HealtyDayS

Food Allergies

A new study Impact of Food Allergies on School Nursing Practice released in the October issue of The Journal of School Nursing findings reverberated what many in the medical community and educators have believed for years. Food allergies are a growing health and safety concern in the classroom. This study supports the American Medical Association (AMA) position calling for training and education of school staff.

In the study, conducted by The Food Allergy and Anaphylaxis Network (FAAN)  60% of the school nurses reported an increase in elementary-age students with food allergies in the classroom over the last five years. 94% of school nurses reported having at least 1 child with food allergies in their school. More than one third of the nurses indicated that they had 10 or more students in the school with food allergies, and 87% stated that, compared with other health-related issues, food allergies among school-age children is somewhat or very serious.

There is no cure for food allergies, so strict avoidance is the only way to prevent severe or life-threatening reactions. Safeguarding a child against a food-allergic reaction at school takes the cooperation and understanding of all parents, doctors, school administrators, teachers, school nurses, food service staff and classmates. Many times, however, this is the sole responsibility of the school nurse who may care for more than 500 students per school.

“Protecting a child from food allergies requires cooperation of the staff and proper educational tools, especially in a classroom setting,” said Anne Munoz-Furlong, Founder and CEO of FAAN. “The Department of Education and state governments across the country must provide standardized training programs to school staff to address this growing health and safety issue.”

In June 2004, the AMA reinforced that message with a call for schools to have established guidelines for managing food-allergic children. Citing concern that dangerous food allergies are on the rise, the AMA recommended that schools provide more student and teacher education on food allergies. The AMA also recommended that schools have guidelines for managing food allergy emergencies; and ensure epinephrine kits, the medication of choice to treat severe reactions, are on the premises with at least one staff member trained in their use.

In late September 2004, California Governor Arnold Schwarzenneger signed Senate Bill 1912 which will allow thousands of California students to carry and administer auto-injectable epinephrine throughout the school day. California students, with known food allergies and other allergic conditions, will be able to react immediately to the onset of an anaphylactic reaction. Quick treatment could be crucial to the recovery process or perhaps save the life of the student.

California became the sixth state to adopt a new law or regulation allowing children to carry prescribed epinephrine during the school day, others include: Delaware, New Hampshire, Michigan, Minnesota, and Maine.

More than 11 million Americans have food allergies and approximately three million children under the age of 18 years old or 1-in-25 American children have a food allergy. Food allergy reactions result in more than 30,000 emergency room admissions each year.

Nearly 400 school nurses were surveyed in the telephone study conducted in 2003. Eighty-six percent of the nurses were full-time, and 91% were employed by public schools. The study was sponsored by The Food Allergy and Anaphylaxis Network (FAAN).

Food Allergy

Many people unnecessarily avoid certain foods because of mistaken fears about food allergies. Parents are especially prone to limiting the diets of their children. In one study, 28 percent of parents thought their children had at least one food allergy during the first three years of life. However, careful testing showed that only 8 percent of the children actually had a food allergy.

“Food allergies can be a serious, even life-threatening condition, and patients need to avoid foods that cause allergic reactions,” said National Jewish pediatric allergist David Fleischer, M.D. “On the other hand, unnecessarily limiting a child’s diet can create anxiety about food and make it difficult to get adequate nutrition. A careful medical history and diagnosis by a physician can clarify exactly what foods, if any, need to be avoided.”

Difficult diagnosis

Self-diagnosis of food allergy can be difficult. For one, a person usually consumes several foods at one sitting, making it difficult to identify the food that caused a reaction. Also, there can be a delay between eating a food and developing a reaction, adding to the difficulty of identifying exactly what caused the reaction.  Furthermore, processed foods can contain substances that most people don’t even realize they are eating unless they carefully scrutinize the ingredients list.

People also often mistake food intolerance for food allergy . Food allergy occurs when the immune system mistakenly recognizes a food as harmful, and reacts against it. Allergic reactions can occur in the skin, respiratory system or gastrointestinal tract, causing swelling, hives, sneezing, nausea, abdominal pain, wheezing, shortness of breath or a drop in blood pressure. People can and do die from severe allergic reactions to food. Food intolerance occurs when the body has difficulty digesting food. It does not involve the immune system, generally causes milder reactions only in the gastrointestinal tract, and requires larger amounts of food to provoke a reaction. While both food intolerance and food allergy cause discomfort, food intolerance is not considered dangerous, and can sometimes be prevented with dietary supplements.

