When should peanuts be introduced in a child’s diet?

There is now scientific evidence that healthcare providers should recommend introducing peanut-containing products into the diet of high-risk infants early on in life, between 4 to 11 months of age, in countries where peanut allergy is prevalent, since delaying the introduction of peanut may be associated with an increased risk of developing peanut allergy.
Infants with early-onset atopic disease, such as severe eczema or egg allergy in the first 4 to 6 months of life may benefit from evaluation by an allergist or physician trained in managing allergic diseases in this age group to diagnose any food allergy and assist in implementing these suggestions regarding the appropriateness of early peanut introduction. Evaluation of such patients may consist of performing peanut skin testing and/or in-office observed peanut ingestion, as deemed appropriate after discussion with the family. The clinician may perform an observed peanut challenge for those with evidence of a positive peanut skin test to determine if they are clinically reactive before initiating at-home peanut introduction.


Peanut-allergic and Soy-allergic Patients Can Safely Use Asthma Inhalers

Information has been circulating that a lot of inhaled medicines for asthma also contain soy and that some children with peanut allergy can also cross react to that, implying that asthma inhalers may be dangerous for patients with peanut or soy allergies.These are based on many misconceptions.

The facts are:
• Most peanut-allergic patients are not allergic to soy.
• Soy lecithin does not contain enough soy protein to cause an allergic reaction even in soy-allergic patients.
• The inhalers in question were rarely used for asthma.
• The inhalers in question are no longer on the market.
• The currently available inhalers do not contain soy lecithin.

The bottom line: It is safe for patients with peanut allergy and soy allergy to use their asthma inhalers.


Is it allergies or asthma?

It is common for people to have asthma and not know it.

It is estimated that as many as one of four people with asthma have never been told they have asthma. Asthma is a chronic condition that can flare during a seasonal exposure. Chronic or recurrent cough is the most common symptom.

People with asthma often are misdiagnosed as having a sinus and bronchial infection, “bronchitis”.

The U.S. Centers for Disease Control and Prevention estimates that asthma affects 25.7-million people in the U.S. and that, of those, 7 million are under age 18.

Asthma is a chronic inflammation of the airways of the lungs. Symptoms are cough, intermittent wheezing, chest tightness and shortness of breath. The most common triggers are allergies and viral infections like the common cold. Air pollutants, especially small particulates from cigarette smoke and diesel exhaust, are also frequent triggers.

Because asthma is a chronic inflammatory disease, it should be managed preventatively. An “asthma ‘attack’ represents poorly controlled asthma and should be able to be prevented with good management.

Identifying and avoiding triggers as much as possible is the first step toward managing asthma. Most patients will need medications, sometimes on a daily basis to prevent episodes of asthma.

Immunotherapy (allergy shots) is an option in many patients whose triggers are allergies. By injecting increasing doses of what a patient is allergic to, a gradual immunity is developed, that gives much better control of asthma. The response rate to allergy shots in most studies has been shown to be 80%. Most patients respond within 3-6 months of starting allergy shots with a decreased need for medications and better control of their asthma.


Do children with asthma need to be tested for peanut allergy?

A new abstract promoted during the American Thoracic Society’s annual meeting has received considerable media attention on the topic of children with asthma being prone to peanut sensitization. Sensitization means having a positive peanut test but no clear history of peanut allergy. The abstract authors suggest that children who have poorly controlled asthma may be more likely to have a peanut sensitization, and that parents should consider having kids with asthma tested for possible peanut allergy.

The American College of Allergy, Asthma and Immunology believes that such testing could potentially lead to misdiagnosis, and represents an unnecessary and unjustified use of resources. While many of the children in the abstract are peanut sensitive on testing, it does not necessarily mean that they are truly “allergic” to peanuts on ingestion. There is no evidence that diagnosing peanut sensitization better controls chronic asthma. Chronic asthma is not a manifestation of peanut sensitization or allergy. There is no practical value to testing in this situation because these children are not showing any signs of possible peanut allergy.


