FCAAIA Notes: This is an up to date and thorough review of the immunologic and clinical features of atopic dermatitis (AD) and dietary issues related to AD. It is thought that about 1/3 or more of infants and toddlers with moderate to severe AD have a food trigger that at least contributes to the disease symptoms. In adults, the incidence of food allergy in Ad is no higher than the population in general (1-3%).
We now recognize that the food allergy reactions contributing to AD are called “mixed IgE/non-IgE”. This means that some of the food triggers Continue reading
FCAAIA Notes: Eosinophilic Esophagitis (EoE) has been recognized with increasing frequency in a variety of settings. It can present in a variety of ways, in part depend on the patients age. In some, it presents as gastroesophageal reflux unresponsive to high doses of reflux medications. In infant it can present as food refusal and failure to thrive. In older children and adults, it might just present as intermittent food impaction with swallowing.
There is a lot of interest and research in oral desensitization to foods (OIT) and to sublingual (under the tongue) immunotherapy (SLIT) for nasal allergies. Continue reading
FCAAIA Notes: There is so much research regarding the safety of asthma medications and the risks of poorly controlled asthma that it never fails to amaze me that some patients are still more afraid of the treatment than the disease. Similarly, there is little evidence to support the effectiveness of most alternative therapies. Those that have been proven more effective than placebo have not been proven more effective than FDA approved medications.
Inhaled corticosteroids are the preventative treatment of choice for persistent asthma (defined in part as having asthma symptoms more than twice per week or middle of the night symptoms more than twice per month). This doesn’t mean that other preventive options aren’t available. Don’t suffer from your asthma! Come see us for safe and effective control of your disease…you won’t regret feeling better!
(Source: http://www.healio.com/allergy-immunology/asthma-lower-airway-diseases/news/online/%7B92dd21e1-4364-4d04-ba48-5182e3ea9374%7D/uncontrolled-asthma-linked-with-negative-ics-beliefs-in-urban-cohort September 25, 2014. Adapted from J Allergy Clin Immunol. 2014;doi:10.1016/j.jaci.2014.07.044.)
Uncontrolled asthma was associated with negative beliefs about inhaled corticosteroids and support for complementary and alternative medicines primarily among urban minority adults, according to recent study results. Continue reading
FCAAIA Notes: Here we are again with another article indicating potential benefits of vitamin D. I can think of several reasons why atopic dermatitis might worsen in the winter and this article adds another. Vitamin deficiency has been associated with a host of conditions including those we see most commonly in an allergy/immunology practice.
If your asthma, allergies, eczema, etc. are not well controlled, has your vitamin D level been measured? If it is low, vitamin D supplements are inexpensive. (Disclaimer: I take 2500 iu of vitamin D every day). Continue reading
FCAAIA Notes: I have posted other articles about the association between obesity and asthma. Some the symptoms for which obese people treat with asthma medications but be from other conditions associated with obesity that mimic asthma (restrictive lung disease, GE Reflux, for example). But, there might also be something about obesity it self that increases the risk and severity of asthma. Further research is necessary, but don’t wait for it! If you are over weight or obese, speak with your primary care doctor about a safe and effective weight-loss program. The benefits go way beyond asthma control! Continue reading
FCAAIA Notes: Cow’s milk is an essential source of protein, fat, calcium, and vitamin D for young children. This is not the first study to identify cow’s milk allergy as a risk for nutrient deficiency. Other sources are available, but many alternative sources of vitamin D and calcium (fortified soy or rice milk for example) might not have adequate amounts of fat. The fat in whole milk is important for peripheral nerve development and most pediatricians recommend that children drink whole milk until 2-3 years old. Speak with your pediatrician to make sure your milk allergic child is getting adequate nutrition. Continue reading
FCAAIA Notes: FPIES is a potentially severe reaction to a food that cannot be identified by any test other than what happens with ingestion. Therefore, a detailed history by an astute clinican is essential. The condition is most common in infants and may last for at least a year. Milk and soy are common triggers, but numerous other foods including cereal grains can trigger the syndrome.
Food protein induced enteropathy has some overlap features with FPIES. Continue reading
FCAAIA Notes: This is a very nice and concise review of the features and treatments of anaphylaxis. If you have any interest in the condition, you should read it.
(Source: http://www.medscape.com/viewarticle/829228_1 October 9, 2014. Adapted from J Emerg Med. 2014;47(2):182-187.. For Medscape articles: User name: FCAAIA, Password: Allergies)
Background: Anaphylaxis is the quintessential critical illness in emergency medicine. Symptoms are rapid in onset and death can occur within minutes. Continue reading
FCAAIA Notes: Medications are the most common cause of fatal anaphylaxis in adults. But, food is probably still the most common cause in children. Why? Probably a few reasons. First, adults generally take more medications than children. Also, intravenous or injected medications are a greater risk than oral medications. Adults are more likely to get IV medications than are children. Finally, food allergy is more common in children than adults.
Unfortunately, allergic reactions commonly occur without prior knowledge Continue reading
FCAAIA Notes: It is generally accepted that during pregnancy, one third of women with asthma improve, on-third stay the same and one-third worsen. There tends to be improved control as the woman approaches term. Outcomes tend to be the same from pregnancy to pregnancy. Many women feel they must stop all their medications during pregnancy. In fact, some are told to stop all their medications. However, poorly controlled asthma is a much greater risk to mother and fetus than are the medications used to control asthma. As with all patients, we aim to control asthma with as little medication as it takes to do so. While we have preferences for some medication over others, most asthma medications pose no increased risk to the pregnancy.
If you are pregnant and ANYONE other than your allergist tells you to stop your medications, check with your allergist before doing so. Continue reading