Food diary

Dr. Fleischer suggests that people who suspect that they or their children have a food allergy keep a detailed food diary for 2-3 days before visiting a physician. Food diaries should include what you ate, when you ate it, how long after you ate it that you had a reaction, what symptoms developed, and what treatment, if any, was necessary.

“A food diary is an easy way for patients to keep track of food reactions so the exact history can be accurately conveyed to the physician,” said Dr. Fleischer.

Allergy testing

The fastest way physicians test for allergies is the prick skin test ; a drop of extract from the suspect food is placed on the skin, and a tiny needle is used to prick the skin where the drops are placed. A patient who develops a reaction at the injection site may have an allergy. However, this test doesn’t always detect allergies and may even be falsely positive. So, the physician may also do a blood test. The most common blood test, a radioallergosorbent test (RAST), measures the IgE antibodies to a specific food in your blood.

“The only definitive test for food allergy is whether a person can consume that food without an adverse reaction,” said Dr. Fleischer. An oral food challenge accomplishes this by exposing a person to the food, first by smell, then by touch, and, finally, by eating increasing amounts of it. A challenge is terminated if an adverse reaction occurs at any stage. All challenges are performed under close medical supervision, usually only at specialized allergy centers like National Jewish. Patients should not perform their own food challenges on food they believe have caused a significant reaction in the past.

Outgrowing an allergy

People do outgrow allergies, so an allergy evaluation can be helpful even if a person has been diagnosed with a food allergy. Milk, egg, soy, and wheat are common childhood allergies that children often outgrow. Peanut, tree nut, and fish allergies are more likely to extend into adulthood, but recent research has shown that some people with peanut and tree nut allergies eventually outgrow them.

Allergy Relief and Bleach

First-ever Human Studies Show Bleach Solution Reduces Allergenic Properties of Mold

Researchers at National Jewish Medical and Research Center have demonstrated that dilute bleach not only kills common household mold, but may also neutralize the mold allergens that cause most mold-related health complaints. The study, published in the September issue of The Journal of Allergy and Clinical Immunology, is the first to test the effect on allergic individuals of mold spores treated with common household bleach.

“It has long been known that bleach can kill mold. However, dead mold may remain allergenic,” said lead author John Martyny , Ph.D., associate professor of medicine at National Jewish. “We found that, under laboratory conditions, treating mold with bleach lowered allergic reactions to the mold in allergic patients.”

The need for denaturing or neutralizing mold allergens is a critical step in mold treatment that has not been fully understood. Currently, most recommendations for mold remediation call for removal since dead mold retains its ability to trigger allergic reactions, according to Dr. Martyny.

The researchers grew the common fungus Aspergillus fumigatus on building materials for two weeks, and then sprayed some with a dilute household bleach solution (1:16 bleach to water), some with Tilex® Mold & Mildew Remover, a cleaning product containing both bleach and detergent, and others only with distilled water as a control.  They then compared the viability and the allergenicity of the treated and untreated mold.

The researchers found that the use of the dilute bleach solution killed the A. fumigatus spores. When viewed using an electron microscope, the treated fungal spores appeared smaller, and lacked the surface structures present on healthy spores.  In addition, surface allergens were no longer detected by ELISA antibody-binding assays, suggesting that the spores were no longer allergenic.

The National Jewish researchers then allergy-tested eight Aspergillus -allergic individuals with solutions from the bleach and Tilex®-treated building materials. Seven of the eight allergic individuals did not react to the bleach-treated building materials, and six did not react to the Tilex®-treated building materials. This evidence suggests that, under laboratory conditions, fungal-contaminated building materials treated with dilute bleach or Tilex® may have significantly reduced allergic health effects.

“This study was conducted under controlled laboratory conditions.  In order to assure that the bleach solutions will function similarly under actual field conditions, additional experiments will need to be conducted,” said Dr. Martyny. “We do believe, however, that there is good evidence that bleach does have the ability to significantly reduce the allergenic properties of common household mold under some conditions.”