What’s the gold standard for food allergy diagnosis

The gold standard for diagnosing a food allergy is an oral food challenge. Although frequently the history and skin tests can diagnose a food allergy, sometimes an oral food challenge is helpful when your history is unclear or if the skin or blood tests are inconclusive. It also can be used to determine if you have outgrown your allergy.
Under strict medical supervision you are fed tiny amounts of the suspected food in increasing doses over a period of time, followed by a period of observation to see if a reaction occurs. Because of the possibility of a severe reaction, an oral food challenge should be conducted only by experienced allergists in a doctor’s office with emergency medication and equipment on hand.


When Should Children and Adolescents Assume Responsibility for Self-Treatment of Anaphylaxis?

While first-line treatment of anaphylaxis is the timely use of self-injectable epinephrine (SIE), current guidelines do not specify the age at which the responsibility of administering SIE should be transferred from the adult caregiver to the child.

Several studies have looked at this issue. Simons, et al (1) surveyed pediatric allergists and found that most expected their patients to describe symptoms of anaphylaxis and the need to use SIE, as well as being able to demonstrate its use, by age 9 to 11 years. Most pediatric allergists expected children to self-carry and use SIE by age 12 to 14 years.

The factors described as most important in determining readiness were: 1) ability to demonstrate appropriate and correct use of SIE, 2) ability to recognize the symptoms of anaphylaxis, 3) comfort level with self-carrying and using SIE, 4) previous history of anaphylaxis, and 5) co-morbid conditions such as developmental delay, ADHD, autism spectrum disorder, and depression.


Control your asthma, Control your life

Good asthma control means:

No or fewer asthma symptoms even at night or after exercise.
Prevention of all or most asthma attacks.
Participation in all activities, including exercise.
No emergency room visits or hospital stays.
Less need for quick-relief medicines.
Minimize side effects from asthma medications.

Each person with asthma is unique – and so are their symptoms – Asthma is complex, and exists in a variety of forms, including allergic asthma, exercise-induced asthma and work-related asthma. Each type can have different symptoms and triggers, and each requires a different approach to diagnosis and treatment.

Allergists are specially trained to treat every kind of asthma – Many people with asthma don’t know that an allergist is specially trained to create an asthma plan that will work for your unique set of triggers and symptoms. An allergist will partner with you to ensure proper use of long-term controller medications and avoid over-reliance on quick-relief medications.

Immunotherapy (allergy shots) can help asthma – Immunotherapy can reduce sensitivity to the allergens that trigger asthma attacks and significantly reduce the severity of the disease. 1 in 4 children with allergies will develop asthma. Allergy shots have been shown to prevent the development of asthma in the majority of these children.


Food allergy, intolerance or sensitivity?

People tend to conflate the terms allergy, intolerance, and sensitivity when they talk about food-related reactions, and especially gluten.

If you have a true allergy, your immune system produces antibodies designed to protect you from something it sees as a threat—be it nuts or shellfish. Even a little nibble can cause cramping or stomach pain, a runny nose, skin rashes, or swelling and breathing issues.

An intolerance is an inability to properly digest or absorb specific foods or nutrients, often due to a lack of one or more digestive enzymes. (For example, people who are lactose intolerant don’t have the enzymes required to break down lactose.) This inability can lead to gastrointestinal problems like stomach pain, vomiting or diarrhea.Food intolerances, unlike allergies, tend to be “dose dependent”—meaning the more of the food you eat, the worse you feel.

But unlike allergies and intolerances, food sensitivities occupy a gray zone. Like an allergy, they may be related to immune reactions. But they’re poorly understood and symptoms are hard to pin down.

Because the mechanisms underlying sensitivities aren’t known, there’s no way to test and validate them. That ambiguity has led to a lot of confusion and disagreement among researchers, while creating ideal conditions for spurious health “experts” to push food elimination diets that may do more harm than good.

If you are confused what your symptoms really mean, the best option is to speak to a board certified Allergist who can expertly diagnose your condition with a carefully taken history and relevant testing.


Severe, Life-threatening Food Allergies

The Food and Drug Administration (FDA) estimates that severe, life-threatening allergic reactions to foods result in some 30,000 emergency room visits, 2,000 hospitalizations, and 150 deaths every year in the United States.