January 22nd, 2012
The recent epidemic of allergic disease seen in developed countries has been difficult to explain. We have seen four-fold increases in allergic diseases such as asthma, rhinitis, eczema and food allergies. Changes in lifestyle and eating habits seem to be implicated and clean, sterile and infection-free “westernised” homes seem to be the probable trigger. One’s first year of life plays a pivotal role in allergic sensitisation and if an infant’s immature immune system is not correctly stimulated, it can transform into allergy-prone mode, particularly in children with a genetic predisposition to develop allergies (this is called atopy).
Factors that seem to reduce the likelihood of developing allergies include:
- A home with 2 or more older siblings living in close proximity.
- Pet ownership (especially dogs & early exposure to animal farms)
- Exposure to parasite or hookworm infections (IgE was designed to combat worms).
- Exclusive breastfeeding for 4 months (confers immune protection).
- Early introduction of probiotic bacteria (acidophilus GG promotes gut immunity)
- Micro-bacteria in spoilt food and drinking water
- Dietary anti-oxidants, folate, fish oils and vitamins (such as Beta carotene)
Factors that seem to promote allergic sensitisation include:
- Lack of older siblings (who carry germs that switch off allergies)
- Advancing parental age (aging genes predispose to allergy)
- Birth by Caesarian section (lacks exposure to protective vagina bacteria).
- Sterile Westernised homes (no germs to stimulate the immune system)
- Predominantly sterile indoor environment (no exposure to dirt )
- No household pets (faecal endotoxins & germs)
- Early use of paracetamol and antibiotics (alter immune responses)
- Lack sun exposure (lack of Vitamin D effects genes)
- Obesity and sedentary lifestyle (smaller lungs cause asthma).
- Parental indoor smoking (maternal during pregnancy and infancy).
- Withholding of potentially allergenic foods such as peanut and egg exposure in early infancy (4 months is better than 12 months).
- Diesel exhaust particles (make aero-allergens more potent)
Reference: Tan T, Ellis JA, Saffery R, Allen KJ. The role of genetics and environment in the rise of childhood food allergy. Clinical and Experimental Allergy 2012 (42) 20-29
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Tags: acidophilus, anti-oxidants, bacterial endotoxin, caesarian, epidemic, hookworm, hygiene hypothesis, obesity, paracetamol, probiotics, vitamin D
Posted in Food Allergy |
December 25th, 2011
For many years indoor Christmas trees have bee suspected to be a source of allergen induced asthma, rhinitis and respiratory problems during the period from mid December to early January. It was thought that coniferous tree pollen, incidental grass and weed pollens on the tree and oleoresins secreted by Fir trees were to blame. However a recent study in the US, has found that coniferous Christmas trees carry and sustain significant amounts of mould spores. Common allergenic moulds such as Cladosporium, Aspergillus, Alternaria and Penicillium are found in significant amounts on Christmas trees and raise indorr mould levels from 300 to 5000 spores per cubic metre of indoor air. Exposure to the spores trigger chronic respiratory conditions such as allergic asthma, rhino-sinusitis and chronic bronchitis (COPD). Spraying the tree with a mist containing household bleech such as Milton (sodium hypochlorite) kills off moulds and prevents their growth on the trees and subsequent indoor mould contamination.
Reference: Identification of mold on seasonal indoor Coniferous trees. Annals of Allergy, Asthma & Immunology 2011 106:6: 543-544
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Tags: alternaria, aspergillosis, christmas allergies, christmas tree, cladosporium, mould allergy
Posted in Airway Allergy |
December 12th, 2011
Although often suspected by many clients as being the cause for localized body rashes, we hardly ever come across anyone with a confirmed allergy to commercial pigment dyes in clothing. One is more likely to develop contact dermatitis from dyes and rubber found in leather footwear, paraphenylene diamine (PPD) in hair dye and latex elastic in underwear. Detergent residues left in clothing can also irritate eczema-prone skin, causing it to flare up, and animal fibers such as wool, silk, mohair and fur in clothing can cause allergies. Cotton is the least allergenic clothing fiber. Most non toxic commercial clothing dyes are quite harmless, but occasionally reactions can be attributed to a particular type of dispersal dye (Disperse Blue 106 and 124) and formaldehyde residues found in new clothing, however these are usually removed after a few washes. Sweating and tight fitting clothing increases the likelihood of a reaction in dermatitis prone people.
Reference: Clothing Dye Allergy
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Tags: clothing dye, contact dermatitis, detergent, dispersal, formaldehyde, latex, paraphenylene diamine
Posted in Skin Allergy |
November 1st, 2011
There is a well established myth that fish and shellfish allergy is linked to the iodine content of fish and that iodine allergy and shellfish allergy are interrelated. This is untrue.
