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
FCAAIA Notes: Fructose is a sugar found in its natural form in fruits and vegetables. So, is this study saying women shouldn’t eat a lot of fruit during pregnancy? No, not at all. The title and the study from which it is derived are a perfect example of why we need to read all the information and not jump to conclusions because of a headline.
Fructose is commonly added to soft drinks and juice to sweeten the beverage. In truth, it was excessive ingestion of fructose infused processed refreshments Continue reading
FCAAIA Notes: With the recent exciting research about early introduction of peanut to an infant’s diet, I thought it apropos to post a recent “state-of-the-art” review of peanut allergy. I put that phrase in quotes because things change fast in medicine. If you have read this far down in my blog, you already read about the LEAP study. Now, read this full article and compare Continue reading
FCAAIA Notes: The relationship between obesity and asthma is complex for a variety of reasons. Many obese patients are short of breath merely because their chest wall is less compliant and does not expand with inhalation as easily as in patients of normal weight. Often, their shortness of breath is misdiagnosed and treated as asthma. Obese patients have often less well physically conditioned so have exercise induced symptoms unrelated to asthma. Finally, obesity predisposes to GE reflux, a common cause of cough and common trigger to asthma symptoms. So, weight loss can lead to symptom improvement even if the symptoms are not asthmatic.
Of course, obesity is a risk for numerous other chronic, dangerous and potentially life threatening problems. It doesn’t matter if you have asthma or not. If you are obese, talk to your primary care physician to discuss weight loss strategies. Continue reading
FCAAIA Notes: There is a lot of news about oral food desensitization, or oral immunotherapy (OIT). Of course the reported news is always about the most exciting and promising advances. But, these reports need to be vetted carefully, as not all that glitters is gold. There is promise in the future of peanut OIT, but the procedure has a relatively high rate (5-10%) of reactions including anaphylaxis. Even in this exciting study from the University of North Carolina, only 10.7% of patients who were on high doses of peanut every day (the equivalent more than 2 tablespoons of peanut butter) could tolerate it after stopping their daily doses for an extended time.
We can only conclude that peanut allergy is not curable (yet). Maybe Continue reading
FCAAIA Notes: Asthma and allergies run in families, but do not exclusively run in families. We frequently hear parents’ surprise that their children have asthma or allergies because no one in the family does. For round numbers, if neither parent has allergies (is atopic), their children will have a 15-20% chance of having allergies. The risk roughly doubles for each affected parent so that if both parents are atopic, their children each have about a 50-60% chance of atopy. There ahs been the suggestion over the years that maternal atopy might contribute to risk greater than paternal history.
This study indicates that a parental history of atopy not only contributes to risk, but contributes to Continue reading