New Guidelines for Early Peanut Introduction to Prevent a Peanut Allergy

Freedom Allergy, New Infant Peanut Guidelines, Pediatric Allergist, Peachtree City, Marietta, Georgia

 

On Thursday, January 5, 2017, the National Institute of Allergy and Infections Diseases released formal and detailed guidelines about the early introduction of peanuts to infants in order to proactively prevent the development of a peanut allergy.  This announcement is a complete reversal from past advice of peanut avoidance for high risk infants until 3 years old.  The American Academy of Pediatrics endorses these guidelines and encourages parents to begin feeding their infants peanuts early.

The new guidelines is a result of the Learning Early About Peanut Allergy (LEAP) study that was published in 2015 in the New England Journal of Medicine.  The study divided over 600 high-risk children between the ages of 4 and 11 months old into two groups, and followed them until age 5.  The participants had to have severe eczema, an egg allergy, or both, with a negative or positive peanut skin prick test less than 4 mm in diameter.  The first group avoided peanuts.  The second group consumed peanut-containing snacks at least three times a week.  Of the children who avoided peanut, 17% developed the allergy by age 5.  Of the children who consumed peanut, only 3% developed a peanut allergy.  The result was definitive and confirms that early introduction of peanut to an infant is highly effective in preventing a peanut allergy from developing.

The new released guidelines are categorized into three groups:

  • High Risk:  infants with severe eczema, egg allergy, or both
  • Guidance:  introduce peanut as early as 4-6 months
  • How/Where:  allergy testing with an allergist is strongly advised, with peanut introduction under physician supervision (see chart below)

 

  • Moderate Risk:  infants with mild to moderate eczema
  • Guidance:  introduce peanut around 6 months
  • How/Where:  peanut introduction can be at home, although testing and physician-supervised feeding may be conducted at the request of the parent

 

  • Low Risk:  no eczema, no food allergies, and no family history of allergies
  • Guidance:  introduce peanut at any time
  • How/Where:  peanut introduction at home

The NIH guidelines also advise parents to feed their infant peanuts for the first time only when he/she is healthy, and to ensure observation of the infant for at least two hours after peanut consumption to watch for signs of a reaction.  Signs of an allergic reaction may include:  hives, vomiting, coughing, wheezing, swelling (face, lip, or tongue), change in skin color, or lethargy.  In addition, recipe options are provided for the safe feeding of peanuts to infants, such as mixing peanut butter with warm water to thin it out, mixing peanut powder into baby food, or using Bamba peanut puff snacks.  It is also recommended to feed peanut-containing food at least three times a week.

Parents who have an high-risk infant (having either eczema, an egg allergy, or both) should contact an allergist before introducing peanut at home.  A parent who is concerned or nervous about introducing peanut to their infant may also contact an allergist for supervised feeding in the office.  A skin prick test or blood test may be conducted to assess the risk of peanut introduction to the child (see chart below).  Based on the results, an in-office introduction may be performed at the office under the supervision of the doctor, or it may be advised that the infant is allergic and should not be fed peanut.

 

SPT = skin prick test OFC = oral food challenge

SPT = skin prick test
OFC = oral food challenge

http://www.annallergy.org/article/S1081-1206(16)31164-4/fulltext#appsec5

Addendum Guideline 1, Figure 1.

 

 

 

References:

Addendum guidelines for the prevention of peanut allergy in the United States: Report of the National Institute of Allergy and Infectious Diseases–sponsored expert panel

http://www.annallergy.org/article/S1081-1206(16)31164-4/fulltext#appsec5

Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy (LEAP study)

http://www.nejm.org/doi/full/10.1056/NEJMoa1414850#t=article

LEAP website

http://www.leapstudy.com/leap-study-results#.WHHBBLGZNWc

New guidelines detail use of ‘infant-safe’ peanut to prevent allergy

http://www.aappublications.org/news/2017/01/05/PeanutAllergy010517

 

Red Meat Allergies are on the Rise

Freedom Allergy, Red Meat Allergy, Pediatric Allergist, Peachtree City, Marietta, Georgia

lonestartick-45114ba9fc67a1de8aebb58ffe8f805eb616861e-s700-c85

 

What is an alpha-gal allergy?

The number of cases for an alpha-gal allergy, or red meat allergy, has risen over the past few years, and the cause is due to the Lone Star tick.  The tick is predominantly found in the southern parts of the United States, ranging from Texas to the East Coast.  People who have been bitten by the Lone Star tick may find that they become allergic to red meat, such as beef, pork, venison, bison, and lamb.

How does a person become allergic to red meat?

When the lone star tick bites a mammal, like a deer, it picks up a sugar called alpha-gal, which is not found in humans.  Then, when the tick bites a human, the alpha-gal is transferred into the human’s bloodstream, where the immune system identifies it as foreign and creates IgE antibodies to it.  The next time the person consumes red meat, the body will recognize the alpha-gal, and the IgE antibodies will cause the release of large amounts histamines through the body, causing an allergic reaction.  The reaction may range from symptoms like upset stomach, diarrhea, hives, or itchy mouth, to more serious symptoms like constriction of the airways, a drop in blood pressure, or anaphylaxis that would require epinephrine.