Shellfish such as shrimp, prawn, crab and lobster are crustaceans (crawl around) and have a protein in their flesh that can cause allergies, they contain too little iodine to cause any problems. Mussels, clams and squid are members of the mollusc (snail) family and a protein in their flesh can also cause food allergies, but they do not contain enough iodine to be a problem. Shellfish can ingest a nasty flagellate organism which causes food poison and a toxic reaction with vomiting, diarrhoea and flushing (this is not an allergy).
Iodine allergy is unrealated to shellfish but iodine can cause a local skin reaction when exposed (contact dermatitis) or a more severe anaphylactic reaction when radiocontrast dye is injected into a vein during invasive radiological examinations such as an isotope scan or angiogram used for investigation of kidney, heart, bone and brain conditions. Many doctors dont realise this seafood myth and will still ask if you are allergic to shellfish before giving radiocontrast.
The common joint supplement Glucosamine taken to help arthritis symptoms, although processed from shellfish extract (crab, shrimp and lobster shells), can safely be taken by people with shellfish allergies according to the Mayo Clinic in the USA.
Reference: http://www.mayoclinic.com/health/shellfish-allergy/DS00987/DSECTION=prevention
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Tags: anaphylaxis, glucosamine, iodine, radiocontrast, seafood, shellfish
Posted in Food Allergy |
October 3rd, 2011
A recent venom allergy guideline¹ published by the British Society for Allergy and Clinical Immunology (BSACI) this year, makes interesting reading. They report a lifetime-risk between 60 and 90% for the UK population of being stung by a wasp (Vespid) or bee (Apis). Of those stung, up to 26% will report large painful local reactions, but significant allergic reactions only occur in about 7% of those stung (bee-keepers being a very high-risk group with severe reactions reported in 30% of those stung). Although wasp venom allergy is more common in the UK, bee-stings carry a higher risk for anaphylaxis. Any patient with a severe reaction to an insect sting should be tested for both bee and wasp venoms sensitivity, as dual-positive IgE antibodies to both insects occurs in 30%, even though they may report being clinically sensitive to only one insect. Venom desensitisation immunotherapy (VIT) or “allergy shots” are highly effective in those severely sensitive to insect stings, resulting in a cure for 95% of wasp and 80% of bee venom allery sufferers treated over the 3 year programme. Older people are more likely to develop life-threatening anaphylaxis and fatal allergic reactions (at an average age of 50 years). Children are less prone to have life-threatening allergic reactions to insects, and 80% of children with a mild venom allergy with tolerate further stings and outgrow their allergy. Once sensitised, reactions are likely to be the same in 45% stings, milder in 43% and more severe in only 12%. Fatal reactions after insect stings are rare (47 deaths in UK over a 10 year period from 1992-2001)
¹Reference: Krishna MT, Ewan PW, Diwakar L, Durham S, Frew AJ, Leech SC and Nasser SM. Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines. Clinical and Experimental Allergy 2011:41; 1201-1220
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Tags: anaphylaxis, bee sting, bsaci, hymenoptera, IgE, insect allergies, vespid, vit, wasp sting
Posted in Allergy Testing |
September 1st, 2011
Urban air pollution is a serious public health hazard and has been associated with exacerbations of chronic respiratory illnesses due to airway mucus membrane irritation and increased oxidative stress. However no convincing link between air pollution and allergic sensitisation has been shown in the scientific literature. We know that nitrogen dioxide, ozone and diesel exhaust particulate matter in air pollution can predispose to increased respiratory infections, aggrevate asthma, bronchiectasis and chronic bronchitis (COPD), but any link to actually triggering allergic sensitisation is less clear. Certainly diesel exhaust particles have been shown to absorb grass pollen grains and increase the pollen load in the nose and lungs, thus making hay fever and hay asthma symptoms worse for city dwellers and those living near motorways.
Reference: Kelly FJ, Fussell JC. Air pollution and airway disease. Clinical and Experimental Allergy 2011 (41) 1059-1071
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Tags: air pollution, bronchiectasis, bronchitis, copd, diesel exhaust, oxidative stress, ozone
Posted in Airway Allergy |
August 2nd, 2011
Recent medical research shows that our middle-class obsession with cleanliness and avoiding weaning until late in infancy has rebounded in a western-world epidemic of childhood wheezing, sneezing and eczema with seven fold increases in peanut, cat, dust mite and pollen allergies. We are now encouraged rather to throw the cat in the cot, smother the baby in peanut butter and get those snotty cousins around to cough on little Hector. Yes, early exposure to farmyard dirt, bacteria, furry pets and nuts seems to be good and paradoxically prevents allergies, especially if there is high allergen exposure in the first few months of life. Health warnings to avoid allergens such as peanut in pregnancy and early infancy have actually led to increased peanut allergies and allergic sensitization in childhood.
