March 10th, 2010
The grass pollen hay fever season is fast approaching and those of you prescribed oral immunotherapy should have now commenced treatment at least 2 months before the summer season kicks off in May. For the rest of us, make sure you start taking antihistamine medication at least for a week before those innocent looking lawns and fields start their unrelenting attack on our upper airways.
Specific grass desensitization to Timothy grass pollen as a treatment for allergy and hay fever has been available for the last 3 years. This sublingual (SLIT) tablet contains a Timothy grass pollen extract which dissolves away under the tongue where it is absorbed promoting immune tolerance to grass pollen when taken over a 3 year period. Although expensive at over £2 per day, Grazax is an additional option for those severe hay fever sufferers (with allergic rhinoconjunctivitis) not responding to conventional antihistamine medication and nasal steroid sprays. It can be prescribed on the NHS but many health authorities deem it too expensive for the 30% improvement in hay fever symptoms and reduced medication requirements documented in clinical studies. Many desperate hay fever sufferers have therefore turned to private prescriptions of this disease modifying hay fever tablet.
Reference: Durham SR et al. Long-term clinical efficacy in grass pollen-induced rhinoconjunctivitis after treatment with SQ-standardized grass allergy immunotherapy tablet. Journal Allergy and Clinical Immunology 2010;125:131-38
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Tags: allergic rhinitis, allergic rhinoconjunctivitis, antihistamine medication, grass allergy tablet, grass desensitization, grazax, hay fever tablet, immunotherapy, SLIT, timothy grass
Posted in Airway Allergy |
February 22nd, 2010
The Sunday Times newspaper has again produced a masterpiece of investigative journalism (Sunday 21st February 2010) highlighting the frightening number of nonsense allergy and food intolerance tests available in central London. It is amazing that there is no public watchdog to prevent these unvalidated and unscientific allergy tests from being promoted to unsuspecting members of the public by inadequately trained practitioners and nutritionalists. Well done to Gillian Passmore and the Sunday Times for again drawing attention to the issue of misleading unorthodox allergy testing.
http://www.timesonline.co.uk/tol/life_and_style/health/article7034867.ece
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Tags: Allergy Testing, food intolerance, investigative journalism, nutritionalists, sunday times, unorthodox testing
Posted in Allergy Testing |
February 18th, 2010
Lactose Intolerance is a deficiency of the digestive enzyme B-galactosidase (Lactase) in the human intestine and a meal containing the cow‘s milk disaccharide sugar lactose (galactose bound to glucose) will induce frothy diarrhoea, flatulence and abdominal cramps. This is caused by undigested lactose passing into the colon where it is hydrolysed by bowel bacteria producing organic acids and gas including CO2, H2 and H2O. Symptoms do not include vomiting, rashes or nasal congestion as there is no immune response, it is purely undigested lactose that results in runny poop!
So if you do indeed have Lactose Intolerance, a proper cow’s milk challenge must theoretically give you rapid onset diarrhoea. No diarrhoea equates to no Lactose Intolerance. If your nose blocks up or they get a rash on your tummy then you probably have some additional problem other than purely lactose intolerance.
Almost all people are born with sufficient lactase but with increasing age, levels drop. Most lactose intolerant individuals tolerate small amounts of lactose in the diet and usually a full glass of fresh milk is necessary to trigger symptoms. Temporary lactose intolerance may follow a bout of viral gastroenteritis due to inflammation and hence it is best to avoid cow’s milk during the recovery period.
Lactose Intolerance may be an inherited trait affecting 10% of Caucasians and up to 80% of ethnic Africans, Asians and people of Mediterranean origin. Treatment is basically lactose avoidance or supplementation with an oral Lactase enzyme preparation such as Colief. Yoghurt is often tolerated as it contains live B-galactosidase producing bacteria.
Useful tests for diagnosing Lactose Intolerance include the popular Hydrogen Breath Test (although less reliable due to false positive results from other dietary sugar intake), as well as measuring serial blood glucose levels after a lactose containing meal, or measuring Faecal Reducing Substances (Sugars) in the watery frothy diarrhoeal stool produced as a consequence of a lactose containing meal.