How is an alpha-gal allergy diagnosed?

An alpha-gal allergic reaction usually takes between 3-8 hours after consumption of red meat.  Because the reaction does not occur immediately after ingesting red meet, like most other food allergies, it is harder to diagnose.  An alpha-gal allergy can be identified by a blood test.  Once diagnosed with an alpha-gal allergy, the patient will be prescribed an epinephrine auto-injector.

If have been recently been bitten by a tick, and you are suddenly experiencing symptoms after consuming red meat, visit an allergist and inquire if you may have developed an alpha-gal allergy.

Why is the alpha-gal allergy on the rise?

No one knows why the number of red meat allergies have risen over the recent years.  There are currently at least 3,500 cases reported, and doctors believe there are many more that have not yet been diagnosed.  The reason could be that ticks have steadily increased in the past 20-30 years, along with an explosion of the deer population.  It’s also possible that doctors are now more aware of the allergy, and are able to identify it quicker.

How can I prevent this allergy?

Since an alpha-gal allergy is linked to the Lone Star tick bite, it is important to protect yourself when outside.  Avoid wooded areas, leaf litter, and high grass areas.  Wear long-sleeved clothing, and use insect repellent like DEET or Permethrin when going to areas where there are ticks.  In addition, be sure conduct a full-body tick check and bath or shower after coming indoors.

Is there a cure for an alpha-gal allergy?

There is good news for people with a red meat allergy.  The alpha-gal allergy may recede with time.  As long as the patient is not bitten by another tick, and has avoided red meat, studies have shown that the allergy may go away within 8 months to 5 years for certain individuals.

 

 

References:

http://acaai.org/allergies/types/food-allergies/types-food-allergy/meat-allergy

http://www.webmd.com/allergies/news/20140813/tick-bites-red-meat-allergy

http://www.today.com/health/tick-bites-linked-rising-number-meat-allergies-t84821

https://en.wikipedia.org/wiki/Alpha-gal_allergy

http://allergicliving.com/2016/07/14/red-meat-allergy-incidence-on-the-rise-therapy-in-works/

http://alpha-gal.org/basics/

http://wncn.com/2016/05/09/unc-doctor-calls-alpha-gal-meat-allergy-tremendously-underdiagnosed/

http://www.cdc.gov/ticks/avoid/on_people.html

It’s Ragweed Season!

Freedom Allergy, Asthma and Allergy, Seasonal Allergies, Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia

Ragweed

It’s ragweed season!  Symptoms of a ragweed allergy include: sneezing, a runny or stuffy nose, itchy skin, eye irritation, sleep disruption, and symptoms of asthma.

About 10%-30% of Americans suffer from allergic rhinitis, or hay fever.  A single ragweed plant can send billions of grains of pollen into the air over the course of a single ragweed season.  Ragweed season usually starts at the end of the summer and ends at the first sign of frost (usually mid-August through October).

If you are experiencing ragweed allergy symptoms, here are a few tips to help minimize your ragweed exposure:

  1. Stay inside when the pollen count is high (check pollen counts in your area here: http://www.aaaai.org/global/nab-pollen-counts/south-atlantic-region)
  2. Keep your house and car windows closed.  Run your air conditioner or air purifier
  3. Change your clothes after being outside
  4. Shower at the end of the day

If your symptoms are affecting your daily life, try:

  1. Nasal sprays
  2. Daily anti-histamines
  3. Decongestants
  4. Immunotherapy (allergy shots)
  5. Make an appointment with your allergist if you need a proper diagnosis or need prescription-strength medications

Read here for more information about Ragweed allergies:

http://asthmaandallergies.org/asthma-allergies/ragweed-allergy/

Vitamin D and Food Allergies

Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia, Vitamin D, Food Allergies

Vitamin-D

Vitamin D, sometimes called the ‘sunshine vitamin,’ is a nutrient essential for good health.  Not only does it maintain healthy bones, but it has an essential role in immune system function.  Research has shown that there is a correlation between Vitamin D deficiency and an increase in allergic sensitization.

Make the effort this summer to go outside and enjoy the sun.  Natural foods that are high in Vitamin D include fish oils, fatty fish, mushrooms, egg yolks, liver, and fortified dairy products.  Or, you may ask your doctor to check your Vitamin D levels, and he/she may prescribe a supplement for you to take.

Read here to learn more about the relationship between Vitamin D and food allergies.

Infants with Food Allergies

Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia

little toddler smiles over her messy mouth and bowl

The new guidance for food introduction to babies is to start feeding them foods as young as 4 months old.  The new guidance stems from the Learning Early About Peanut Allergy (LEAP) study that was published in The New England Journal of Medicine in February 2015.  Rather than avoid highly allergenic foods during the first few years of a child’s life, it is important to introduce it as early as possible for the child’s body to recognize it as a food, and not an allergen.