Reference Clinical and Experimental Allergy July 2011:
Wegienka G, Johnson CC, Havstad S, Ownby DR, Nicholas C, Zoretti EM, Lifetime dog and cat exposure-and cat-specific sensitization at age 18 yrs Clinical and Experimental Allergy 2011 (41) 979-986
Erwin EA, Woodfolk JA, Ronmark E, Perzanowski M, Platts-Mills TAE The long-term protective effects of domestic animals in the home. Clinical and Experimental Allergy 2011 (41) 920-922
Kim JS, Jarvinen. Peanuts for preschoolers: less preposterous than previously perceived? Clinical and Experimental Allergy 2011 (41) 914-916
LEAP study (www.leapstudy.co.uk)
http://www.independent.co.uk/life-style/health-and-families/features/crunch-time-for-peanut-allergies-885074.html
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Tags: allergen exposure, alllergic sensitisation, health warnings, peanut allergies
Posted in Airway Allergy |
July 2nd, 2011
Allergy to red mammalian meat is relatively common in Africa and so are tick bites. I was recently shown a study by Platts Mills et al from USA in 2011 in which they suggested there may be a link between tick bites by the Amblyomma species of North American tick and the development of IgE antibodies to a galactoside common to mammalian meat (beef, pork and lamb) and ticks. This IgE antibody then leads to anaphylactic sensitisation to mammalian red meat with angioedema and urticaria or hives. 80% of the people studied who had developed sensitisation and allergies to red meat reported previously being bitten by a tick. To confuse the issue, the allergic reactions are often delayed occuring 3 to 6 hours after eating red meat, Similar reactions have been reported following tick bites in Australia. This “alpha Gal” IgE antibody production is switched on by tick bites and could explain the relatively high incidence of red meat allergy seen in indiginous Africans as ticks and tick bites are very common in Subsaharan African.
Study by Platts Mills et al (2008)
Latest research on tick bites and meat allergy
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Tags: alpha gal, ambylomma, anaphylaxis, mammalian meat, meat allergy, tick bite, urticaria
Posted in Food Allergy |
June 5th, 2011
Many people develop debilitating patches of dermatitis after contact with various common environmental chemicals and agent in cleaning materials. This type of reaction by the skin immune system results in a Type 4 delayed hypersensitivity reaction with rashing. A common contact allergy occuring in 20% of women is to the metal nickel found in clothing clips and studs, cheap costume jewellry and also wound adhesive dressings such as Elastoplast. Many building contractors will develop a chronic irritating and scaling painful dermatitis on contact with builders cement, while hair-dressers may develop skin allergies to hair dyes, high-lights and shampoos. Chemicals found in cosmetics, Lanolin in skin lotions, Balsum of Peru, detergents, soaps, shampoo, make up, perfume, fragrances and toiletries can cause severe contact dematitis on exposed areas such as the hands, scalp, face and skin with an itchy, dry swollen and scabby dermatitis. Even natural organic dyes in leather goods, glue, resins and hair products can cause localised foot and scalp dermatitis. While indoor plants such as primula, chrysanthemums and daisies, nail varnish and rubber boots can cause unexplained contact allergies. Antibiotic creams and local anaesthetic agents may become contact sensitisers on vulnerable skin. These chemical derived rashes take a few days to develop after initial irritant exposure, making the primary cause difficult to identify and so confound the diagnosis. By using specially prepared patch tests impregnanted with the culprit chemicals, the contact allegen cause can be identified. The TRUE test contains 24 patches of different common contact chemical allergens and we recommend these tests in our clinics. The patches are applied to the skin on the back for 2 days and are then removed and any allergic reaction can be clearly identified and the culprit allergen avoided in future. In a majority of dermatitis sufferers, it is detergents and soaps that remove natural grease and moisturisers from the skin resulting in dryness, iching and subsequently the skin breaks down and oozes. This is called a non-allergic irritant contact dermatitis and responds well to ointment based emollients such as emulsifying ointment.. Some delayed reactions to food such as cow’s milk, soy, hen’s egg and wheat can be identified by using patch tests containing these food allergens which are applied to the skin in Finn chambers for 48 hors and then read at 72 hours.