References:
Joneja JMV. Food Allergy & Intolerances. Mechanisms and Management. J.A.Hall publications 2003.
Metcalfe D, Sampson H, Simon R. Food Allergy: adverse reactions to food and food additives 4th Ed. Blackwell Science 2008
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Tags: colief, cows milk intolerance, diarrhoea, faecal reducing substances, flatulence, galactosidase, hydrogen breath test, lactase
Posted in Allergy Testing, Food Allergy |
February 4th, 2010
The Staphylococcus Aureus (Staph) skin germ plays a pivotal role in aggravating moderate to severe atopic eczema especially in children. Eczema first occurs in infancy but may persist through childhood into adulthood. Many factors have been implicated in causing and promoting eczema such as our gene makeup (atopy), skin allergy (to dust mites, pet dander and food allergens) and skin damage. The common skin Staph bacterium carried on our skin plays an important role in triggering eczema exacerbations. While 10 and 40% of the general population naturally carry Staph on their skin, a whopping 90% of eczema sufferers have this germ inhabiting their skin. Studies reveal that 30% of moderate eczema sufferers are actually allergic to a toxin produced by the Staph, while in severe or difficult to control eczema, up to 68% of sufferers will have an allergy to it. The Staph also seems to make established eczema more difficult to treat by increasing skin resistance to therapeutic steroid creams – they just don’t seem to work as well if there is a Staph infection present.
Studies show that systematically eradicating the Staph from the skin will make the eczema easier to control and ultimately clear. In an established infection, the eczema will spread rapidly appearing bright red, crusty, weepy and blistered. The Staph can also persist by being harboured in the nasal passages, under dirty finger nails and in moist skin creases. Fortunately most Staph will be eliminated by antibiotic skin creams such as Mupirocin (Naseptin) or Fusidic acid (Fucidin) as well as by antiseptic skin disinfectants such as povidine iodine (Betadine), hydrogen peroxide, potassium permanganate and chlorhexidine (Hibitane). The beneficial effect of using sodium hypochlorite (found in bleech) and silver impregnated garments has not been proven. In more extensive Staph infections presenting with Impetigo (skin honey crusts), Folliculitis (pimples and pustules) and Cellulitis (widespread skin surface infection), oral antibiotics such as Flucloxacillin, Erythromycin and Co-amoxyclav will effectively treat the skin infection (unless the superbug MRSA (Methicillin Resistant Staphylococcus Aureus) is present).
http://pediatrics.aappublications.org/cgi/content/abstract/120/Supplement_3/S122
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Tags: antibiotics, eczema, MRSA, skin infection, staphylococcus, steroid cream
Posted in Skin Allergy |
January 14th, 2010
Irritable bowel syndrome otherwise called IBS is a common medical condition affecting the lower bowel in 1 in 5 young adults. Females are especially prone to IBS which presents with one or more of 3 cardinal symptoms:
A. Abdominal pain and spasm which eases when emptying the bowels.
B. Bloating, fullness on eating and abdominal distension with wind.
C. Change in bowel habit with passage of frequent loose mucus-laden stools (an enhanced gastro colic reflex), often alternating with episodes of constipation.
Other more serious bowel conditions such as food allergies, inflammatory colitis, stomach ulcers, intestinal infection and coeliac disease may cause similar but more intense symptoms, and will need to be excluded by testing. A few simple blood tests undertaken by your GP (such as ESR, CRP, FBC) will exclude colitis or gut infection, while specific IgE allergy testing will identify food allergy and coeliac screening measuring Tissue Transglutaminase antibodies will exclude gluten intolerance. Certain non-specific food intolerances may be triggers for IBS and these include excess fruit intake, wheat, dairy produce, onions, excess tea, coffee, alcohol and highly insoluble dietary fibre such as bran, all of which may exacerbate IBS symptoms. The artificial sweetener Sorbitol and processed starch in ready meals may also promote IBS. While emotional stress, masked depression and missed or erratic meals may also be triggers, whereas taking a regular Probiotic supplement (Acidophilus GG) and drinking plenty of filtered water every day may calm the symptoms.
