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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.

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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.

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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.

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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.

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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.

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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.

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Fish Allergies and Omega-3 Supplements

The protein content in fish-derived Omega-3 fatty acid supplements is thought to be minimal, and likely denatured. A recent review did not uncover any reports of allergic reactions. In a study to answer this question, Mark et al tested 6 fish-allergic patients in 2008 to 2 different brands of fish oil supplements. All had negative skin tests and food challenges in this study (Mark BJ, Beaty AD, Slavin RG. Allergy Asthma Proc 2008; 29:528-9). However, as only 2 brands of fish oil were tested in so few people, these results should be interpreted with caution, especially if you are extremely allergic to fish. If you are very sensitive, it would be recommended to first see an allergist who could skin test you to the product, and then administer a food challenge to be absolutely certain.

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What if my allergy skin tests are negative

Almost 20% (1 in 5) patients that are skin tested for typical allergy symptoms or asthma have negative skin tests. The skin testing that normally is done is for the most common things. For example, there are over 50,000 species of mold in air. You were undoubtedly not tested for all of those. The same is true for pollens and other allergens. Many things are less common or even unknown. If you were negative to the usual panel of skin tests then you probably have either a sensitivity to something that was not tested or you have nonallergic rhinitis that just seems like an allergy. At any rate, you certainly can get on with treatment. A combination of nasal sprays, antihistamines and eye drops (if needed) should help. If not, there are other options that don’t require knowledge of what you are allergic to.

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