If you would like to book a Patch test with the Surrey Allergy Clinic; please telephone 01252 851789
For more iniformation on the TRUE test patch tests check out: http://www.truetest.com/commonallergens.aspx http://wikipedia.org/wiki/Patch_test_(medicine))
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Tags: chemical allergy, chemical sensitivity, contact dermatitis, cosmetic allergy, lanolin allergy, nickel allergy, patch test, perfume allergy, true test, type 4 reaction
Posted in Skin Allergy |
May 2nd, 2011
Many different so-called wonder-cures for hay fever have come and gone over the years. This is particularly evident online, as one searches for a drug-free natural alternative to conventional hay fever medication. The problem is that many of these remedies, which sound attractive at face value , have no track record or clinical evidence base. Mere anecdotal reports of efficacy aren’t robust enough to allow their large-scale endorsement by the medication regulatory authorities. However many people do find them enticing and feel they do help alleviate those incapaciaiting hay fever symptoms that so badly affect our work, school and social lives during the peak pollen season when we really want to be outdoors enjoying the summer.
Nasal pollen filters have been around in various guises for over 100 years, but some recently developed nasal plug filters with effective HEPA (high efficacy particle arresting) filters seem on first impression to provide encouraging protection from pollen, although not yet readily available on the UK market.
Nasal sprays that deposit a fine protective film of particles that impede pollen deposition on the nasal membranes have reached the local market. Most have no proven efficacy in clinical trials but seen harmles enough, and these include Prevalin thixotropic and Nasaleze micro-gel barrier sprays which seem to have a soothing effect on the nose.
Portable infra-red light treatments directed into the nose using using two small probes have been purported to help symptoms, although the exact physiological basis on which they work seems unclear. A number of these products have also reached the UK market and can be bought at health stores or online. Products now available in the UK include Bionase and Medinose, Lumie Haylight Light diodes.
Modern acupauncture meridean activating devices such as Hay band and Qu-Chi acupressure bands worn on the arm are readily available on the internet, but again their effectiveness in controlling hay fever has not been proven.
Taking a daily teaspoonful of locally-produced honey, starting a few months prior to the pollen season, may or may not be effective in providing a form of pollen desensitisation. Medibee bee pollen capsules seem less likely to effect a hay fever cure especially when the sales phrase is (“bees don’t get hay fever”). As far as I can remember from my GSCE biology days, bees don’t have a nose in the first place.
www.quackwatch.com
http://www.dailymail.co.uk/health/article-1378328/Is-allergy-real-just-reaction.html
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Tags: allergy gimmicks, bionase, hayband, haylight, medibee, medinose, nasal filter, nasal light, nasaleze, prevalin, quchi, thixotrophic
Posted in Airway Allergy |
April 1st, 2011
Spring has suddenly broken through the icy winter and the trees are covered in blossom this April. But this is a time of discomfort and suffering for those tree pollen allergic hay fever sufferers who will experience itching, sneezing, watering nose and irritatingly painful eyes. Silver birch pollen will be pouring from dangling catkins suspended from dormant trees coming back to life again after the long cold winter. Silver Birch pollen contains a particulary potent allergy provoking substance called Bet V 1 otherwise known as Profilin, which is curiously also contained in fresh apples, pears and stone fruit such as peaches, nectarines, cherries and plums. In addition, Profilin is found in hazelnuts and walnuts as well as vegetables such as celery, carrot, potato and tomato. Fortunately most afflicted will only experience itching of the mouth, palate and throat if they eat these foods in the raw form. Cooking these foods damages the Profilins and makes them less allergy provoking. These pollen-food cross reactions are usually irritating but rarely ever lead to more serious allergic reaction such as anaphylaxis and will respond promptly to antihistamine medication such as cetiriizine, loratadine and fexofenadine.
Visit our webpage on hay fever and oral allergies for more information
www.allergy-clinic.co.uk/airway-allergy/hayfever
http://www.allergy-clinic.co.uk/airway-allergy/oral-allergy-syndrome
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Tags: apple allergy, betv1, blossom allergy, cetirizine, fexofenadine, fruit allergy, hay fever april, loratadine, oral allergy syndrome, profilin, silver birch pollen, stone fruit allergy
Posted in Airway Allergy, Food Allergy |
March 9th, 2011
Conventional first line treatments for hayfever and allergic eyes (conjunctivitis) are non-sedating antihistamine medication. However there is growing evidence that topical nasal sprays containing low dose steroids control both nasal symptoms (such as congestion, rhinorrhoea, sneezing and itching) and eye symptoms (such as itching/ burning, tearing/watering and redness) in persistent allergic rhinitis and conjunctivitis. The recommended nasal sprays containing fluticasone, mometasone or triamcinolone only need to be used once daily into the nose but should be continued throughout the tree and grass pollen hay fever season for best results. Just in case you are now totally confused; the beneficial effects are when the nose spray is discharged into the nose only - these sprays should never be discharged onto or into the eyes.