Discuss any concerns you might have regarding food allergies, intolerance or colitis with your GP, Practice Nurse or a qualified Dietician.
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927
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Tags: Allergy Testing, artificial sweetener, diet and stress, Food Allergy, Food Intolerances, gluten intolerance, high fibre diet, infections, probiotics, ready meals
Posted in Allergy Testing, Food Allergy |
December 22nd, 2009
Although some people have a general aversion to all things Christmas, this is not truly an allergy. But for those genuinely allergic people, the festive season can be a frankly dangerous period. Unprecedented numbers of children have developed nut, fruit and general food allergies in recent years as the allergy pandemic takes hold of our lives on a scale that outstrips global warming and climate change. Christmas time is a highly risky period for these people. Consider the contents of Christmas foods such as cakes, mince pies, puddings, nuts and all those special treats abundantly available during the Festive Season. No wonder it’s a worrying time for parents and allergy sufferers. Even the traditional Christmas tree may be a hotbed of allergens, distributing pollen, moulds and resin inside the home. Whilst a synthetic tree may be as problematic for it may contain allergenic chemicals such as formaldehyde and isocyanates. These chemicals can trigger off asthma, rhinitis, skin allergies and allergic conjunctivitis.
On a more positive note, the traditional Christmas turkey is a particularly low allergy-risk protein and if served together with low allergy-risk vegetables such as rice, sweet potato, cooked carrot, parsnip, beetroot and peas, this can make a particularly suitable Christmas meal for allergy-prone children and their parents. Finish off the festivities with a hypo-allergenic dessert of cooked pears or apricots. The process of cooking foodstuffs tends to reduce the allergy provoking effects on the immune system by slightly changing the molecular structure of the food. If in doubt about allergy-risk friends and visitors always keep a good supply of antihistamine medication on hand just in case…………….
www.allergy-clinic.co.uk/food-allegy/food-allergy-guide
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Tags: christmas allergies, christmas turkey, climate change, food aversion, formaldehyde, hypo-allergenic, isocyanates
Posted in Airway Allergy, Food Allergy |
December 10th, 2009
In the Cincinnati study into Childhood Allergy and Air Pollution, 624 babies and toddlers of allergic parents were assessed and when exposured to a combination of high levels of indoor allergens (such as bacteria from throat infections, house dust mites and mould spores) plus traffic air pollution, this increased their risk of developing wheezing and persistent asthma by six fold. The well-established Hygiene Hypothesis highlights the connection between a sterile home environment in infancy and the risk of deveoping childhood allergies. It was the combined effect of exposure to high levels of indoor allergens (endotoxin) together with the motor car diesel exhaust fumes that seemed to be such a potent trigger for wheezing and persistent airway inflammation. The resultant chronic airway inflammation is also known to retard long-term normal lung development. While in children exposed to moderate levels of indoor or outdoor allergens, only 11 percent developed asthma and in those exposed to low levels of allergen but high level air pollution, 18 percent developed persistent or chronic asthma.
http://www.newswise.com/articles/view/558806/?sc=mwtn
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Tags: air pollution, airway inflammation, allergens, childhood allergy, chronic asthma, diesel exhaust, hygiene hypothesis, wheezing
Posted in Airway Allergy |
December 4th, 2009
Even if allergic to the same food, not all people react to the same protein in the food. There a number of potential allergy provoking proteins found in each food.
Cow’s milk allergy sufferers may react to one of five different casein or whey proteins in milk. Hence most casein allergic children react to cheese and goats milk while whey allergic children seem to tolerate these products. Heating of milk lowers the allergy potential of the whey components. This explains why whey allergic children seem to tolerate boiled or UHT long-life cow’s milk.
