Fish Allergy

Unlike other food allergies, which are typically first observed in babies and young children, an allergy to fish may not become apparent until adulthood; in one study, as many as 40 percent of people reporting a fish allergy had no problems with fish until they were adults.

Having an allergy to a finned fish (such as tuna, halibut or salmon) does not mean that you are also allergic to shellfish (shrimp, crab and lobster). While some allergists recommend that individuals with a fish allergy avoid eating all fish, it may be possible for someone allergic to one type of fish to safely eat other kinds. If you are allergic to a specific type of fish, your allergist can help you determine whether other varieties may be safe to eat.

Many prepared foods contain fish in some form. Fish is a common ingredient in Worcestershire sauce and Caesar salad and is sometimes found in imitation crab products in the form of surimi, a processed food made mainly from Alaska pollock. Fish is also prevalent in Asian cuisine, which uses fish-based stock for many dishes.

While an allergy to fish protein is most common, it is possible to be allergic to fish gelatin (made from fish skin and bones). People with a fish allergy should consult their allergist before taking fish oil dietary supplements.

Treatment for fish allergy includes strict avoidance of fish.

Because fish is often implicated in cases of food-induced anaphylaxis, allergists advise fish-allergic patients to treat symptoms of a reaction with epinephrine (adrenaline), which is prescribed by your doctor and administered in an auto-injector. Anaphylaxis can come on quickly and can be fatal unless epinephrine is injected as soon as you notice symptoms developing. Be sure to call for an ambulance, and alert the dispatcher that epinephrine has been used and more may be needed.


Welcome Dr. Camara

It is with great pleasure that we announce that Miguel Camara, M.D. is joining our practice starting October 17, 2016.

Dr. Camara has impressive credentials. He trained at the world renowned National Jewish Center in Denver along with Dr. Ahmed Mohiuddin, and also where Dr. Maaz Mohiuddin trained about 25 years later. He is board certified by the American Board of Allergy and Immunology.

He has worked in the Joliet area for years. He is a very thorough professional, pleasant, and highly ethical, well loved by his patients. He will be a great addition and asset to our practice.

We welcome him to our family at Allergy, Asthma & Sinus Centers.


Are You Allergic To Exercise?

About 11 percent of the population is estimated to have cholinergic urticaria, or hives triggered by heat, exercise, sweat or all of the above. The hives can also appear in reaction to a hot bath, sauna or even when eating hot or spicy foods.

In rarer cases, exercise can even trigger anaphylaxis, a potentially deadly allergic reaction.

Typically, the hives appear within 30 minutes of exercising and go away not long after patients stop and cool off.

Food-dependent exercise-induced anaphylaxis, is more complicated, since the reaction only occurs when someone eats a particular food and then exercises vigorously soon after.

While wheat, shellfish, peanuts and corn are most commonly implicated in food-dependent exercise-induced anaphylaxis, there are also reports of it being caused by hummus, milk, meats and more. Some factors like alcohol, non-steroidal anti-inflammatory drugs like ibuprofen and, for women, being premenstrual can exacerbate the reactions.

In addition to using antihistamines for the hives– which some people take preventively and others only in response to a reaction – clinicians recommend carrying an Epipen and always exercising with someone who knows how to use it, if you’re at risk of exercise-related anaphylaxis. It can also help to exercise in a cool gym rather than in the summer heat, and not eating for several hours before you exercise.


Early Egg Introduction Does Not Change Allergy Risk

Regular egg consumption starting at 4 to 6 months of age does not change the risk for egg allergy at 1 year of age or older, compared with delayed introduction of eggs, the authors of a new study report.

“We found no evidence that regular egg intake from 4 to 6.5 months of age substantially alters the risk of egg allergy by 1 year of age, in infants who are at hereditary risk of allergic disease and had no eczema symptoms at study entry,” the authors conclude

However, some of the findings, do hint at a possible benefit of early egg introduction, they point out.

An earlier study showed that waiting until after 10 months of age was associated with a higher risk for egg allergy.


Ragweed season is here

While many people regard spring as prime pollen season, one type of pollen wreaks havoc in the late summer and fall. Ragweed pollen usually starts mid August and reaches peak levels in mid-September; this type of pollen can cause seasonal allergic rhinitis (more commonly known as hay fever), which affects as many as 23 million Americans. Ragweed is particularly abundant in the Midwest region of the U.S.

Symptoms of ragweed allergy are similar to those of other pollen allergies:

  • Sneezing
  • Runny nose
  • Nasal congestion
  • Headaches
  • Irritated eyes
  • Itchy throat

Ragweed pollen can also aggravate asthma symptoms, leading to increased coughing and wheezing.

Management and Treatment

If you’re suffering from hay fever symptoms in the late summer or fall, consult an allergist about the possibility of a ragweed allergy. Your allergist can confirm a diagnosis with a skin test — applying a diluted allergen to the surface of your skin and waiting about 15 minutes to see if there is a reaction, such as a raised red bump that itches.

Ragweed allergies can be treated with antihistamines and other allergy medications. As with pollen season in the spring, you can try to get ahead of these allergies by starting your medication two weeks before you expect your symptoms to be at their worst. Ask your allergist whether any of your medications can be taken before symptoms develop.