Reference: Rodrigo GJ, Neffen H. Clinical and experimental allergy 2011 (41) 160-170
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Tags: allergic rhinitis, allergic rhinoconjunctivitis, allergy treatment, eye allergy, eye irritation, fluticasone, hayfever, mometasone, nose sprays, steroid spray
Posted in Airway Allergy |
February 1st, 2011
It’s early February and with the cold weather one forgets that Spring is around the corner. Now is the time to proactively prepare for the hay fever season. First of all the tree pollens will arrive with Silver Birch tree pollen being the main culprit and those sensitive to this aeroallergen will get typical hay fever very early in March. Most hay fever sufferers will have problems when the Grass pollens become prevalent a little later in April/May. Now is the time to prepare as prevention is better than cure. Start your once-daily non-sedating antihistamines 2 to 3 weeks before the season gets under way, for tree pollen allergies, that means starting this month and for grass pollen allergy start in mid March. Take your antihistamine every day during the season for best results, low dose nasal steroid sprays are very effective if taken together with antihistamines for breakthrough symptoms. For those lucky enough to have been prescribed immunotherapy such as Grazax, get your prescription immediately and start taking this oral grass pollen desensitization treatment this month. Other measures such as a daily teaspoonful of local honey, herbal Butterbur and cromoglycate drops (Optrex) may also help and should be started soon. Don’t leave treatment until your eyes are streaming and your nose is like a “Fireworks display”. Be proactive, and plan your hay fever prevention so that the spring and summer months are enjoyable and full of fun rather than being a time of sneeze, itch, coryza and misery.
http://www.allergy-clinic.co.uk/airway-allergy/hayfever/
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Tags: allergic rhinitis, allergic rhinoconjunctivitis, allergy prevention, antihistamine, butterbur, grass desensitization, grazax, hayfever, optrex
Posted in Airway Allergy |
January 3rd, 2011
Many surgical procedures involve implanting artificial metallic components such as joint replacements (arthroplasties), plates, screws and internal “plumbing” that contain metals such as titanium, nickel, cobalt and other heavy metal alloys. Ever since mercury dental amalgam was thought to be a health hazard in the 1970’s, people have become very aware of possible side effects of foreign metallic implants. Although implants are now commonly used, there seems to be no convincing evidence that they cause local or systemic allergic or immunological problems. Some clinics offer blood tests and skin patch tests for possible heavy metal toxicities, but it must be pointed out that these tests are not scientifically validated and offer no proven diagnostic aid. They increase anxiety and lead to many people declining quality of life improving procedures such as a hip or knee repalcements for crippling arthritis, or worse still, the unnecessary removal of such prosthesis.
Reference: American Academy for Allergy and Clinical Immunology (AAAAI) website: http://www.aaaai.org/professionals/ask-the-expert/view.asp?id=9944
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Tags: arthroplasty allergy, heavy metal, hip replacement allergy, metal implants, nickel allergy, titanium
Posted in Allergy Testing |
December 6th, 2010
Cow’s milk allergy is relatively common in babies (1:50) but rarely develops after one year of age. Symptom improvement on a cow’s milk-free diet and recurrence of symptoms with reintroduction of cow’s milk formula is the most accurate diagnostic procedure. Cows milk allergy may be underdiagnosed as it is common (but misguided) practice amongst UK GP’s and Paediatricians only to perform food allergy testing in children once they are 4 years or older.
Skin prick tests using fresh cow’s milk and RAST blood tests for cow’s milk protein IgE antibodies are the only reliable tests and have 60-90% accuracy. The whey (liquid) fraction of milk tends to cause most allergies, but the casein (curd) fraction triggers more severe and persistent allergies.The higher the milk-specific IgE level, the more likely there will be a clinically relevant milk allergy. High levels of Casein specific IgE antibodies indicate a higher risk for severe cows milk allergy and also for persistent cows milk allergy, On the other hand, IgG antibody testing for cow’s milk proteins (casein and b-lactoglobulin) is of no allergy diagnostic value and merely indicates exposure.
The clinical history and observation of the infant feeding are very helpful, and a family history of atopy increases the likelihood of a food allergy. Cow’s milk allergy can manifest with immediate urticaria and facial angioedema and respiratory, oral and laryngeal symptoms, as well as deteriorating eczema in addition to typical intestinal symptoms such as vomiting, diarrhoea, persistent reflux, food refusal and even anaphylaxis in severe cases.
Mildly milk-allergic infants often tolerate small amounts of processed dairy produce such as yoghurt and cheese as well as Goat’s milk. Infants with severe cow’s milk allergy will react to any traces of milk protein in partially hydrolysed milk formula, cooked foods and even breast milk, as well as any skin contact with milk proteins.