The five principal allergenic proteins in cow’s milk have now been identified as Bos d 4 (alpha-lactalbumin) and Bos d 5 (beta-lactglobulin) in whey, as well as Bos d 6 (Bovine serum albumin), Bos d 8 (Casein) and Bos d lactoferrin (Bovine lactoferrin)
While in Hens’ egg white, there are four different allergenic proteins. These are Gal d 1 (Ovomucoid), Gal d 2 (Ovalbumin), Gal d 3 (Conalbumin) and Gal d 4 (Lysozyme). One of these could set off an egg allergic reaction in a sensitised individual.
In Peanut we find 9 different Ara h allergens and in Latex there are 13 different Hev b allergens, all capable of triggering a peanut or latex allergic reaction. The Latex Hev b 8 allergen, also called a Profilin is similar to the allergy provoking Profilin found in apple, banana and many other fruits.
This may seem very complicated, but a new range of allergy tests for these specific components are now available. The tests are called recombinant allergen components and confirm to which protein in a food the individual will react. Certain allergy provoking proteins such as Profilin, PR-10 proteins, Tropomyosin and Lipid Transfer Protein (LTP) can occur in unrelated food such as Hazelnut and Apple or Latex and Avocado. For example an unsuspecting Latex allergy sufferer may have an acute allergic reaction when eating Avocado, Banana, Kiwi or Chestnut for the first time.
Once the specific allergen is identified on allergy testing, the person can be advised which other foods may cause an adverse allergic reaction
Ref: Steinman H, Native & recombinant allergen components. Phadia AB 2008, ISBN 91-970475-6-2
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Tags: allergen testing, cow milk allergy, egg allergy, lactglobulin, latex, lipid transfer protein, peanut allergy, profilin, recombinant allergens
Posted in Allergy Testing |
November 23rd, 2009
More than five million individuals in the UK receive regular treatment for chronic asthma. Many are unsure about when or how to use inhalers, which reduces the effectiveness of their medication and can be a health risk.
A leading pharmacy group has developed a service, designed to help patients use long-term prescription drugs correctly. They found patients either breathe in too fast or not strongly enough and many individuals don’t seem to be able correctly alter their inhaler technique. These patients are then advised to speak to their GP about finding an alternative asthma medication delivery system. A study at Belfast City Hospital revealed 35 per cent of asthmatic patients used half or less of their prescribed medication, and another 21 per cent used treatment more than prescribed.
Asthma control is reliant on adequate use of low dose inhaled steroids as preventer medication particularly during the winter months when viral infections are likely to exacerbate asthma attacks.
http://www.dailymail.co.uk/health/diets/article-1229842/Millions-asthma-sufferers-misuse-medication.html
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Tags: asthma control, Asthma Medication, asthma preventer, chronic asthma, steroid inhaler
Posted in Airway Allergy |
November 18th, 2009
A scientific study due to be published in the American medical journal Pediatics (December 2009) has found a massive 18% increase in reported food allergies amongst US children (under 18 yrs of age). This increased reporting of food allergies took place over the last decade between 1997 and 2007. While between 1993 and 2006 ambulatory visits to the doctor for food allergies have tripled. In 2007 alone, 3.9% of US children reported food allergic conditions. The most severely affected were ethnic minorities such as Hispanics. In 2005 to 2006, an estimated 9% of US children had detectable peanut IgE in their blood on allergy testing while over the same period hospitalisations with a diagnosis of food allergy also tripled. It is uncertain whether this trend is due to a true increase in food allergic diseases or represents increasing allergy testing and physician and parental food allergy awareness.
