Showing posts with label allergy. Show all posts
Showing posts with label allergy. Show all posts

Wednesday, February 25, 2015

Washing the Dishes: A New Way to Reduce the Risk of Allergy!

By: Lewis First, MD, MS; Editor-in-Chief  

          We hear more and more in the news about the role of the hygiene hypothesis resulting in less allergic symptoms.  As a refresher, this hypothesis suggests that early microbial exposure triggers early immune stimulation that results in immunologic tolerance compared to later exposures that result in allergy and infection from a more inflammatory versus tolerant immune response. 
With that in mind, Hesselmar at al. (doi:10.1542/peds.2014-2968) decided to study the common practice of washing dishes to see if the washing dishes by hand (and thus exposing oneself to many more microbes than letting a dishwasher do the washing) resulted in less risk of allergy in those children.  The investigators collected data on more than 1000 children age 7-8 years in Sweden and asked them whether their families washed dishes and whether they had signs and symptoms of asthma, eczema, or allergic rhinitis as compared to those families who used a dishwasher.
To our surprise (perhaps yours as well), the families who do hand dishwashing showed much less allergic disease in their children compared to those who used the dishwasher.  So—does hand dishwashing mean more microbes to generate immunotolerance at an early age of exposure or not?  Is there another explanation for what the authors of this study show nicely in this study? 
Drs. Laurence Cheng and Michael Cabana (doi:10.1542/peds.2014-3911) have added an accompanying commentary to this study to try to clean up your concerns about whether or not to buy in or wash away your belief in the hygiene hypothesis.  Both the study and commentary dish out some provocative information and opinion, and we welcome your input as well. Just respond directly to this blog, or send us an e-letter or simply comment on our Facebook or Twitter page.

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Thursday, September 11, 2014

Do Your Food Allergic Patients Have Health Management Plans at School?

By: Lewis First, MD, MS; Editor-in-Chief 

Photo by US Dept. of Agriculture
With the increasing prevalence of asthma and food allergies in our patients nowadays, the need for a health management plan in school is critical to insure their health and well-being. Yet how good are our schools at making sure health management plans are in place for asthma and food allergic patients? A new study we published this week is itching to tell you more.

Gupta et al. (doi:10.1542/peds.2014-0402) share with us the results of some demographic and health data from the Chicago Public School database. The results are disappointing and indicate only one in four students has an asthma action plan, and about 50 percent of students with food allergy had school management plans. Just who are the students with and without plans, and why are so few getting these plans instituted in schools are topics included in the Results and Discussion sections of this interesting paper.

Read it in detail and learn more so you can insure that your patients do have asthma and food allergy action plans in place as we enter a new school year.

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Tuesday, August 26, 2014

Asthma, Eczema & Allergic Rhinitis from Pre-, Postnatal Second Hand Smoke Exposure?

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Javier Ignacio Acuna Ditzel

We certainly suspect an association exists between second-hand smoke exposure and allergic disease, but has it ever been confirmed in peer-reviewed scientific literature? Not as well as Thacher et al. (doi: 10.1542/peds.2014-0427) have done in an early release article we are sharing this week.

Their study involved more than 4,000 children followed for 16 years prospectively, while information was gathered on parental smoking habits, and symptoms of asthma, eczema and allergic rhinitis.

The results are fascinating and itching for your perusal. For example, second-hand smoke exposure in infancy seems to result in increased risk for asthma and allergic rhinitis, while exposure later in life seems to increase the risk of eczema.

These findings just scratch the surface of what awaits your own review of this study—so read on and learn more!

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Friday, September 13, 2013

Yet Another Reason to Avoid Ticks

Associate Editor Dr. William V. Raszka offers insight into topics in the news. This week, he reflects on the strange association between tick bites and red meat allergies: 

In Vermont, ticks have a bad reputation. The most recent data suggests that Vermont has the second highest incidence of Lyme disease in the country only lagging behind Delaware. It turns out that Vermonters (at least those living in the southern part of the state) may have to worry about yet another complication of tick bites: red meat allergy.

As reported in The Wall Street Journal (Health Journal: June 14, 2013), this odd allergy is on the rise. The culprit is not Ixodes scapularis but Amblyomma americanum, the Lone Star Tick. Some individuals bitten by the tick develop allergy to different meat products. Unlike allergies associated with bee stings, the symptoms tend to develop hours after ingestion of the food – and weeks and months after the tick bite. While symptoms range from vomiting, diarrhea, and abdominal cramps to hives and shortness of breath, no deaths have been reported. Given the interval between the tick bite and the food ingestion, making a connection between the two can be difficult. Patients often report the symptoms initially follow ingestion of a specific meat product, but then may follow ingestion of other meats as well.

The association between tick bites and red meat allergy was found by chance when studying cancer patients with an allergy to a specific monoclonal antibody, cetuximab. Further research showed that patients with IgE antibody to the mammalian oligosaccharide epitope, galactose-alpha-1,3-galactose (alpha-gal) could develop either immediate anaphylaxis to intravenous cetuximab or delayed onset anaphylaxis three to six hours after ingestion of meats. The presumed reason for the delay in symptoms following meat ingestion is that alpha-gal is concentrated in fat and it takes time for the fat to break down. Only patients in the distribution of the Lone Star Tick had the antibody to alpha-gal.

Unfortunately, the Lone Star Tick continues to expand its habitat, so more people may be at risk. As for me, this is yet another reason to wear long-sleeved clothing while hiking, and using plenty of repellents or insecticides while outside.

*This filler excerpt can be found in the September 2013 Pediatrics print journal p. 546, or online here.