FCAAIA Notes: I posted a summary of the LEAP study on this web site recently. Within hours of the study results being announce, national food allergy experts met to start revising our recommendations on the introduction of peanut to an infants’ diets. Continue reading
FCAAIA Notes: The National Asthma Education and Prevention Program published its first set of guidelines for the diagnosis and management of asthma nearly 25 years ago. There have been several revisions since. However, all iterations of the Guidelines identify patients who should be treated with daily controller medications for asthma. Each iteration also stresses the importance of gradual steps down to the lowest controlling dose.
Importantly, no guideline published anywhere in the world states that patients should just STOP their controller medications without physician guidance. The reason is clear: Continue reading
FCAAIA Notes: Isoflavones are known antioxidants and have become popular dietary supplements. I am aware of no data showing that isoflavones have any proven health benefits. My reason for posting this article is not to “diss” isoflavones. Rather, I posted it to show the importance of the scientific method and double-blind, placebo-controlled studies in evaluating any treatment for any disease.
Most supplements, etc. that people take for asthma and allergies have been proven ineffective compared to placebo or just not studied. Importantly, most are benign and Continue reading
FCAAIA Notes: No one denies that medical care is expensive. Health insurance is expensive and every year rate increases far exceed the CPI. Insurers cover some medications better than others and regularly change their “preferred” formularies, making care of chronic disease such as allergies and asthma difficult for patients and doctors. Increasing costs of medication, the incredibly high penetration of high deductible health care plans, and rising office visit co-pays are all a burden on the patient as consumer. So far, the Affordable Care Act has not stemmed the cost of health care to patients. Continue reading
FCAAIA Notes: Did you ever wonder why your allergist requests follow-up visits with you at regular intervals? This study provides on explanation. Allergists have long been cognizant of the “atopic (allergic) march” in which children with milder forms of allergic disease, especially atopic dermatitis in infancy, progress to develop allergic airway disease including allergic rhinitis and asthma. Continue reading
FCAAIA Notes: How exciting! Shortly after these data were released, the FDA granted “breakthrough therapy designation” to the peanut patch for children ages 6-11 with peanut allergy (“FDA Grants Breakthrough Designation for Viaskin Peanut in Children“). The patch is not commercially available yet.
More research is needed before we can make full recommendations to patients when the peanut patch for allergies is available. At the end of this study, patients could tolerate significantly more peanut than before the study. The amount tolerated would certainly protect almost all patient form an accidental ingestion. However, the authors did not challenge the study participants to a full serving of peanut (2 tablespoons, or about the amount in a peanut butter sandwich) to see how much they could eat. In addition, there is no data as to whether patients would continue to tolerate peanut if they stopped using the patch. Continue reading
FCAAIA Notes: Triggers to asthma are numerous and varied. Why some children develop asthma and others do not is unknown. We know that psycho-social factors affect asthma and that chronic diseases including asthma are family stressors affecting the quality of life of all family members.
I’m not sure how we can use these data in our daily practice other than to continue a holistic approach to the care we provide and continue to be aware of all factors that might influence a patient’s disease. Continue reading
FCAAIA Notes: Previous studies have shown that exclusive breast feeding early in life might decrease the risk of atopic dermatitis and perhaps other atopic diseases during infancy and early childhood. This is one study showing that the effect might not last to early school age.
But, I wonder….Does it really matter in the long run? I think probably not. There are so many other good reasons to feed breast milk exclusively to 6 months old that one suggestive contradictory study should not change our recommendations. So new mothers…please continue to breast feed! Continue reading
FCAAIA Notes: This article is not allergy-specific, but is great information for children (and adults) who cannot swallow pills.
Pills are more convenient to dispense than liquids and some medications don’t come in liquid or chewable forms. Also, as more and more medications go over the counter, insurers are less willing to pay for prescription formulations even if the liquid or chewable is not over the counter.
I recommend starting with a Tic-Tac and then moving up to an M&M or Skittle for practice.
(Source: http://health.usnews.com/health-news/news/articles/2015/04/20/pill-taking-can-be-less-yucky-for-kids-study-review-finds April 20, 2015)
Many sick kids can’t or won’t swallow pills Continue reading
FCAAIA Notes: By now, probably everyone with any interest in food allergy has heard about this study. To summarize, it shows that infants at risk of peanut allergy (history of severe atopic dermatitis and/or egg allergy) who had a negative skin test to peanut or who had a SMALL positive skin test but passed a peanut challenge were less much likely to become allergic to peanut if they ate peanut regularly until 5 years old. Children with LARGE skin tests or those who failed a peanut challenge in infancy were excluded.
About 15 years ago, the American Academy of Pediatrics (AAP) recommended peanut avoidance until 3 years old in hopes that the incidence of peanut allergy would decrease. It didn’t. In 2008, that recommendation was retracted because there was no evidence that delaying introduction changed the risk of peanut allergy. Now, we have powerful evidence that early introduction decreases risk in some children.
There are important caveats, however. Continue reading