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Tags: Allergy Testing, casein aliergy, cow milk allergy, IgE testing, IgG testing, lactoglobulin, whey allergy
Posted in Allergy Testing, Food Allergy |
November 2nd, 2010
Samter’s triad is a respiratory intolerance to aspirin or salicylate containing medication (such as non-steroidal antiinflammatories NSAI’s), that results in maturity onset asthma and polyps obstructing the nasal passages with exacerbations induced by the intake of salicylate (aspirin) containing medications. This group of medications reduce production of prostaglandins and pain, but may increase production of pro-inflammatory leucotriences in the airways of susceptoible individuals. They may then present with nasal blockage and loss of smell (anosmia), with acute asthma attacks and even urticaria (hives) in middle age. About 5% of asthma sufferers are sensitive to aspirin and salicylate which may trigger asthma attacks when these medications are taken.
Treatment includes withdrawal of all salicylate containing medications (such as aspirin, ibuprofen, diclofenac, indomethacin) and related preservatives such as sodium benzoate and artificial colourings (tartrazine). Paracetamol is usually safe to be taken. Surgical removal of nasal polyps helps but very often the polyps grow back. Steroidal nasal sprays and Montelukast (a leukotiriene receptor antagonist) with slow the regrowth of the polyps and prevent asthma. Desensitisation starting with traces of aspirin to induce tolerance is possible but requires hospitalisation in a specialist unit. An enormous number of foods contain traces of salicylate, thus making a salicylate-free diet impractical except perhaps to avoid excess spicy foods, berriy fruits and strong tea all of which contain high levels of natural salicylate.
Read more….
http://en.wikipedia.org/wiki/Aspirin-induced_asthma
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Tags: aspirin allergy, desensitisation, intolerances, montelukast, polyps, salicylate, samters triad
Posted in Airway Allergy |
October 16th, 2010
House Dust Mites are tiny spider-like 8-legged creatures called dermatophagoides pteronyssinus. They do not bite and are invisible to the naked eye being only 0.3 mm in length The adult mite lives about 6 weeks, lays 50 eggs and produce 20 faecal pellets per day, which contain the allergen Der P1 (a dermatophagoides digestive enzyme). Der p 1 is the allergy-provoking particle produced by the House Dust Mite that triggers asthma and allergic rhinitis. This protein penetrates clothing, bedding, carpets and upholstery and can remain airborne for prolonged periods. Mites require 70% humidity to survive as they extract water vapour from ambient air to live. The indoor temperature needs to be about 20deg C for them to survive as they are cold-blooded. They do not survive at high altitudes over 1500 metres, in “sterile” hospital environments or in very dry places. House dust mites live on shed human skin flakes and fungal moulds growing on the dead skin flakes make them more edible. Mites have adhesive suckers on their legs with which they cling to carpets and bedding. Predator mites (Cheyletus) who in turn eat the common House dust Mites have less adhesive suckers and are preferentially vacuumed up, allowing allergy-provoking mites to proliferate. Mites will colonize a new mattress within 3 months with up to 10 000 mites inhabiting an average mattress.
Can we get rid of this allergy-provoking scourge? They are extremely difficult to completely eradicate from our bedroom environment. Chemicals that kill mites called acaricides may themselves trigger asthma but read more……….
http://www2.cochrane.org/reviews/en/ab001563.html
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Tags: acaricide, cheyletus, dermatophagoides, derp1, dust mite asthma, environment allergy, house dust mite, pteronyssinus
Posted in Airway Allergy |
September 1st, 2010
Allergic reactions to stone fruits (apple, peach, cherry, nectarine etc) localised to the mouth, are common in Silver Birch tree pollen allergy and hay fever sufferers. This reaction is not related to chemicals pesticides or the manner in which the fruit is grown, for example organically grown fruits are just as likely to be problematic. Thankfully these reactions are rarely life threatening and no reaction occurs if the fruit is cooked. However some people of southern European descent are prone to more severe allergic reactions when eating stone fruits such as apple. nectarine, peach and hazelnut presenting with a more generalised anaphylaxic response. This group of higher risk patients who are more likely to develop a severe allergic or anaphylactic reactions can be identified by a simple blood test which measures antiodies to a protein found in stone-fruit family called Pru p 3. Those with milder Silver Birch oral allergy syndrome (OAS) can be identified by measuring antibodies to the Pru p 1 component allergen found in the fruit. These tests done on a blood sample can be arranged by your GP and the results will help identify those at greater risk of a more severe fruit related allergic reaction.