This study was partially funded by a grant from The Clorox Company.

National Jewish is the only medical and research center in the United Stated devoted entirely to respiratory, allergic, and immune-system diseases, including asthma, allergies, and chronic obstructive pulmonary disease. It is a non-profit, non-sectarian institution dedicated to enhancing prevention, treatment, and cures through research, and to developing and providing innovative clinical programs for patients regardless of age, religion, race, or ability to pay.

Allergic Rhinitis

A small study indicates that there was no difference between an over-the-counter decongestant (pseudoephedrine) and a prescription medication (montelukast) in relieving symptoms associated with allergic rhinitis and improving quality of life, according to a study in the February issue of the Archives of Otolaryngology - Head & Neck Surgery, one of the JAMA/Archives journals.

Allergic rhinitis, inflammation and congestion of the nasal passages associated with seasonal allergies, such as hay fever, affects about 40 million people in the United States. Symptoms include sneezing, runny nose, itchy nose and throat and nasal congestion, according to background information in the article. The condition also may cause more serious consequences, such as problems sleeping, daytime sleepiness and reduced productivity. Several medications, including pseudoephedrine hydrochloride (an over-the-counter preparation) and montelukast sodium (a prescription drug), are available to treat symptoms, the authors report.

Samatha M. Mucha, M.D., and colleagues at the University of Chicago compared these two treatments in a group of 58 adults with ragweed allergic rhinitis, as documented by the results of skin testing. Participants recorded their symptoms and quality of life at the beginning of the study and took one of the medications each morning for two weeks. Thirty patients received montelukast and 28 took pseudoephedrine.

Both treatments reduced all the symptoms of allergic rhinitis, including congestion, runny nose and sneezing, and improved quality of life. Pseudoephedrine was more effective than montelukast at alleviating the symptom of nasal congestion. Both medications improved nasal peak inspiratory flow, which objectively gauges nasal congestion by measuring the amount of air flowing into the nose.

Food Allergies

Effective January 1, 2006, the Food and Drug Administration (FDA) is requiring food labels to clearly state if food products contain any ingredients that contain protein derived from the eight major allergenic foods. As a result of the Food Allergen Labeling and Consumer Protection Act of 2004 (FALCPA), manufacturers are required to identify in plain English the presence of ingredients that contain protein derived from milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans in the list of ingredients or to say “contains” followed by name of the source of the food allergen after or adjacent to the list of ingredients.

“I applaud Congress for the passage of FALCPA,” said Andrew C. von Eschenbach, M.D., Acting FDA Commissioner. “Chairman Joe Barton and Ranking Member John D. Dingell in the House, Energy and Commerce Committee were instrumental in moving this bipartisan legislation forward. Representative Nita Lowey was the original sponsor of the legislation. FDA also applauds the dedication and leadership of the legislation’s sponsors in the Senate, which include Senators Judd Gregg and Edward Kennedy.”

This labeling will be especially helpful to children who must learn to recognize the presence of substances they must avoid. For example, if a product contains the milk-derived protein, casein, the product’s label will have to use the term “milk” in addition to the term “casein” so that those with milk allergies can clearly understand the presence of the allergen they need to avoid.

It is estimated that 2 percent of adults and about 5 percent of infants and young children in the United States suffer from food allergies. Approximately 30,000 consumers require emergency room treatment and 150 Americans die each year because of allergic reactions to food.

“The eight major food allergens account for 90 percent of all documented food allergic reactions, and some reactions may be severe or life-threatening,” said Robert E. Brackett, PhD, Director of FDA’s Center for Food Safety and Applied Nutrition. “Consumers will benefit from improved food labels for products that contain food allergens.”

FALCPA does not require food manufacturers or retailers to relabel or remove from grocery or supermarket shelves products that do not reflect the additional allergen labeling as long as the products were labeled before the effective date. As a result, FDA cautions consumers that there will be a transition period of undetermined length during which it is likely that consumers will see packaged food on store shelves and in consumers’ homes without the revised allergen labeling.