http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-1210v1
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Tags: allergy in children, Allergy Testing, food allergies, Food Allergy, IgE, peanut allergy
Posted in Allergy Testing, Food Allergy |
November 12th, 2009
A recent study on children attending day care or nurseries by de Jongste in the American Thoracic Society journal cast some doubt on the so-called Hygiene Hypothesis for allergy development. The Hygiene Hypothesis notion that farm animal faeces exposure and childhood infections will prevent allergies has been promoted for decades. The hygiene hypothesis essentially links a more clean and sterile home environment with the overall rise in allergies seen in many developed Western counties. Poor living conditions with early exposure to germs, infections and parasites seem to shift the infant’s immune system into survival mode (TH1) and away from allergy mode (TH2) when allergy testing. However this immune switching probably occurs very early in the first few months of life. Therefore as mentioned in the American study, day care centre exposure and subsequent childhood infections may have little impact on allergy development. Particularly if the child attends a day-centre after one year of age when their immune type reactivity is more established. It still seems likely that a germ-filled household with difficult living conditions and plenty of sickly older siblings will be more protective from allergies while a sterile, insular environment in early infancy seems to promote allergies.
http://news.bbc.co.uk/2/hi/health/8241774.stm
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Tags: allergy protection, Allergy Testing, children's allergies, day care allergies, hygiene hypothesis, immune switching, infections, parasite
Posted in Allergy Testing |
October 29th, 2009
In the UK, blood tests for immunoglobulin G4 (IgG4) against foods are actively promoted for the diagnosis of food intolerance and hypersensitivity. Mounting clinical research indicates that food-specific IgG4 allergy testing does not indicate (imminent) food allergy or intolerance, but is rather a normal physiological response by the immune system after food exposure. In fact IgG4 is more likely to indicate food tolerance and that the person can safely eat that food with no adverse effect. This should not be confused with IgE which is the main allergy antibody used in allergy testing and this has an established “track record” in conventional allergy diagnosis.
Not really convinced? Have a look at these research papers:
No recommendation for IgG and IgG4 testing against foods
J. Kleine-Tebbe, I. Reese, B. K. Ballmer-Weber, K. Beyer, S. Erdmann, Th. Fuchs, M. Henzgen, A. Heratizadeh, I. Hutt egger, L. Jäger, U. Jappe, U. Lepp, B. Niggemann, et al Allergo J 2009;4: 267
Testing for IgG4 against foods is not recommended as a diagnostic tool: EAACI Task Force Report*
Stapel SO, Asero R, Ballmer-Weber BK, Knol EF, Strobel S, Vieths S, Kleine-Tebbe J.
Allergy 2008 July;63(7):793-796.
Unproven techniques in allergy diagnosis.
Wuthrich B.
J Investig Allergol Clin Immunol 2005;15(2):2-90
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Tags: Allergy Testing, Antibody, Food Allergy, Food Intolerances, IgE, IgG
Posted in Allergy Testing, Food Allergy |
October 17th, 2009
There has recently been a lot of debate in the media about safety of vaccines, particularly relating to the MMR (Measles, Mumps & Rubella) vaccination with unsubstantiated links to Autism and Ashbergers Disease. In addition, the measles vaccine was historically grown on chick embryos, thus running the risk of egg allergen contamination, and consequently recipients could potentially develop anaphylaxis if highly egg allergic. Today the MMR vaccine no longer contains any egg allergen and is absolutely safe to administer to highly egg allergic children.
The influenza and yellow fever vaccines are still cultured on chick egg embryo’s and thus potentially contain egg protein. But the World Health Organisation (WHO) suggests that this is unlikely to be problematic if mildly egg allergic and in those who tolerate egg without anaphylaxis. In severe egg allergy with anaphylaxis, administration of the conventional influenza and yellow fever vaccinations are contraindicated.
Does the same go for the current Swine Flu (H1N1) influenza vaccine? I’m informed that Pandemrix currently being promoted to prevent the second wave of the Swine Flu pandemic is also cultured on chick egg embryos. Fortunately there is an alternative Swine Flu vaccine called Celvapan which is not cultured on egg and therefore safe to give to egg allergic individuals. But the Celvapan vaccine does not contain the immunity enhancing adjuvant Squalene and therefore requires 2 doses 3 weeks apart. Celvapan is also the WHO preferred adjuvant-free Swine flu vaccine to be given during pregnancy.
