Archive for the ‘Food Allergy’ Category
Sunday, 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
Tags: acidophilus, anti-oxidants, bacterial endotoxin, caesarian, epidemic, hookworm, hygiene hypothesis, obesity, paracetamol, probiotics, vitamin D
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Tuesday, 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
Tags: anaphylaxis, glucosamine, iodine, radiocontrast, seafood, shellfish
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Saturday, 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
Tags: alpha gal, ambylomma, anaphylaxis, mammalian meat, meat allergy, tick bite, urticaria
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Friday, 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
Tags: apple allergy, betv1, blossom allergy, cetirizine, fexofenadine, fruit allergy, hay fever april, loratadine, oral allergy syndrome, profilin, silver birch pollen, stone fruit allergy
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Monday, 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.
Tags: Allergy Testing, casein aliergy, cow milk allergy, IgE testing, IgG testing, lactoglobulin, whey allergy
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Wednesday, 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.
Tags: apple allergy, fruit allergy, oas, oral allergy syndrome, pesticide allergy, prup3, silver birch pollen
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Thursday, 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
Tags: children's allergies, Food Allergy, Food Intolerances, NICE guidelines
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Monday, 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.
Tags: egg albumin, egg allergy, hen egg, IgE, MMR allergy, ovomucoid, rast testing, skin prick test
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Friday, 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
Tags: arah2, component allergens, legume allergy, lupin, nut allergy, oral allergy, peanut allergy, rast test
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Thursday, 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
Tags: colief, cows milk intolerance, diarrhoea, faecal reducing substances, flatulence, galactosidase, hydrogen breath test, lactase
Posted in Allergy Testing, Food Allergy | No Comments »
Thursday, 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
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 | No Comments »
Tuesday, 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
Tags: christmas allergies, christmas turkey, climate change, food aversion, formaldehyde, hypo-allergenic, isocyanates
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Wednesday, 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
Tags: allergy in children, Allergy Testing, food allergies, Food Allergy, IgE, peanut allergy
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Thursday, 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
Tags: Allergy Testing, Antibody, Food Allergy, Food Intolerances, IgE, IgG
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Saturday, 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
Tags: asthma, autism, egg allergy, flu, H1N1, influenza, mmr, swine, vaccination, yellow fever
Posted in Airway Allergy, Food Allergy | No Comments »
Saturday, 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
Tags: Allergy Testing, anaphylaxis, cure, desensitisation, immunotherapy, peanut
Posted in Food Allergy | 1 Comment »