Allergens

A new Mayo Clinic study reveals the most common causes of allergic contact dermatitis, a skin inflammation resulting in swollen, reddened and itchy skin due to direct contact with an allergen. Topping the list were:

• Nickel (nickel sulfate hexahydrate) - metal frequently encountered in jewelry and clasps or buttons on clothing,

• Gold (gold sodium thiosulfate) - precious metal often found in jewelry,

• Balsam of Peru (myroxylon pereirae) - a fragrance used in perfumes and skin lotions, derived from tree resin,

• Thimerosal - a mercury compound used in local antiseptics and in vaccines,

• Neomycin sulfate - a topical antibiotic common in first aid creams and ointments, also found occasionally in cosmetics, deodorant, soap and pet food,

• Fragrance mix - a group of the eight most common fragrance allergens found in foods, cosmetic products, insecticides, antiseptics, soaps, perfumes and dental products,

• Formaldehyde - a preservative with multiple uses, e.g., in paper products, paints, medications, household cleaners, cosmetic products and fabric finishes,

• Cobalt chloride - metal found in medical products; hair dye; antiperspirant; objects plated in metal such as snaps, buttons or tools; and in cobalt blue pigment,

• Bacitracin - a topical antibiotic,

• Quaternium 15 - preservative found in cosmetic products such as self-tanners, shampoo, nail polish and sunscreen or in industrial products such as polishes, paints and waxes.

This study, to be presented Monday at the American Academy of Dermatology annual meeting in San Francisco, confirmed that patch testing with a standard contact dermatitis series of substances is useful for identifying common contact allergens. Patch testing is conducted by placing potential allergens covered with patches on patients’ backs for two days and then observing which substances cause skin inflammation. The study confirmed previous findings by the North American Contact Dermatitis Group.

The researchers examined contact dermatitis testing results from 3,854 patients over a five-year period between Jan. 1, 2001 and Dec. 31, 2005. The patients were tested with an average of 69 allergens. Of these patients, 2,663 (69 percent) had at least one positive reaction, and 1,933 (50 percent) had two or more positive reactions.

Results of two other Mayo Clinic studies on contact dermatitis will be presented at the American Contact Dermatitis Society meeting, which immediately precedes the American Academy of Dermatology meeting. In the first study, researchers mailed a written survey to 1,458 recently tested contact dermatitis patients. The survey found that, overall, patients were satisfied with the contact dermatitis patch testing process and with subsequent improvement of their skin conditions. More than 75 percent of respondents said they were at least “somewhat satisfied” with the overall testing and treatment process, and over one-half reported they were “very satisfied.” Nearly 60 percent indicated improvement in their skin conditions since the patch testing.

In the second study to be presented at the American Contact Dermatitis Society meeting, researchers included a write-in question with the aforementioned survey mailing. The survey found patients could recall only 50.6 percent of the allergens for which they tested positive an average of 13.4 months after patch testing. The researchers indicate these findings point to the ongoing need for education to remind patients of their allergens and reinforce the importance of avoiding them.

Contact dermatitis is common among all age groups and can cause minor annoyance to more severe handicaps, according to Mark Davis, M.D., Mayo Clinic dermatologist and lead study researcher. “Patients with contact dermatitis can get a very itchy rash from head to toe, or in a confined area,” he says. “If it’s on the hands and feet it can be disabling, and patients at times can’t do their jobs.”

Allergen avoidance is the chief treatment for contact dermatitis, according to Dr. Davis, though at times corticosteroid creams are used to treat rashes. He notes, however, that 3 percent of patients with contact dermatitis are allergic to the topical steroids that would alleviate their symptoms.

Hay Fever Relief

There is no significant difference between an over-the-counter decongestant and a prescription medication that costs almost four times as much in relieving hay fever symptoms, report researchers from the University of Chicago in the February issue of Archives of Otolaryngology - Head & Neck Surgery.

The study, conducted during the 2003 ragweed allergy season in Chicago, found that daily doses of 240 mg of pseudoephedrine hydrochloride (Sudafed® 24 Hour) were just as effective as 10 mg daily of montelukast sodium (Singulair®) at relieving symptoms such as nasal congestion, runny nose, sneezing, and itching, and at improving quality of life for those with hay fever - without any additional side effects.

“This came as a genuine surprise,” said Fuad Baroody, MD, associate professor of surgery at the University of Chicago and director of the study. “Our hypothesis was that montelukast would have additional benefits and pseudoephedrine would interfere with sleep, but when we compared them head-to-head we found that for treatment of allergic rhinitis, these drugs at these doses were virtually identical.”