Annual Flu vaccines are routinely recommended for asthma sufferers as they are generally more prone to viral illnesses, influenza and chest complications. But Asthma sufferers are also a greater risk group for anaphylaxis if concomitantly egg allergic and inadvertently given the egg cultured flu vaccine. If in doubt, 1/10th of the vaccine should be administered under medical supervision as a test dose followed by the 9/10th balance if no reaction occurs within 30 minutes. For detailed advice on egg allergy and Swine Flu vaccinations visit the British Society for Allergy and Clinical Immunology via this link:
http://www.bsaci.org/index.php?option=com_docman&task=doc_download&gid=80
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Tags: asthma, autism, egg allergy, flu, H1N1, influenza, mmr, swine, vaccination, yellow fever
Posted in Airway Allergy, Food Allergy |
October 17th, 2009
The current epidemic of allergic disease seems to be in part related to living in a much cleaner more sterile environment together with a lack of parasitic worm infestations. This leads to an early switch in the infant’s immune systems to reacting in a more allergy prone (TH2) manner and less of a bacteria and viruses (TH1) targeting manner.
In a recent study published in Clinical and Experimental Allergy, investigators found that if mice had their gut infested with parasitic worms, they developed fewer food and airway allergies, but the parasites gave no protection from skin allergies. This is the first evidence that intestinal worms can actually modulate the immune system and “protect” against developing allergies.
A similar study on Vietnamese children showed that if they were treated to eradicate their parasitic gut hookworms, they became much more likely to develop house dust mite allergies and asthma.
Reference: Gastrointestinal nematode infection interferes with experimental allergic airway inflammation but not atopic dermatitis. Hartmann S, Schnoeller C, Dahten A et al. Clin Exp Allergy 2009 (39) 1585-1596.
http://news.bbc.co.uk/2/hi/health/8268584.stm
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Tags: hookworm, parasite, prevention, TH2
Posted in Airway Allergy |
October 17th, 2009
Salbutamol is the mainstay of treating acute asthma and relieving wheeze. Some children may not respond to this medication. Up to 100,000 children – 13% of all children with asthma – carry two copies of a gene that renders the blue inhaler drug salbutamol ineffective.
If these children need to use their “reliever” inhaler daily they are 30% more likely to suffer an asthma attack than others, a UK research study shows.
Fortunately it is possible to test for the gene change using a simple mouthwash.
http://news.bbc.co.uk/2/hi/health/8292915.stm
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Tags: asthma, reliever, salbutamol, treatment
Posted in Airway Allergy |
October 17th, 2009
In a recent peanut allergy study at Addenbrookes Hospital in Cambridge, traces of peanut flour were used to desensitise 18 highly peanut allergic children. At the end of the study conducted in a controlled hospital environment, they were able to consume 12 peanuts each without any allergic reaction. The study involved eating minute trace amounts of peanut flour mixed with food or drinks on a daily basis to slowly induce peanut tolerance. Then at regular 2 weekly intervals the peanut flour dose was doubled so that by the 10th hospital visit, they each ate 5-6 peanuts each without reacting on allergy testing. But to maintain thispeanut tolerance they will have to continue eating peanuts regularly on a daily basis, otherwise they may lose this tolerance and their peanut allergy recur.
WARNING: This was a highly controlled study in hospital and peanut allergic children should not be given peanut flour unsupervised!
http://news.bbc.co.uk/2/hi/health/7899383.stm
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Tags: Allergy Testing, anaphylaxis, cure, desensitisation, immunotherapy, peanut
Posted in Food Allergy |
October 17th, 2009
The British Society for Allergy and Clinical Immunology (BSACI) has recently raised concerns about allergy testing in pharmacies.
They site a major problem being that pharmacy training involves education about medicines, not about clinical disease, patient history taking, psychology etc. This means that pharmacists do not know what the possibilities for diagnosis are in patients who present with, say, a blocked nose. Read More
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Tags: Allergy Testing, IgE, pharmacy, tests
Posted in Allergy Testing |