Reference: Asero R et al, J Allergy Clin Immunol 2003;112:427-32, Asero R, Int Arch Allergy Immunol 2005;138:1-11.
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Tags: apple allergy, fruit allergy, oas, oral allergy syndrome, pesticide allergy, prup3, silver birch pollen
Posted in Food Allergy |
August 12th, 2010
The National Institute for Health and Clinical Excellence (NICE) has released consultation guidelines for diagnosing and treating food allergy in children and young people. Although long overdue these guidelines are most welcome. This document released this month highlights that in Europe and North America 6 – 8% of children under 3 years suffer with some form of IgE mediated food allergy. While only 25-40% of children with a self diagnosed food allergy will actually have a food allergy confirmed. The incidence of non-IgE food allergies is largely unknown due to the limited accurate diagnostic tests available. The guidelines stress that the clinical history of the food allergy taken by a competent practitioner is most important in diagnosing an allergy and allergy tests done in isolation can be misleading. Skin Prick tests and specific IgE testing on a blood sample are the most reliable food allergy tests available. Diagnosing food allergies and intolerances using Vega testing, applied kinesiology, hair analysis, leucocytotoxic testing and IgG blood tests are inaccurate and should be discouraged.
Reference: Food allergy in children and young people: Guideline consultation www.nice.org.uk
http://www.bbc.co.uk/news/health-10925371
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Tags: children's allergies, Food Allergy, Food Intolerances, NICE guidelines
Posted in Food Allergy |
July 26th, 2010
Hen egg allergy is very common in infants with eczema and usually outgrown by age 6 with a few children retaining their egg allergy into adulthood. The egg white or albumin is more allergenic than the yolk and heat or cooking damages the allergen making it less allergenic. Some children will therefore tolerate cooked but not raw egg, whereas other more severely allergic children will react to all traces of egg. Early onset of egg allergy is associated with asthma at age 18 months. Fortunately the Measles (MMR) vaccine no longer contains any egg so is not contraindicated in egg allergic children. However the Influenza and Yellow Fever vaccines are grown on chick egg embryo’s and therefore may be a problem for egg allergic children.
A new ImmunoCAP f233 blood test can now determine whether hen’s egg allergy is likely to be severe and persists into adulthood. Once the IgE skin prick test or blood RAST testing show a positive allergy result for eggs, a further test for raised antibodies to the heat-stable egg protein Ovomucoid (Gal d 1) is very useful for determining if egg allergy will persist.
Ref: Ando H, Moverare R, Kondo Y et al Utility of ovomucoid-specific IgE concentrations in predicting symptomatic egg allergy. J Allergy and Clin Immunology 2008:122;583-8.
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Tags: egg albumin, egg allergy, hen egg, IgE, MMR allergy, ovomucoid, rast testing, skin prick test
Posted in Allergy Testing, Food Allergy |
July 16th, 2010
Not all peanut allergy sufferes react in the same manner. Some will only have mild oral itching after eating a handful of peanuts, while others will have catastrophic anaphylaxis after minor exposure to airborne peanut allergen. Some peanut allergy sufferers will also have reactions to other seeds such as Sesame or tree nuts such as Brazil nut, Hazelnut and Walnut. While others may only react to legumes such as beans, peas and lentils. Yet others may have allergic cross-reactions to soybean and lupin flour.
This has all been rather unpredictable and guess work until recently when a new blood tests was developed which can show with accuracy which part of the peanut an allergy suffer has or will react to in the future. For example there is a particular peanut protein called Ara h 2 which is likely to cause anaphylactic reactions. This type of component allergy test is useful in predicting whether a cross-reaction to nuts, beans, seeds or fruit is likely to occur.
Peanut component allergy testing and likely cross-reactivity:
Ara h 2 High risk anaphylaxis to peanut and nuts
Ara h 1 – cross-reactions with legume (pea, bean, lentil) and nuts
Ara h 3 – cross-reactions with soybean and lupin flour
Ara h 8 – localised oral reactions to peanut and stone-fruit only.
Reference: Astler C et al. Journal Allergy and Clinical immunology 2007: 118; 250
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Tags: arah2, component allergens, legume allergy, lupin, nut allergy, oral allergy, peanut allergy, rast test
Posted in Food Allergy |
June 1st, 2010
Mould or fungal spores contained in black mildew which grows both indoors in damp bathrooms, kitchens and cellars and outdoors on dead leaves particularly in autumn can trigger severe asthma and chronic rhino-sinusitis. The main fungal culprits namely Cladosporium and Aspergillus can trigger brittle and difficult to treat asthma as well as chronic sinusitis in allergy prone individuals. This mould allergic asthma may occur as change-of-season epidemics and result in severe asthma attacks often necessitating hospitalisation and ICU admission.