In fact, pseudoephedrine had small advantages in specific categories. It was slightly more effective, for example, in reducing congestion, which it was specifically designed to do.

Despite similar results, the drugs work in completely different ways. Pseudoephedrine, designed to treat nasal congestion, constricts vessels within the nasal mucosa, thus leading to a more patent airway and less nasal congestion. It does not have known anti-inflammatory effects.

On the other hand, Montelukast, originally designed to treat asthma, antagonizes leukotrienes, substances released during the allergic response. These substances have potent inflammatory effects and are known to cause nasal congestion and contribute to chronic inflammation, which is one of the hallmarks of allergic rhinitis.

Because of these properties, montelukast was approved by the FDA to treat allergic rhinitis, and “indeed,” notes Baroody, “this study is one of few that shows that montelukast causes a significant improvement in nasal airflow, an objective measure of nasal congestion, an effect shared by pseudoephedrine in this study.”

Another difference between the agents is the cost. At www.drugstore.com timed-release 240 mg capsules of pseudoephedrine cost about 80 cents a day, compared to $3.20 a day for montelukast. Since allergic rhinitis - the nasal congestion, runny nose, sneezing and itching associated with seasonal allergies such as hay fever - affects about 40 million people in the United States, the difference can add up.

This study compared these two treatments in 58 adults with ragweed allergy during the hay fever season, from mid-August until late September, of 2003. Participants recorded their allergy symptoms, quality of life without medication, and peak nasal inspiratory flow (PNIF - a measure of air flow through the nose) for two days before beginning the drug trial.

During the study, 30 patients took montelukast and 28 took pseudoephedrine each morning for 14 days. For these two weeks, they recorded allergy symptoms and PNIF twice a day. At the end of the study they filled out another questionnaire about quality of life and side effects.

“There were two surprises,” Baroody said. “We expected pseudoephedrine to be effective against congestion, but we underestimated its impact on sneezing, runny nose, and itching.”

The second was the lack of sleep problems among those taking pseudoephedrine. Although nervousness, anxiety, insomnia, dry mouth and palpitations have all been associated with pseudoephedrine in previous studies, neither medication caused any significant side effects in this investigation.

“Both medications were well tolerated,” note the authors, “and pseudoephedrine did not lead to any of its well-known stimulant adverse effects, likely owing to its once-daily administration in the morning and lower blood levels in the later hours of the day closer to bedtime.”

Food Allergy

Millions of food allergy sufferers in the United States will have a bit of added security in 2006 under new federal rules that require clear, no-nonsense labeling of products that contain common allergy-triggering ingredients.

“The Food Allergen Labeling and Consumer Protection Act,” passed in the summer of 2004, will officially take effect on Jan. 1 after companies were given an 18-month head start to prepare. The law targets eight food groups that cause 90 percent of all food allergies, including milk, eggs, fish, peanuts, shellfish, wheat and soybeans.

Dr. James Gern, a professor of pediatrics at the University of Wisconsin-Madison, can talk to reporters about the causes and prevalence of food-based allergies and the implications of these new rules. Gern is a national expert of childhood asthma and allergies and recently served on the Executive Committee, Section on Allergy and Immunology, for the American Academy of Pediatrics.

A recent Food and Drug Administration study found that one in four sampled foods failed to list peanuts or eggs as ingredients on their food labels. About 2 percent of adults and 5 percent of children in the U.S. suffer from food allergies, and they cause roughly 150 deaths and 30,000 emergency-room treatments each year.

Allergies and Sneezing

Some advice for allergy season? Don’t stifle your sneeze.

Whether ladylike and whisper-silent or hurricane-force honking, sneezing makes spring miserable for allergy sufferers. But what we commonly think of as a nuisance has a powerful purpose.

“Sneezing can shoot tiny particles out of the nose at up to 100 miles per hour,” said Dr. Cassius Bordelon an associate professor of cell biology who teaches anatomy at Baylor College of Medicine. “If we couldn’t sneeze, we wouldn’t be able to rid the body of substances that could harm it.”

