FCAAIA Notes: There is no question whatsoever that food allergy has a huge impact on the quality of life of patients and their family members. Our relatively recent recognition that many children with milk and egg allergy can tolerate the foods in baked products certainly helps ease the burden on the family. However, it does eliminate the burden. Speak with your allergist about strategies to improve you and your family’s food-related quality of life.
Along those lines it is important that you not be labeled allergic to a food that you tolerate. I have frequent conversations with my patients Continue reading
FCAAIA Notes: This is really exciting research, but let’s not get too excited yet. First of all, “hypoallergenic” does not mean “non-allergenic”. Peanut allergic patients would still need to be cautious. More importantly, until EVERY peanut in the environment is hypoallergenic, the peanut allergic patient is still at risk of accidental ingestion of unmodified peanuts.
So, peanut allergic patients: Keep reading those labels, keep asking questions about what is in a food before you eat it, and keep Continue reading
FCAAIA Notes: Guidelines for allergy shots recommend that patients stay on injections for about 5 years and then discuss the potential risks and benefits of stopping or continuing. When patients start allergy shots in our offices, they come in every 3-14 days to build up to the top dose (called the maintenance dose). After that, patients are generally able to get shots every 3-4 weeks. The build up phase is the most inconvenient part and requires 20-25 visits to get to maintenance for most patients. But, the good news is that most of the 5 years of allergy shots only requires a visit every few weeks or so.
Allergy shots are a potential cure for allergies. Continue reading
FCAAIA Notes: Pregnant? Congratulations! It is important to take care of your baby’s health, but don’t forget about your own. Many women are afraid to take any mediation during pregnancy. Unfortunately, some doctors encourage their patients to STOP medication during pregnancy. But, what is worse, the treatment or the disease? It is clear that poorly controlled maternal asthma during pregnancy is dangerous to the fetus.
During pregnancy one third of women with asthma get better, one third get worse, and one third stay the same. It tends to be the same from one pregnancy to the next. During pregnancy, asthma tends to improve as one nears delivery.
Take care of your self (and by extension your baby) during pregnancy. Continue reading
FCAAIA Notes: Up to 95% of people who report penicillin allergy are NOT allergic. Some never were and the rest “outgrew” the allergy. This interview with 3 of the nation’s experts on penicillin allergy is revealing and useful.
If you or a family member were told that you “can never take penicillin”, you should speak to one of our allergists about penicillin testing. Of all medications to which testing can be done, penicillin is probably the only one we really know how to interpret the test results.
Importantly, penicillin only tells us about one kind of reaction that people can have Continue reading
FCAAIA Notes: The last time I updated articles on this website, I posted news about FDA approval of sublingual (under-the tongue) treatment for grass allergy. (See “FDA OKs Oralair, First US Sublingual Allergy Immunotherapy”). The same caveats I noted then apply to Ragwitek. That is, it is useful for just one allergen (ragweed), not for other weeds or anything else. Treatment must be started 3-4 months before the onset of ragweed pollination (usually about August 15th in Connecticut) and it must be used daily with the tablet kept under the tongue for at least a minute. The tablets are reported to cost $7-$8 each and may or may not be covered by insurance companies.
But, this is still a reasonable treatment option next summer for patients with significant and bothersome symptoms from ragweed exposure.
Sublingual immunotherapy (SLIT) has not been studied for any other pollens Continue reading
FCAAIA Notes: This article highlights the significant association between use of oral antibiotics in infancy and the risk for having asthma by 7 years old. Importantly, the authors remind us that it is not the antibiotics themselves that lead to increased risk for asthma. Rather, the antibiotics may cause changes in the way the immune system recognizes foreign substances (such as dust mites, cat dander, etc), leading to allergic airway diseases including asthma. Also, we need to recognize that perhaps it is the children who are most likely to later have asthma who are at greatest risk for needing antibiotics as infants. These are complex associations still under intense investigation.
Nonetheless, only children with proven or highly likely to have bacterial infections should be prescribed antibiotics. Continue reading
FCAAIA Notes: Omalizumab is a humanized murine (mouse) monoclonal antibody against IgE, the immunoglobulin associated with allergies. About 1/3 of patients with chronic idiopathic urticaria (CIU, hives lasting at least 6 weeks that do not have any other identifiable cause) make an antibody to the receptor for IgE that sits on the surface of cells called mast cells that are found (among other places) ion the skin). Activated mast cells release histamine and other chemicals (that’s why ANTI-histamines are used in allergies). Omalizumab helps prevent mast cell activation by preventing IgE from binding to its receptor. Until now, it only had FDA approval for asthma.
Patients with CIU should still be treated with antihistamines first. Continue reading
FCAAIA Notes: This the first and only sublingual (under-the tongue) treatment for allergies approved for use in the United States. It is only useful for northern grasses (prevalent in Connecticut). It has no utility for any other allergen. It is given daily, starting 4 months before the start of grass pollination and used throughout the season. In Connecticut, we are talking about 6 months worth of treatment.
Sublingual immunotherapy (SLIT) has gained a lot of attention over the last few years. Some practitioners use SLIT “off-label”. That is, they give extracts approved for injection under the tongue. Most of the time, patients receive only small doses of allergen. Continue reading
FCAAIA Notes: The title of this article is misleading, because it implies a great safety risk with allergy shots. We know that allergy shots (subcutaneous immunotherapy, SCIT) are extraordinarily safe, but not risk free. Most significant reactions occur within 30 minutes of an injection. Practice parameters for allergen immunotherapy therefore recommend a 30 minute in-office wait period after allergy shots are given. This study confirms the safety. In fact, the numbers reported are even better than when the last similar survey was done.
Allergy shots are a highly effective treatment for allergy and asthma. Continue reading