Halloween and Food Allergies

Halloween Can Be Scary – If You Have Food Allergies!

October 13, 2015
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By Lora Stewart, MD

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Halloween can be a frightening time if you or someone in your family has a food allergy. Candy with potential food allergens seems to be lurking around every corner this time of year. As a result, trick-or-treating can be a perfect disaster between the excitement, the candy and the darkness! But if you have a plan for Halloween, you can take the FRIGHT out of the NIGHT! Here are a few ideas to incorporate into your trick-or-treating plan. Be sure to discuss these points with your children before heading out to eliminate any surprises.

2659B518FASAVE THE TREATS FOR HOME

Be clear from the beginning that there will be no eating while trick-or-treating. You might want to bring safe snacks from home or feed your kids prior to leaving. Do not put yourself in a position of having to read labels and make decisions in the dark and away from home.

ON THE TRICK-OR-TREAT TRAIL

If applicable, be sure to have your epinephrine auto injector with you the entire time. There are also many homes that participate in the Teal Pumpkin Project. These homes will have a teal pumpkin outside and will only offer non-food items for Halloween. Learn more at foodallergy.org

CANDY INSPECTION

Once you are home, inspect all candy for potential allergens. Keep in mind that “Fun-sized”        treats may have different labels than the normal-sized treat. Be sure to inspect all labels carefully.  Your unwanted candy can be donated to several different organizations, such as   those that send care packages to U.S. troops.  Click here for options for donating candy.

CELEBRATE YOUR OWN WAY

Consider avoiding trick-or-treating altogether. Instead plan a new family tradition of a movie and popcorn at home, board games or even a craft night!

We hope that following these guidelines will help you and your family enjoy a fun and safe Halloween. As always, contact us with any questions or concerns. Happy Halloween!

Hives and Caterpillars

August 12, 2015
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by Lora Stewart, MD

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There are certain types of insects that can cause allergic reactions.  Most people know about bees and fire ants, but there is a caterpillar that can cause allergic reactions too.

The Douglas-fir Tussock Moth caterpillar is covered with small hairs which may cause allergic reactions in some people and some pets.  The typical reaction includes rash, hives, redness and itching of the skin, sneezing, runny nose and watery eyes.  The reaction is called “Tussockosis”.   The caterpillars must touch your skin in order to cause the allergic reaction, it is not airborne.

Douglas County currently has high levels of tussock moths and caterpillars.  The Douglas-fir tussock moth caterpillars are a native species that primarily feed on Douglas fir needles. According to the Douglas county website, the current tussock moth caterpillar activity is occurring on both private and US Forest Service lands between Perry Park and Valley Park, areas off Dakan Road and west of Pine Creek Road.

Preventative measures include:

  • Avoid spending time in infested areas

  • Avoid touching the caterpillars

  • Wear long sleeves, long pants and gloves

  • Wash exposed skin immediately with soap and water

  • Shower and change clothes after spending time in an infested area

  • If rash occurs, treat with Over-The-Counter anti-itch creams and anti-histamines.

If the rash is significant or the medications are not working, contact our office.

Contact us with any questions or concerns, and have a fun and safe summer!

Skeeter Syndrome

July 21, 2015
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by Lora Stewart, MD

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We’ve all had mosquito bites, but for some, those bites are larger and more troublesome than normal. This type of reaction to a mosquito bite may be an allergy to mosquito saliva called Skeeter Syndrome.  Almost all mosquito bites have some redness and itching, but with Skeeter Syndrome, the bites are very swollen, extremely itchy and often last for days. The bite site also may be warm to the touch, and the skin can even break down and ooze. This type of allergic reaction is rarely serious or life threatening, but it can be very uncomfortable and, at times, temporarily disfiguring.

In people with a significant history of reaction, allergy shots can be used to treat Skeeter Syndrome. But for most, there are other options. Avoidance is very important and includes wearing long sleeves and pants in areas with mosquitoes. It also is very important to apply mosquito repellent. Finally, if someone has a history of Skeeter Syndrome, pre-treating with antihistamine will lessen the reactions. Once bites are noted, treating the site with ice and a topical antihistamine or steroid also can help.