Sneezing begins when people inhale foreign substances such as smoke, pet dander, pollution and perfumes through the nostrils. These substances irritate the nasal passages and stimulate nerve endings, activating a reflex inside the brain that controls the muscles in the head and neck.

“The sensation can be compared to an itch inside the nose, and the only way to scratch it is to sneeze,” Bordelon said.

At the beginning stages of a sneeze, pressure builds up inside the chest. Sneezing occurs when this compressed air explodes out the respiratory tract and out the nose.

The person doing the sneezing, more often than the amount or kind of irritant, determines if the sneeze comes out as a gale-force windstorm or several small ach-oos, Bordelon said.

“The reasons behind the severity of the sneeze are usually more sociological than physical,” he said. “Some people are just more comfortable letting it all out, while others try to be more discreet.”

Whether loud or quiet, the same process that removes irritants from the body also spreads germs and viruses like the common cold to others. Time elapsed photos of people sneezing show countless droplets of moisture surrounding their heads. But while covering your nose when sneezing helps protect others from germs, stifling a sneeze out of politeness may do more harm than good. In rare cases, increased pressure from holding your nose and closing your mouth can blow out the eardrums.

“When you stifle a sneeze, you can prevent the clearance of the germs or irritants from your body and increase your needs to keep sneezing or develop an infection,” said Dr. Donald Donovan, an associate professor of otorhinolaryngology at Baylor. “The best thing is to sneeze with your nose and mouth open into a tissue away from other people.”

That same pressure activates a reflex in most people to close their eyes while they sneeze. Scientists speculate that the reflex evolved to help protect the eyes from the particles a sneeze expels, but not everyone has it.

“The old wives tale that if you sneeze with your eyes open, you will blow them out is absolutely untrue,” Bordelon said.

Child Allergies

University of Cincinnati (UC) researchers say exposure to a certain group of fungal spores - abundant in the air that we breathe every day - can make young children more susceptible to developing multiple allergies later in life. The team found that infants who were exposed to basidiospores and other airborne fungal spores - specifically penicillium/aspergillus and alternaria - early in life were more likely to develop allergies to mold, pollen, dust mites, pet dander and certain foods as they grew older.

This is the first study to show a relationship between specific airborne fungal spores and an increased risk for multiple allergies in children, the UC team reports in an upcoming edition of Pediatric Allergy and Immunology and an early online edition June 14.

A fungus is a plantlike organism that grows by releasing tiny reproductive cells (spores) into the air. Mold is a type of fungus that can grow on any moist surface - including wood, drywall and cement.

Previous allergy studies focused on visible mold or total mold concentrations, not the identification of specific airborne fungal spores. The UC-led study showed that exposure to specific airborne fungal spores may increase allergic reactions and others could help reduce them.

These findings reinforce the idea that not all fungi are created equal, says Tiina Reponen, PhD, professor of environmental health at UC and corresponding author on the study.

“It turns out that the health effects of airborne fungal spores are more complicated than we thought,” she says. “It’s not enough to look just at total mold in our homes and offices. We need to understand how specific types of mold interact with each other in the environment to affect our respiratory health. Some fungi can have harmful effects on the body, but others may be beneficial.”

“There are literally thousands of different types of mold in the air we breathe,” adds Melissa Osborne, a graduate of UC’s environmental and occupational hygiene program and study lead author. “But because mold exists naturally in the outdoors, it’s very difficult to completely remove mold spores from the air.”

Osborne conducted this research while pursuing her master’s at UC and is currently employed as an environmental consultant at Quantus Analytical, a mold and allergen laboratory and consulting group in Cincinnati.

Using a small air sampling device, the UC research team collected fungal spores from the homes of 144 infants enrolled in the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS).

The CCAAPS, funded by the National Institute of Environmental Health Sciences, is a five-year study examining the effects of environmental particulates on childhood respiratory health and allergy development.

Air samples were collected for a total of 48 hours in the child’s primary activity room and in the child’s bedroom during sleep. Samples were analyzed for both total and individual spore counts.

“We found that, at least in children, some fungi may cause allergic sensitization while other fungal types may actually inhibit the development of allergies,” explains Osborne.

“But very little is known about how infant allergies to environmental allergens develop,” she adds, “and more research is needed before we will fully understand the impact of fungi as an allergen in infants.”