Two immunotherapy options are available for severe cases of ragweed allergy:

  • Allergy shots can help your body build resistance.
  • Tablets that dissolve under your tongue are available by prescription. Pills must be started 12 weeks before the beginning of ragweed season.

Other tips include:

  • To avoid pollen, know which pollens you are sensitive to and then check pollen counts. In spring and summer, during tree and grass pollen season, levels are highest in the evening. In late summer and early fall, during ragweed pollen season, levels are highest in the morning.
  • Keep your windows closed at all times, both at home and in the car.
  • Remember that pollen can be tracked into your home via your clothes, your hair or your pet — so change your clothes after being outside for long periods of time, shower before going to bed and wash your hands after petting an animal that has been outside.

Can people with fish allergies take fish oil supplements?

This is a difficult question to answer.

In 2008, a study skin prick tested (SPT) 6 fish allergic individuals with 2 different fish oil supplements and the participant then underwent an oral food challenge (OFC). None of the participants showed a positive SPT or OFC – which meant that they all safely tolerated the fish oil supplements. Both of these supplements carried a warning “not suitable for fish allergics”.

In contrast to this, a team from Canada reported on a case where a crab allergic individual showed recurrent episodes of anaphylaxis to a fish oil supplement. This is slightly difficult to interpret as the major allergens in fish (parvalbumin) and shell fish (tropomyosin) are different. No cross-reaction between these two allergens is seen, despite the fact that fish and shellfish allergies often co-exisit.

Most immune-assays will only detect (cod) parvalbumin in fish and tropomysin in shellfish. Detection of the parvalbumin becomes more difficult in fatty fish, and these two proteins (parvalbumin and tropomyosin) do not cover all the allergens in seafood. It therefore seems that at this point in time, it may not be possible to declare that fish oil supplements are safe for fish allergic individuals and krill oil supplements for shellfish allergic individuals.

Another point to take into account that the techniques used to measure the protein content of food for nutritional purposes, differ from detecting allergenic proteins. Just because a product indicates 0 grams of protein, does not mean trace amounts of allergenic proteins are not present.

Is there an alternative?

Algal oils contains* both EPA and DHA and are therefore a suitable alternative to fish/krill oil. Some, however, contain only DHA and it is therefore important to choose a supplement that contains both. REMEMBER: Always check the label and ask the manufacturer if the product is safe for fish and shellfish allergy suffers.


Should I bathe my child with eczema every day?

Eczema involves extremely dry skin, and some medical professionals think infrequent bathing (defined in this paper as less than once a day) is the best way to avoid irritating the skin. They believe infrequent bathing helps keep skin hydrated because it avoids constant evaporation of water, which can be drying. Infrequent bathing also means less use of the soaps which can aggravate eczema.

Those in favor of frequent bathing (defined in the paper as at least once a day) believe the presence of very dry skin requires hydration with daily baths followed by moisturizer. Limited use of pH balanced skin cleansers should also be part of frequent bathing, along with gentle patting dry, and the immediate application of a moisturizer to “seal” in moisture. This process is known as “soak and smear.”

A new article in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) looks at the research and answers the question. According to the authors, daily bathing is fine, as long as it’s followed by lots of moisturizer. In other words, “soak and smear.”

We, at Allergy, Asthma & Sinus Centers have always strongly recommended soaking baths with lukewarm water once or twice daily, with minimal use of a mild soap, immediately followed by applying the prescribed ointments to the eczematous skin and liberal use of Vanicream or Aquaphor to the rest of the body.


Is Eczema an Allergic Reaction?

Eczema is a red, itchy rash that can be triggered by food or other allergies. Because of this, some people ask: Is eczema an allergic reaction or is it a separate skin condition?

Almost 40 percent of children with eczema have food allergies. According the American College of Allergy, Asthma and Immunology, “it is recommended that children under the age of five who have moderate to severe eczema be evaluated to milk, egg, peanut, wheat and soy allergies.”

It can sometimes be difficult to determine the trigger or allergen, as the eczema rash might not show up for 24- to 48-hours after you have been exposed to the allergen. This is because it takes a while before the immune system is triggered and starts to fight off what it sees as an attack. Some common environmental triggers include:

Dust mites
Chemicals found in clothing or hair dyes
Soaps and other cleaning products

While many people find that the eczema rash develops around where the contact to the allergen occurred, it can also appear on other parts of the body.

Your doctor can conduct patch tests to determine what substances cause an allergic reaction. A patch test involves placing a patch that contains a common allergen on your back and then checking the area after 48 hours to see if there is any skin reaction.


New drug approved for children with asthma

The US Food and Drug Administration (FDA) has approved expanded use of omalizumab (Xolair, Novartis) to children as young as 6 years of age with uncontrolled moderate to severe persistent allergic asthma who have a positive skin test result or in vitro reactivity to an airborne allergen and symptoms that are inadequately controlled with inhaled corticosteroids, the company has announced.

Omalizumab was first approved in 2003 to treat adults and children age 12 years and older with moderate to severe persistent allergic asthma not controlled by inhaled steroids. The expanded approval to children age 6 to 11 years comes 3 months ahead of the FDA action date, the company said.