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

Starting Young – Breckan’s OIT Journey

Pediatric Allergist, Peachtree City, Fayetteville, Marietta, Georgia, Peanut Oral Immunotherapy

Starting Young – Breckan’s OIT Journey

Written by Deborah C.

At just over a year old we did what most parents do – give their child peanut butter for the first time.  His older brother isn’t allergic and we had no reason to think he would be.  Breckan’s first two small bites were uneventful and I thought we were in the clear.  I made him a peanut butter and honey sandwich and he LOVED it!!  Fifteen minutes later that sandwich would lead to the most terrifying trip to the ER to date.  My little boy looked as though he had been attacked by a swarm of bees from head-to-toe and was screaming to breathe.  That pivotal day is ingrained forever in my mind, and from that point onward I searched for any sign of hope or treatment for his anaphylactic food allergy.

When Breckan was 18 months old, I came across a Facebook group where someone mentioned Oral Immunotherapy (OIT).  I honed in on it immediately.  It just made sense, and I knew it was the treatment best suited for Breckan’s deadly allergy.  I hit the jackpot, because at the same time I learned of OIT, I heard there was a doctor opening up a private practice in the Atlanta area and I tracked him down and called him immediately.  It sounds cliche, but when Dr. Agrawal picked up the phone he changed our family’s life forever!  We watched Breckan’s peanut IgE numbers with hope over the next year, but when they shot up and his skin test exploded at 2.5 years old we decided to start OIT asap under the direction of Dr. Agrawal.

Breckan began his OIT journey on October 5, 2015 at 2 yrs, 9 months old.  Personally, I find beginning OIT at a young age provides so many benefits!  Some of these being little or zero anxiety, being completed before starting kindergarten, earlier protection, and at this age such a young child really hasn’t had to feel much, if any, exclusion due to their allergy.  Many parents who are interested in starting their child younger ask “what about communicating symptoms?”  I can assure anyone that communication is both verbal and non-verbal.  Your child doesn’t have to speak every word perfectly and know a vast vocabulary to complete OIT.  You are watching and observing (more like hawk-eyeing) and you will know if there are any symptoms or reactions.  Without a doubt, you will know.  A parent knows their child better than anyone and even the slightest change in expression can tell you if something is “off.”  We had zero issues with communicating symptoms throughout our experience and we did have a handful of them along the way, but nothing that couldn’t be worked through and overcome.  I also found that starting young made it easier to control and shape that this is just how things are now.  Period.  Meaning when it comes to dosing and then the observation period after for Breckan, I just made it into “this is what we do and this is just part of life.”  He is one of the most stubborn kids I have met, but by treating this as “peanut medicine” to him it was that – medicine – he ate a meal, he took his medicine, and he knew that meant “calm play” after.  Anyone who knows Breckan knows that calm and him do not go hand-in-hand.  Active is an understatement.  However, I think the term “rest period” with OIT is mis-labeled.  Kids do not have to sit still and not move!  They can do so many things!!  MagnaTiles, Legos, color, paint, use their imaginations to build cities or anything for that matter, play with dinosaurs or their favorite current toy, Star Wars themed toys, and the list goes on and on for all the things Breckan could do during his calm play time.  That list doesn’t even include video games or apps on his tablet which we’d sometimes do too.  We even dosed during vacations, like on our family winter ski vacation which was very active.  Breakfast, dose, calm play in condo, drive to mountain, and by the time he was skiing we were good to go!  OIT adapts to your life and you adapt to OIT.

Even being young, it amazed me throughout this process how much Breckan just “got it.”  One example was back in February 2016, in an instance that reminded me why we were doing this.  We had picked up Panda Express (not for the kids), and to our surprise, Breckan wanted to try the entree.  At this point he wasn’t “cleared” to eat any cross-contaminated food yet.  We obviously didn’t get any items that contained peanuts, but there was still too much of a risk for him to eat it when it’s a place that serves peanuts like that.  We hadn’t brought that food into our house at all in a couple years, but we felt ok doing it now with where he was at with OIT.  Unfortunately, we had to explain to him that he couldn’t try the entree.  I wasn’t expecting his reaction or I would have never brought it home.  He got teary-eyed and very upset that he wasn’t allowed to try it because of his allergy.  He kept saying, “but I take my peanut medicine” through a quivering lower lip.  My heart just broke for him.  I explained that this is why we are doing it, that this is why he is eating more and more peanuts and when he can eat even more, which will be soon, that he’ll be able to try new foods like this.  He understood, smiled, and was happy then and said, “I want to see Dr. Agrawal tomorrow.”  It probably seems so small to so many, but the exclusion to things like this and gaining freedom to have choices are some of the reasons we went through OIT.