If you are concerned about Skeeter Syndrome, please contact us (303-706-9923 or www.allasth.com).

Enjoy your summer, and remember to use insect repellent!

Allergy Patch Testing

June 2, 2015
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by Lora Stewart, MD


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Patch testing is another type of allergy testing that you may not have heard about, but it can be very helpful and effective. Its technical name is Delayed Type Hypersensitivity Testing, and it has been around for more than 100 years! The first patch testing studies were used to determine the poisonous parts of certain insects.

Today we use patch testing to determine allergies that do not show up with scratch/prick testing or blood allergy testing. Patch testing can test for an allergy to metals (such as nickel), preservatives, fragrances, additives, dyes and even natural products, such as lavender or tea tree oil. Patch testing can also be used for certain types of food allergies. Patch testing is often used in patients with a rash that will not go away, in patients who have trouble when metal touches their skin, or in patients with stomach issues that might be caused by allergies.

Patch testing is quite different from scratch/prick skin testing. During patch testing, the different substances are placed on your skin (usually your back) and held in place with large stickers designed for this purpose. The stickers and allergens are left on your skin for two days and then removed. At that time, early reactions may be seen, but the final interpretation of the test will occur in one to two more days. At the final visit, positive results will be reviewed, and you and your allergist will determine if the results are relevant to your unique situation and symptoms.

Contact us at 303-706-9923 if you have any questions.

Peanut Exposure in Children: We Should Look Before we LEAP

May 27, 2015
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by Lora Stewart, MD

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As you may know, a recent medical publication will likely change our approach to food allergies in our youngest patients. The LEAP (Learning Early About Peanut Allergy) study was published in the New England Journal of Medicine, one of the premiere journals in the medical community. The study suggests that we can prevent peanut allergy by feeding young patients peanuts regularly. This study will likely go down as key research in the world of food allergy science, but it is important to understand what this study really means and what it does not mean.

This study included 640 young children with severe eczema, egg allergy or both severe eczema and egg allergy. The children were very young – four to 11 months of age. All were skin tested to peanut before the study. A large number had a negative skin test to peanut and a small number had a small positive result to peanut. Then each patient was either placed in a group told to intentionally avoid all peanuts or in a group told to regularly eat peanuts. After five years, the researchers looked at how many kids were allergic to peanuts. It is important to note, that if a child had a significant skin test to peanut prior to the study or did not have severe eczema or an egg allergy, they could not be in the study. This is something to consider when determining if the results are applicable to other children.

After five years, the researchers found that in the group that had negative skin testing to peanut at the beginning, almost 14 percent of those kids who intentionally avoided peanuts were now allergic versus only 2 percent of the children who regularly ate peanuts. And for the group of kids with a small positive to peanut skin testing at the start of the study, 35 percent of the avoidance group were now allergic compared to only 11 percent of the peanut-eating group.

This suggests that eating peanuts starting at a young age may decrease the risk of being peanut allergic at age five. However, we need to keep in mind that this study had a specific population that either had severe eczema rash or already had an egg allergy. They also only looked at patients without a history of previous peanut reaction and very small positive peanut skin test results.

Nonetheless, the idea of exposure rather than avoidance in an “at risk” population is pivotal information that will likely change our approach to food allergy as we move forward.

References: Du Toit, G et al.  Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy.  N Engl J Med 2015; 72:803-813.

Anitbiotic Sensitivity Testing

March 31, 2015
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  • ANTIBIOTIC SENSITIVITY TESTING: Penicillin allergy is the most commonly reported antibiotic allergy. In fact, penicillin allergy is reported to affect approximately 10% of the U.S. population. Confirming or ruling out true penicillin allergy is very important for future antibiotic treatment options.

