one vaccine should be examined and might be able to have other vaccines. It is common at the moment to avoid giving subsequent immunisations after an allergic reaction.

But Dr John Kelso of Scripps Clinic in San Diego, California, USA, and his team say this could leave people at greater risk of infection, and might not be necessary.

In new medical guidelines published in the journal Annals of Allergy, Asthma & Immunology, he writes that only one in every million vaccine causes the serious medical reaction called anaphylaxis. Deaths are very rare.

He says that small allergic reactions at the injection site, and symptoms such as fever, are common after vaccinations and "do not contraindicate future doses".

He recommends that all serious events after a vaccination are reported so that possible risks can be identified, and that an allergist is brought in to carry out allergy testing and decide on a treatment.

These allergic reactions are usually caused by components of the vaccine including gelatin or egg protein, and rarely, yeast, latex (contained in vial stoppers or syringe plungers), neomycin and thimerosal.

Dr Kelso added: "The MMR (measles, mumps and rubella) and one type of rabies vaccine contain negligible or no egg protein, and can be administered to egg allergic children without prior skin testing."

These children may also be able to receive the H1N1 vaccine or the seasonal flu vaccine safely. Anyone who is concerned should check with their doctor and an allergist.

The Joint Task Force on Practice parameters. Adverse reactions to vaccines. Annals of Allergy, Asthma and Immunology. Vol. 103, October 2009. No. 4, Supp. 2, pp.1-14.

advice leaflet for people newly diagnosed with a food allergy

2010-01-12T13:43:00.001-08:00

An advice leaflet for people who have been newly diagnosed with a food allergy has been published by the Food Standards Agency in collaboration with six allergy and nutrition organisations.

The leaflet, ‘Buying food when you have a food allergy or intolerance’, guides people with a food allergy or intolerance, including coeliac disease, through the steps to remember when buying food and when eating out. The topics covered include:

checking the label on pre-packed food

what to look out for when foods aren't pre-packed

talking to restaurant staff about your allergy

what to watch out for when using self-service restaurants

The Agency worked closely with Allergy UK, the Anaphylaxis Campaign, the British Dietetic Association, the British Nutrition Foundation, Coeliac UK and Foods Matter to produce the leaflet.

Click here to download your copy of 'Buying food when you have a food allergy or intolerance' or to order a copy, telephone 0845 606 0667 or email:foodstandards@ecgroup.co.uk.

Helpful website re weaning in allergic children...

2010-01-11T06:47:00.001-08:00

http://www.littlepeoplesplates.co.uk/tot-it-up.html

JACI Blog Address

2010-01-10T06:34:00.000-08:00

Excellent Blog newly launched from highest ranked Allergy Journal - http://www.jaci-nbop.blogspot.com/

Swine Flu Vaccination Information

2010-01-05T00:57:00.000-08:00

For an excellent summary of the topic and risks please visit -

http://www.informationisbeautiful.net/2009/is-the-h1n1-swine-flu-vaccine-safe/

Winter Pollen and Spore Counts in UK

2009-12-29T02:29:00.000-08:00

Link to common UK 'winter' aeroallergens - http://www.zirtek.co.uk/

You may have experienced unexpected 'Christmas' allergy symptoms, these may have arisen due to seasonal aeroallergens (see link above) or allergens lurking in Christmas decorations, Christmas trees, scented candles and even food.

Adrenaline Auto Injector accidents

2009-12-28T22:52:00.000-08:00

Please avoid preventable Adrenaline injuries sustained at time of administration - http://www.newswise.com/articles/view/550804/

Changing recipes

2009-12-28T22:49:00.000-08:00

Please beware of ever changing recipes - two important examples are:

1. Cashew Nut is now frequently used in Pesto sauces.
2. Peanut is now substituted for Almond nut in curries.http://news.bbc.co.uk/1/hi/england/7974619.stm

Allergy Testing - Unorthodox techniques

2009-12-28T02:31:00.000-08:00

The Australasian Society of Clinical Immunology and Allergy have posted a position paper on 'Unorthodox techniques for the diagnosis and treatment of allergy, asthma and immune disorders'. It's a good read and available at http://www.allergy.org.au/content/view/322/271/

Allergy Petition

2009-12-28T02:22:00.000-08:00

Would you like to have your say on what it is really like to live with allergies? To do so sign the following petition to highlight the need to improve NHS allergy services by following this link http://petitions.number10.gov.uk/AllergyServices/

You may also wish to visit the newly launched National Allergy Group website at www.nasguk.org

Fun website for older Food Allergic and/or Asthmatic Children

2009-12-28T01:57:00.000-08:00

A fun website for allergic children to join/visit - http://www.medikidz.com/

2007-04-06T02:51:00.000-07:00

Welcome to the alert4allergy linked blog!