Dr. Adrian Morris of Surrey Allergy Clinic Tests and Treats allergies

Salt water nasal sprays aid hay fever control.

Dr. Adrian Morris — Sun, 13 May 2012 11:55:57 +0000

There is good evidence that physiological saline (salt water) nasal sprays, help control hay fever. These sprays and nasal irrigation solutions will wash away pollen grains that cause nasal allergies resulting in hay fever and chronic rhinitis. They also aid and restore the normal muco-ciliary clearance of mucus which is very important for the normal functioning of the nose. Normal saline helps reduce nasal congestion after viral colds and improves the control of hay fever when used together with antihistamines and nasal steroid sprays. These saline sprays are cheap, simple to use and very safe in all age groups including pregnancy, while breastfeeding and in infants. Allergic rhinitis is a growing problem for babies who are naturally obligate nose breathers (principally breathing through their nose and not their mouth) and if their noses are blocked with mucus, they will have great difficulty with sleep and feeding disturbances.

Garavello W, Di BF, Romagnoli M, Sambataro G, Gaini RM. Nasal rinsing with hypertonic solution: an adjunctive treatment for pediatric seasonal allergic rhino-conjunctivitis. Int Arch Allergy Immunol 2005;137: 310-4

Eczema and food allergies

Dr. Adrian Morris — Sat, 07 Apr 2012 11:55:23 +0000

Atopic dermatitis AD (otherwise known as Infantile Eczema) is a common skin condition affecting 15-20% of children under the age of 2 years, manifesting with an itchy dry dermatitis in the skin creases (flexures) and often associated with a family or personal history of rhinitis and asthma (UK diagnostic criteria). Of great interest is that 55% of these AD children will also be sensitized to one or more food or inhalant allergens. The debate continues as to whether this allergic sensitization to one or other food or inhalant allergens contributes adversely towards their eczema control, when exposed or whether the concomitant allergen sensitization has no real impact on their eczema. Recent studies indicate that although concomitantly sensitized to foods (cow’s milk, hen’s egg and peanut) or inhalants (dust mite, pollen & pet dander), only a small percentage of sensitised AD sufferers will have a clinically relavant allergy contributing to the dermatitis. They conclude that routine food and inhalant allergy testing in infants with eczema may flag up clinically irrelevant sensitivities and lead to unnecessary allergen avoidance and hardship, most of which aren’t actually contributing to their dermatitis. Some authorities even actively discourage routine allergy testing in infants with eczema and suggest only testing if there is a documented associated deterioration in the eczema or associated urticaria (hives).

Reference: de Bruin Weller MS, Knuslt AC, Meijer Y, Bruijnzeel-Koomen CA, Pasmans SG. Evaluation of the dhild with atopic dermatitis. Clinical Experimental Allergy 2012; 42: 352-362

IBS, FODMAPs and fermentable sugars

Dr. Adrian Morris — Fri, 02 Mar 2012 10:39:59 +0000

We see many patients with presumed wheat intolerance, but who test negative for gluten intolerance and wheat allergy despite debilitating symptoms such as bloating, abdominal cramps and diarrhoea with constipation. Despite these negative tests, they respond favorably to a wheat exclusion diet.

These symptoms may be attributed to fructans (sugars derived from fruit juice such as sucrose and fructose) which are either added or naturally occur in honey, cereals (wheat and rye), legumes, onions, leeks, asparagus and root vegetables. Fructose is also found naturally in Rosacea family fruits such as apple, cherry, apricot, plum and pear juices and may be added as Sorbitol sweetener found in processed foods and chewing gum. With excessive intake, these short chain carbohydrate Fructans, may pass unabsorbed into the lower bowel where they ferment under influence of bowel microorganisms producing unpleasant gases (hydrogen, methane, carbon dioxide and hydrogen sulphide). These gases then lead to the typical bloating and flatulent symptoms similar to those experienced by individuals with lactose intolerance to dairy products. Fermentable dietary oligosaccharides, disaccharides, monosaccharides and polyols or FODMAPs exacerbate Irritable Bowel Syndrome (IBS) symptoms as well. Corn, rice, potato, spelt and gluten-free products tend not to contain fructans or FODMAPs

Reference: Bolin T. IBS or intolerance. Australian Family Physician 38 12 962-965

http://ibs.about.com/od/ibsfood/a/The-FODMAP-Diet.htm

Positive allergy tests of doubtful clinical significance.

Dr. Adrian Morris — Thu, 16 Feb 2012 11:06:57 +0000

Skin Prick and Challenge allergy testing remain the “gold standard” in diagnosing allergies. Blood testing for specific IgE antibodies can occasionally give misleading and falsely elevated positive results. For example a number of previously non-allergic people stung by Honey bee’s develop an antibody to a glycoprotein which seems to precipitate multiple unrelated positive allergy RAST test results to many of the common food and inhalant allegens. These blood tests include RAST tests and ImmunoCAP specific IgE allergy tests. It appears that it is a CCD glycoprotein on the actual test reagent or “CAP” that reacts with the person’s blood sample leading to falsely elevated test results which are not clinically relevent. Fortunately there is a new Immuno CAP test that identifies these polysensitised people and they can then be further investigated for possible allergies. The international allergy test company Phadia / Thermofisher now have an specific ImmunoCAP MUXF3 for Bromelain (o214) which identifies those people who may be showing false positive allergy tests. The cardinal feature is a person who reports modest allergy symptoms but has tests results showing they are highly sensitized to numerous unrelated allergens and who appears to be able to normally tolerate exposure to these allergens in day to day life.

Reference: Pevec B, Radulovic Pevec M, Stipic-Markovic A, Batista I. Polysensitisation as a diagnostic problem in a clinical practice: a case report. EAACI Congress, Vienna-Austria. 2006 Jun; Oral Abstract 1038.

Hygiene Hypothesis revisited

Dr. Adrian Morris — Sun, 22 Jan 2012 18:54:43 +0000

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