Negating true penicillin allergy may allow for treatment with more cost-effective drugs and help to combat drug resistance in the community. For penicillin testing in particular, we now have the FDA-approved Pre-Pen® test available which is easy, safe, and can be completed in approximately 1 hr. Following this testing, patients with negative skin test results are challenged, in our office, with oral penicillin or amoxicillin and observed for one hour to confirm their ability to tolerate the drug. In addition to penicillin testing, we also have the capability to assess other classes of antibiotics as well.

Allergen Patch Testing

March 31, 2015
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  • ALLERGEN PATCH TESTING: Patch testing is a test for a skin reaction or rash which is also called a hypersensitivity reaction. Patch testing can be done for a number of different substances including metals, fragrances, preservatives and other chemicals.

This reaction is a delayed-type hypersensitivity reaction which will occur on the skin due to contact with the allergen. Patch testing is a reliable and easy test designed to assist in identifying substances found in commonly used products such as makeup, aftershave, shampoo, jewelry, medications, medical appliances, clothing, cleaning supplies, paper/ink, disinfectants, and construction materials. Our standard patch test can identify up to 33 different materials as possible allergens. Some examples of specific allergens that may be identified include Nickel, fragrance, thimersol, formaldehyde, thiuram, and paraben. The test is applied to the skin in the form of a sticker or patch (usually on a patient’s back) and is then read at 48 hrs and at 96 hours to check for reactions. Once an allergen is identified, avoidance of this agent is curative.

Ingestion Challenge

March 31, 2015
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  • INGESTION CHALLENGE: Often specific foods or prescription drugs are suspected of triggering symptoms which can range from classic hives and facial swelling to vomiting or diarrhea. For the appropriate patient we are able to test or challenge the patient to a specific food or medication in a safe environment by using a graded dosing protocol.

Skin testing initially may be performed, followed by controlled ingestion of increasing amounts of the suspected substance while under careful observation. Ingestion challenges can be performed with one food item at a time– a good example would be almonds. Ingestion challenges may also be done with antibiotics if this is the item in question. These challenges may be very helpful in expanding the diet of someone with multiple food allergies, or expanding the drug options of someone with multiple drug allergies.

Exercise Challenge

March 31, 2015
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  • EXERCISE CHALLENGE: This is a test to determine how physical exertion might affect the way you breath.

Exercise-induced asthma (EIA) is a common disease and exercise is a common trigger for patients who have asthma. Exercise-induced asthma occurs as a result of drying or cooling of the airways during exercise. Lung function testing is performed sequentially both before and after a prescribed exercise protocol which is completed on a treadmill. For the majority of asthmatics, exercise can induce some airway constriction and this test will identify changes in lung function that will rule out or confirm EIA. Additionally, if a patient has a firm diagnosis of EIA, this test may also be used to assess the effectiveness of one’s pretreatment medications in preventing their symptoms. Our test is about 2 hours long and is performed in our office.

Methacholine Inhalation Challenge

March 31, 2015
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  • METHACHOLINE INHALATION CHALLENGE: This test is one of the most widely utilized bronchial challenges and is performed to determine if a patient will react with asthma symptoms when challenged. The test is painless and consists of a series of breathing treatments and blowing tests.

The patient will inhale small amounts of a medication mist called methacholine. Each inhalation treatment is followed by a brief physical exam (listening to the lungs) and a blowing test (also called spirometry). If asthma symptoms are seen during this challenge, then the diagnosis of asthma is confirmed. If asthma symptoms are seen, these symptoms will be treated and reversed immediately. Although the goal of the test is to demonstrate asthma, the symptoms seen are usually very mild and do not persist and are not dangerous. This test will show airway hyperresponsiveness which is one of the hallmark features of asthma. Methacholine challenge testing may also be an appropriate way to evaluate the possibility of occupational asthma. Finally, the methacholine challenge may be a test that is required of someone wanting to enter a branch of the armed forces but has a history of lower respiratory symptoms such as cough, wheezing, or shortness of breath.

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