At Freedom Allergy, we specialize in the prevention, diagnosis, treatment, and management of pediatric food allergies.  Every child is unique, and we treat each patient as an individual.

We encourage you to schedule an appointment with us if:

  • if you are pregnant, and want to receive guidance on ways to possibly prevent a food allergy from developing in your unborn child
  • you are unsure how to introduce foods to an infant in the same household of a sibling with food allergies
  • there is a concern that your child may be allergic to a food,
  • your child is allergic to a food, and you are interested in oral immunotherapy (OIT), a food desensitization treatment that will allow your child protection from accidental ingestion or cross contamination of his/her allergen

We will review you and your child’s overall health history, family genetic risk factors, and perform and evaluate skin and blood tests, if necessary.  We will then come up with a plan to help your family navigate through the prevention or management of food allergies.

Back to School Allergy and Asthma Tips

Pediatric Allergist, Peachtree City, Fayetteville, Georgia

ACAAI Back to School Tips

With the new school year now underway, you may consider these back-to-school allergy and asthma tips from the American College of Allergy, Asthma and Immunology. These simple tools can help set up you and your child for success in this exciting new school year!

Teacher Teacher – While your child’s teacher is the first line of defense at school in helping reduce sniffing, wheezing and sneezing, the right systems must be established at home before they get on the bus. If your child takes an allergy or asthma medication, make sure they take them at home, and that good avoidance measures are set up to keep their triggers under control. If your child’s teacher knows your child’s triggers, she may be able to help them steer clear in the classroom as well.

Too cool for school? Nah. – Discuss how to handle emergencies with the school principal and school nurse. Since 2010, all 50 states have laws protecting students’ rights to carry and use asthma and anaphylaxis medications at school. Children who are at risk for a life-threatening allergic reaction (anaphylaxis) from certain foods or insect stings should have epinephrine auto-injectors immediately available for treatment.  Be sure your child and school staff know how to use emergency medications. Continue reading

Blood Tests – False Positive?

Freedom Allergy, Allergy Doctor, Atlanta, Georgia

False Positive Food Allergies

While many medical offices use blood tests to evaluate allergies, board certified allergists rely on skin prick testing, which offers a more appropriate reflection of true allergies. Blood tests frequently show “false positive” results, and provide evidence of an allergy that is not accurate. Many times, families come to our office with blood results from another doctor’s office showing a food allergy, when they have never actually had an allergic reaction to that food. If you have a question of blood results, it would be best to discuss the findings with an allergist, to make sure you move forward with the best plan for your allergies. After all, why eliminate a food from your diet, when you are not actually allergic to that food?

Read more, from the American College of Allergy, Asthma and ImmunologyContinue reading

Senate Bill 126: Access to Epinephrine Auto-Injectors in Public Facilities

Allergy Doctor, Peachtree City, Atlanta, Georgia

Senate Bill 126

Photo courtesy of Food Allergy Kids of Atlanta

In 2013, Georgia became one of the first states to pass legislation authorizing public and private schools to stock a supply of epinephrine auto-injectors in their facilities (House Bill 337).  This year, the Georgia General Assembly passed Senate Bill 126, which provides access to auto-injectors in public facilities such as restaurants, sporting facilities, amusement parks, resorts, and sports and recreation camps.  The bill provides for emergency public access stations to allow a “lay rescuer” to consult with a medical professional to administer or make available epinephrine auto-injectors in the case of a medical emergency.  This measure could be life-saving for anyone in a public facility suffering an anaphylactic reaction.

Read more here.

Fall Allergies Are Upon Us

Allergy and Asthma Doctor, Atlanta, Georgia  

Freedom Allergy, Fall Allergies Ragweed, Atlanta, Georgia

Autumn is rapidly approaching. As backpacks fill with homework, football games kick off, and the Georgia heat simmers down, many know ragweed season also lurks around the corner. Ragweed grows most predominantly in the southern, northeastern and midwestern United States, and thrives in warm, humid environments. According to the Asthma and Allergy Foundation of America, 75% of people who are allergic to pollen-producing plants also suffer ragweed allergies. Ragweed emits a particularly large amount of pollen – up to 1 billion pollen grains per plant – and the pollen can extend up to two miles into the atmosphere. Ten to twenty percent of Americans suffer ragweed allergy flare-ups near the end of the summer, usually peaking around early September, and these flare-ups can lead to asthma exacerbations, headaches, and chronic sinusitis. With fall allergy season already upon us, do not wait to schedule an appointment with your board certified allergist, who can help keep your allergies and asthma under control.

Read more about ragweed allergies here.

Resources:

Costa S. Are Your Allergies Ready for a Relocation? U.S. News & World Report.  Aug 2014. http://health.usnews.com/health-news/health-wellness/articles/2015/08/14/are-your-allergies-ready-for-a-relocation.

Pongdee T. Ragweed Plants Packed with Pollen. American Academy of Allergy Asthma and Immunology. Aug 2011. http://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/EL-ragweed-patient.pdf.