FCAAIA Notes: Ever since warnings about lack of efficacy data and appropriate doses arose, we frequently hear, “You can’t give young children those medications”. This article indicates that you CAN give these medications. Doses should be adhered to unless you are otherwise instructed by your physician. It is also important to know what you might expect from each class of medication. Antihistamines will not help a run of the mill viral infection. Decongestants will not prevent or treat ear infections. These are just symptom relievers. They will not cure anything. But, when symptoms are bothersome, it can be useful to find the most effective symptom reliever for you child. Continue reading
FCAAIA Notes: Chronic urticaria (hives lasting 6 weeks or longer) is a frustrating problem for patients and their doctors. The frustration arises because the majority of cases are “idiopathic”, meaning there is no identifiable trigger. We now know that about 1/3 or more of chronic idiopathic urticaria are not idiopathic at all; in those cases, patients make an autoantibody to a certain molecule on the surface of cells called mast cells. When mast cells are activated by that autoantibody, they release histamine and other chemicals that cause hives. Technically then, those hives are not idiopathic. But, there is still no specific therapy for them and no way to avoid an external trigger. Idiopathic urticaria are uncomfortable and can be unsightly, but are completely benign.
The next largest group of chronic hives is those with a physical trigger (cold, scratching, heat, etc.). The smallest group is the one of most concern. Continue reading
FCAAIA Notes: Peanut oral immunotherapy (OIT) allows patients to gradually increase the amount of peanut they eat each day to protect them in the event of accidental ingestion. It has been shown to improve food-specific quality of life. In some cases (50% or less), peanut OIT “cures” the allergy so that patients no longer need to take a daily dose and can still eat peanut without a reaction.
However, there is a very high rate of clinically significant reactions during peanut OIT that requires many patients to drop out completely. OIT to foods should NEVER be tried at home. If you have any questions about OIT to food, discuss it with your allergist. Continue reading
FCAAIA Notes: We have posted several articles about the safety and efficacy of sublingual immunotherapy (SLIT) for aeroallergen sensitivity. In recent weeks, the FDA has approved sublingual tablets for grass and ragweed immunotherapy, affirming older European data proving that these treatments are better than placebo. The total monthly dose is dramatically higher than that given by injection. In order to achieve these doses, the tablet must be placed under the tongue everyday and be allowed to melt for 10 seconds. There are a few studies comparing SLIT with conventional subcutaneous allergen immunotherapy (allergy shots, SCIT). Those studies show that SCIT is more effective than SLIT.
Of great importance, SLIT tablets are not available in the United States for other allergens. Continue reading
FCAAIA Notes: About 30 years ago, a study suggested that women who avoided cow’s milk during pregnancy and lactation were less likely to have a child with milk allergy and atopic dermatitis. Otherwise, there was never any strong data to support the idea that maternal diet had any great impact on a child’s development of food allergy. The most recent guidelines from the American Academy of Pediatrics for maternal diet noted that there were no data upon which to base a recommendation. Without data we could never make any strong recommendations one way or another. Continue reading
FCAAIA Notes: Numerous studies over the years have had similar findings as this one. That is, frequent use of antibiotics early in life is associated with an increased risk of asthma and other allergic diseases later in childhood. A major problem with them all is that an association does not imply cause and effect. For instance, what if children destined to have asthma and other allergic diseases are more likely to require antibiotics early in life? Maybe antibiotic-induced changes in the human microbiome (those microorganisms that live in and on us) predispose to the later development of allergic airway disease. Continue reading
FCAAIA Notes: Have you or a loved on had al allergic reaction to a sting? Stinging insect allergy is probably one of the most curable things an allergist sees. For decades, it has been quite clear which patients are at risk of significant reactions to bee, wasp, or hornet stings and require venom immunotherapy (allergy shots). Risks of severe systemic reactions to subsequent stings can virtually be eliminated. Continue reading
FCAAIA Notes: Classic allergic reactions to food almost always have immediate onset with symptoms starting within 30-60 minutes of ingestions. Symptoms can progress over time and worsen without treatment. Reactions to “alpha-gal” are a rare exception to the rule. In this instance, anaphylactic reactions start 4-8 hours after ingestion of mammalian meat and can be quite serious. Continue reading
FCAAIA Notes: The herbal medication market in the United States is a multi-billion dollar industry. Unfortunately, most of the products sold have not been studied or proven effective for the things they claim to treat. That is why most products carry disclaimer labels. You may have seen this report in the Science Times section of the New York Times a couple weeks ago. The researchers did not want to single out any one company or product, so did not release that information. But, their findings were pretty clear: You are probably not buying what you think you are. Continue reading
FCAAIA Notes: Is this a cool concept or what? The idea from the headline is not that if a mother and child both have allergies that the child will get better if the mother takes allergy shots. Rather, it suggests the possibility that a woman who goes on allergy shots BEFORE pregnancy decreases (not eliminates) the chance that her child will have allergies. This can only work through epigenetics (about which I have commented in other articles posted). By “turning off” the activation of some of her genes, the mother might decrease the likelihood that those genes will be “turned on” in her child.
Allergy shots may safely be administered during pregnancy, Continue reading