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Study shows oral food challenges are safe for diagnosing food allergies

The best way to find out if someone has a food allergy is through an oral food challenge (OFC) where the person is given a very small dose of the food by mouth under the supervision of a board-certified allergist to test for a severe reaction.  A new study shows that OFCs are extremely safe, with very few people having a reaction of any kind.

The majority of those tested were under the age of 18. Researchers found about 2 percent of those being tested had a severe allergic reaction, also known as anaphylaxis, and only about 14 percent had any reaction at all.

“Food challenges improve the quality of life for people with food allergies, even if they are positive,” said allergist Carla Davis, MD, ACAAI member and study senior author. “When an OFC is delayed, sometimes people unnecessarily cut certain foods out of their diet, and this has been shown to lead to increases in health costs to the patient. A delay risks problems with nutrition, especially for children. It’s important to have an accurate diagnosis of food allergy so an allergist can make a clear recommendation as to what foods you need to keep out of your diet. And if no allergy exists, that clears the way to reintroduce foods you may have thought were off-limits.”

Diagnosing food allergy is not always simple, but the need to make a proper diagnosis is very important.

Allergists are specially trained to administer allergy testing and diagnose the results. They can then tailor a plan specific to your allergies.

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Asthma during Pregnancy

One in 10 pregnant women worldwide has asthma. Asthma symptoms worsen in one-third of women, improve in one-third, and remain similar in another third;[7] however, these changes are variable from woman to woman, and pregnancy to pregnancy.

At least 20 to 45% of women have been reported to have an exacerbation of asthma requiring medical intervention during pregnancy, including unscheduled doctor visits, emergency department (ED) presentations, hospitalization, or requirement for oral corticosteroids. Severe exacerbations requiring oral corticosteroids use have been reported in 5 to 11% of women.

A 2011 systematic review and meta-analysis described the increased risks of poor perinatal outcomes associated with maternal asthma, including preterm birth, low birth weight, and preeclampsia.

Asthma in pregnancy guidelines recommend that asthma exacerbations be treated in the same way as nonpregnant women, and emphasize that exposure to asthma medications to appropriately treat exacerbations poses less risk than exposure to exacerbations themselves.

There is ample reassuring data to support the safety for budesonide (ICS) and Albuterol (SABA), and the recommendation that asthma medications be used in pregnancy, as for nonpregnant women. Guidelines also recommend the continued use of ICS medication that has been effective in controlling asthma before pregnancy.

Review of asthma symptoms every 4 weeks is recommended. Guidelines recommend a stepwise approach to treatment adjustment for asthma, and these clinical decisions are made primarily upon symptoms and lung function. However, a novel approach has been suggested, whereby asthma treatment decisions are made according to the level of eosinophilic lung inflammation, which is responsive to ICS treatment. The level of eosinophilic inflammation may be ascertained using FENO (exhaled nitric oxide).

Pregnant women with asthma are at risk of numerous comorbidities, which may impact their asthma, including rhinitis, GERD, cigarette smoking, obesity, and anxiety and depression. These issues need to be addressed.

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Penicillin Allergy in Children Substantially Overreported

Most children with parent-reported symptoms of penicillin allergy have negative results for a true allergic reaction to the drug, a new study shows.

“Our results showed that the majority of children had rash and itching as their primary reported symptom of allergy,” the authors write. “Consistent with our hypothesis, all children with symptoms deemed to be low risk for true [immunoglobulin E (IgE)]-mediated drug hypersensitivity ultimately had negative results for true penicillin allergy after the standard 3-tier testing process.”

 Penicillin allergy is the most frequently reported drug allergy, and its reporting affects how clinicians treat affected patients.

According to the authors, although many children present to the pediatric ED with parent-reported symptoms of penicillin allergy, most of these symptoms are low risk for true reaction.

However, because clinicians in the pediatric ED cannot safely and quickly diagnose true penicillin allergy, they avoid giving penicillin to children with a reported penicillin allergy. Thus, many children are not receiving optimal antibiotic treatment because of penicillin allergy misdiagnosis.

The gold standard for diagnosing penicillin allergy comprises a three-tier testing process, in which a percutaneous skin test is followed by more sensitive intracutaneous testing and an oral drug challenge.

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Half of kids who needed epinephrine didn’t get it before trip to the emergency room

Anyone suffering a severe allergic reaction (anaphylaxis) should receive epinephrine as quickly as possible. A new study showed that even kids who were prescribed an epinephrine auto injector didn’t receive the life-saving medication when they needed it.

The study in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) examined 408 patient records for children seen in an emergency department (ED) or urgent care (UC) setting for anaphylaxis. The records showed fewer than half the children received epinephrine prior to arriving at the ED or UC even though approximately 65 percent had a known history of anaphylaxis, and 47 percent had been prescribed epinephrine.

“We found kids who had a reaction at home were less likely to receive epinephrine than kids who had a reaction at school,” says allergist Melissa Robinson, DO, ACAAI member and lead author of the study. “Treatment with epinephrine is often delayed or avoided by parents and caregivers. And sometimes antihistamines are used even though they are not an appropriate treatment.”

“Allergists want parents, caregivers and emergency responders to know epinephrine should always be the first line of defense when treating anaphylaxis,” says allergist David Stukus, member of the ACAAI Public Relations Committee and co-author of the study. “Our study found that only two-thirds of those who had an epinephrine prescription had their auto injector available at the time of their allergic reaction. It’s vital to keep your epinephrine with you if you suffer from any sort of severe allergy. Anaphylaxis symptoms occur suddenly and can progress quickly.  Always have a second dose with you and, when in doubt, administer it too.  Anaphylaxis can be deadly if left untreated.”