On August 16, 2016, Breckan completed OIT and is now in maintenance!  Dr. Agrawal has given him the gift of protection and life insurance in its truest form.  I never thought this was possible when my head was swirling after that fateful ER trip 2.5 years ago.  Our lives were changed forever that day after being sealed with an anaphylactic peanut allergy diagnosis, but because of OIT we are able to give him the most “normal” life possible without the usual limitations of a deadly allergy.  He will never know what an allergy table is like at school, he’ll be able to eat the same birthday cake with all the other kids at parties, he can try new restaurants and new foods (and without having to investigate them first), we don’t have to worry about all the food recalls that are totally out of our control, we have no worries about mistakes made at the hands of others in food service industries, no more reading labels with a magnifying glass, he won’t have to leave a playground because a kid comes with a peanut butter sandwich and I can see it on their fingers as it smears everywhere, he’ll be able to go to overnight camps and field trips without his mom hovering over him (or maybe I still will)…and the list goes on and on.  It is really the simple day-to-day things that mean so much and one of the reasons we did OIT!  The biggest reason is accidental exposure and preventing a possible life-ending anaphylactic reaction… I would do anything to protect him to the best of my ability from that, but I also want him to be able to live the fullest life possible and thanks to Dr. Agrawal, his staff, and OIT, he can do just that!

If you’d like to read more about our OIT journey, please refer to our blog, “conquering peanut: Breckan’s OIT journey”  at http://coxfamilyconquers.blogspot.com

 

First peanut OIT dose!

First peanut OIT dose!

Eating peanut M&M’s with Nurse Danielle!

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

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.

Back to School with Food Allergies

Pediatric Food Allergy Doctor, Peachtree City, Fayetteville, Georgia

Back to School

School is right around the corner, and along with the excitement of new clothes, bright supplies, and fresh possibilities, your child may also have a few butterflies in the stomach. For a parent of a child with a severe food allergy, you may have some butterflies of your own. Many parents worry their child will accidentally eat a food they’re allergic to while at school, and suffer a severe reaction. Setting your child up at school with an epinephrine auto-injector (EAI) is important, but this also requires staff and personnel who can recognize an anaphylactic reaction and can correctly use the EAI.

Children need help from adults in managing their food allergies. One survey out of Mississippi schools revealed 97% had at least one child with a food allergy, but only 30% had action plans for these students. Schools were more likely to have action plans when the school nurse had received appropriate information from a physician. If you need refreshing on how to use your EAI, or would like assistance in educating personnel at your child’s school on recognizing and treating anaphylaxis, call our office today. Anaphylaxis action plans can also be written by physicians and distributed in daycares and schools.

Reference: O’Keefe AW, De Schryver S, Mill J, et al. Diagnosis and Management of Food Allergies: New and Emerging Options: A Systematic Review. Journal of Asthma and Allergy. 2014;7:141-164.

Allergist Versus Ear, Nose, and Throat Doctor

Allergy Doctor, Peachtree City, Atlanta, Georgia

Freedom Allergy, Ruchir Agrawal, Peachtree City, Fayetteville, Georgia

Why Choose an Allergist for your Allergy and Asthma?

Allergies and asthma are both chronic conditions, and warrant visiting a specialist for the best management. However, with so many specialists out there, how do you know which one to choose?  Read the FAQ below.

My allergies bother my ears, nose and throat – doesn’t this mean I should see an ear, nose and throat doctor?

Many times, patients go directly to an ear, nose and throat (ENT) doctor for their allergy symptoms. After all, don’t allergies bother your ears, nose and throat?

Ear, Nose and Throat doctors are surgeons who specialize mainly in structural problems that can be corrected with surgery. But many of these problems, such as difficulty breathing through the nose, or having a raspy voice or having trouble hearing, are actually due to allergies.  Allergies, eczema, and asthma are all chronic conditions that fall under the same umbrella of allergy medicine, and more than 50% of sinus problems are caused by allergies.  The other 50% are often caused by a combination of both allergy and non-allergy related problems. Continue reading