Moulds and fungal spores are also recognised causes of a number of respiratory problems especially in immune-compromised leukaemic and transplant patients, elderly with chronic bronchitis, children with cystic fibrosis and those suffering with HIV and TB. In northern Europe a delayed hypersensitivity to the Aspergillus mould may result in Acute Bronchopulmonary Aspergillosis (ABPA) which causes progressive lung damage with cavities (bronchiectasis) and severe disability.
In addition to Aspergillus and Cladosporium other allergy trigger factors in difficult to treat asthma may be common environmental fungal spores such as Alternaria, Penicillium (mouldy fruit), Botrytis (blight) and even common skin fungi such as Candida (thrush) and Trichophyton (ringworm) mould spores. This condition is called SAFS or Severe Asthma with Fungal Sensitivity which is ordinarily very difficult to treat with resultant severe asthma exacerbations despite high doses of inhaled preventer and reliever medication. Recent research has highlighted the probability that up to 60% of these patients may respond well to antifungal medication such as itraconazole and amphotericin B.
Reference: Denning DW, Driscoll B R, Hogaboam CM , Bowyer P Niven RM, The link between fungi and severe asthma; a summary of the evidence. European Respiratory Journal 2006; 27:615-626
No Comments
Tags: abpa, aspergillosis, autumn asthma, fungus sensitivity, itraconozole, mould allergy, safs
Posted in Airway Allergy |
May 2nd, 2010
Summer is here, it’s time for a sunny break abroad and perhaps a temporary tattoo which is very fashionable. But beware, temporary Henna tattoos done on unsuspecting holiday makers in tourist resorts can have a disfiguring long-term and even dangerous result. The usually harmless Henna-plant tattoo chemicals are often illegally darkened by unscrupulous vendors adding a concentrated hair dye chemical called PPD (para phenylene diamine) or “Black Henna”. This dangerously concentrated hair dye chemical is highly sensitising when applied neat onto the skin and in 15% of people will lead to a delayed allergic reaction some days later (usually after returning home from their holiday). Tell-tale allergy signs include irritation and reddening of the tattooed skin, later resulting in a blistering and scarring contact dermatitis which in some cases can last many weeks. The long-term consequences are that once sensitised to PPD, you will have a life-long risk of reacting to other less concentrated-PPD containing hair colourings, black rubber products, sulphonamide antibiotics, local anaesthetics and even sunscreens containing PABA (para-aminobenzoic acid). Therefore be extremely cautious about having any temporary Henna tattoos applied to your skin whilst on holiday.
Reference http://en.wikipedia.org/wiki/Henna
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Tags: allergy hair dye, black henna, contact dermatitis ppd, henna tattoo, p phenylene diamine, paba sunscreen, ppd
Posted in Skin Allergy |
April 16th, 2010
The Volcanic dust and ash cloud currently drifting over western Europe from Iceland is unlikely to cause any acute health risk or exacerbate allergies and asthma in the United Kingdom. Volcanic ash contains fine grains that may irritate the airways, as well as associated sulphur gas, but the amount that falls to earth and reaches ambient air is likely to be very small. Scientists believe it will be equivalent to Sahara desert sand particles that are regularly drawn up into the atmosphere and then sprinkled down over Britain. Allergy and allergic asthma sufferers should continue to use their preventer and reliever inhalers as usual and see their GP if they have any health concerns.
Reference: Skynews.com
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Tags: allergic asthma, reliever inhaler, volcanic ash
Posted in Airway Allergy |
April 7th, 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 are implicated and certain and promote eczema such as our gene makeup (atopy), skin allergy (to dust mites, pet dander and food allergens). The common skin Staph bacterium carried by us on the skin seems to play an important role in triggering eczema exacerbations. While 10 and 40% of the general population carry the germ Staph on their skin, a whopping 90% of eczema sufferers have this germ on their skin. Studies reveal that 30% of moderate eczema sufferers are allergic to a bacterial endotoxin produced by the Staph, while in severe and difficult to control eczema, up to 68% of children will have an allergy to this germ. 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 respond to antibiotic skin creams such as Mupirocin (Naseptin), Fusidic acid (Fucidin) as well as to 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 established 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). Read more about managing eczema
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Tags: bacterial endotoxin, eczema exacerbation, impetigo eczema, severe eczema, skin infection eczema, staphylococcus aureus, superbug MRSA
Posted in Skin Allergy |
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
1 Comment
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
No Comments
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
No Comments
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
No Comments
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
1 Comment
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
1 Comment
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
1 Comment
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
1 Comment
Tags: Allergy Testing, IgE, pharmacy, tests
Posted in Allergy Testing |