Anyone seen for anaphylaxis in the ED/UC needs to be referred to an allergist for a follow up visit. Allergists provide the most comprehensive follow-up care and guidance for severe allergic reactions.

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CHRONIC COUGH

Cough is usually described as chronic if it is present for eight weeks or more. The most common causes of chronic cough are postnasal drainage, asthma and gastroesophageal reflux disease (GERD), or heartburn. Any or all of these may be the cause of chronic cough, in addition to a number of other less common causes. An allergist can help diagnose the cause(s) of your chronic cough.

Allergists have particular expertise in allergic rhinitis (or hay fever) and sinus infections, which may contribute to postnasal drainage, a common cause of chronic cough. Allergists are also experts at diagnosing and treating asthma, which may be present in 25% of patients with chronic cough. Cough from asthma may be associated with wheeze, shortness of breath or chest tightness and may be worsened by colds, exercise, smoke exposure and laughter, among other things. In addition, allergists are experienced in dealing with GERD, or heartburn, which may produce cough.

When to see an allergist:
• If you have a cough that lasts more than eight weeks.
• If your cough is associated with symptoms of asthma.
• If your cough is associated with nasal symptoms or tobacco use.
• If your cough is severe and affecting your quality of life.

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FDA Approves New Epinephrine Prefilled Syringe

The US Food and Drug Administration (FDA) has approved an epinephrine prefilled syringe (Symjepi, Adamis Pharmaceuticals) for the emergency treatment of allergic reactions (type I), including anaphylaxis, the company has announced.

“Symjepi provides two single dose syringes of epinephrine (adrenaline), which is considered the drug of choice for immediate administration in acute anaphylactic reactions to insect stings or bites, allergic reaction to foods (such as nuts), drugs and other allergens, as well as idiopathic or exercise-induced anaphylaxis,” the company said in a news release.

Each Symjepi prefilled syringe contains 0.3 mg epinephrine.

“With an anticipated lower cost, small size and user-friendly design, we believe Symjepi could be an attractive option for a significant portion of both the retail (patient) and non-retail (professional) sectors of the epinephrine market,” Dennis Carlo, president and CEO of Adamis, said in the release.

“We are currently in the process of exploring all of our commercialization options and in discussions with potential partners in order to facilitate broad patient access to this new epinephrine treatment option and to maximize the value of our important asset. In the interim, we expect to build inventory levels in preparation for an anticipated launch in the second half of this year,” he added.

The company said it is also preparing to submit a second new drug application to the FDA for a junior version of Symjepi.

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Body weight and Asthma

When you are overweight or obese, most excess weight is usually in the central area of the body, or the midsection. This can reduce your lung volume, making you not able to breathe as well.

Also, the foods you put in your body are an important factor. With obesity, there’s often a pro-inflammatory diet that includes sugary, starchy foods. This can cause your body to release inflammatory hormones, such as leptin, that increase inflammation in the lungs and can lead to asthma symptoms.

Diseases that often occur with obesity, such as gastroesophageal reflux disease (GERD), diabetes and hypertension, have also been found to worsen asthma. So losing weight can also help you reduce the risk of developing these conditions.

Losing 10 pounds can make a huge difference in a person’s asthma symptoms. And as an added benefit, weight loss allows patients to be better able to exercise – obviously the less weight you have, the easier it is to move around. Regular exercise has been shown to improve not only asthma symptoms but also asthma outcomes.

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Asthma and Obstructive Sleep Apnea

A recent study demonstrates that asthmatic patients with obstructive sleep apnea (OSA) have a greater decline in lung function (FEV1) over time than those without OSA. The natural history of FEV1 decline in asthmatic patients has been reported to be about 40 ml/year, twice the normal age-related decline. Factors associated with the decline in pulmonary function are age, sex, smoking, acute exacerbations, and obesity.

This is also the first study reporting more exacerbations in asthmatic patients with OSA than in patients without OSA. CPAP treatment, however,  can reduce exacerbations in asthmatic patients with OSA. Such exacerbations are also associated with the decline in pulmonary function among asthmatic patients with OSA.

Finally, CPAP treatment was found to alleviate the accelerated decline in FEV1 in asthmatic patients with severe OSA.

 

 

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Do You Really Have Asthma?

 

Shortness of breath. Wheezing. Coughing. Chest tightness. If you had asthma, you’d know it, right? It turns out that it’s not always that simple, and even your doctor can get it wrong. When Canadian researchers studied more than 700 people who had been diagnosed with asthma in the past five years, they determined that one-third of them didn’t have asthma after all. Their study, published in JAMA, suggests that you might very well be treating a condition you don’t even have—while simultaneously neglecting your real issue.

How could this happen? Lead study author Shawn Aaron, MD, a senior scientist at the Ottawa Hospital Research Institute, suspects that doctors are often relying on symptoms to make a diagnosis, but “asthma” symptoms can overlap with those caused by other health problems. He says that physicians ought to be conducting an objective spirometry test, but some are skipping this step.

The test is simple—you blow into a tube, and the doctor measures how quickly you blow the air out—but only half of the patients in Aaron’s study were given one. “We think that doctors are taking shortcuts,” he says. “Although we can’t say exactly how many were misdiagnosed initially verses how many went into remission, we think a sizable proportion were misdiagnosed from the beginning.”

If you’ve been told you have asthma but haven’t had a spirometry test, see an asthma/immunology specialist to get tested now. “You wouldn’t let a physician give you insulin to treat diabetes without testing your blood sugar,” says Aaron. “Patients are accepting inhalers for asthma all the time without getting appropriate testing to confirm.”

 

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