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Fall Bulletin

Back to School Allergy and Asthma Readiness Tips

School supplies? Check. New shoes? Check. Allergies and asthma under control? Let’s go over the list one more time to make sure you and your child are ready for the school year.

Below are four tips to put you at the head of the class when it comes to controlling allergy and asthma.

Questions? Raise your hand. – If you need answers to questions about your child’s health, ask now. Find out in advance how the school nurse handles allergy emergencies. Who calls 911? What if your child can’t remember how to use their epinephrine auto injector, or can’t locate it? Are there stock supplies of epinephrine and asthma medications? How are teachers trained to respond to allergic reactions? Create a list and take it with you when you meet with the school nurse.

Make sure a food allergy diagnosis is correct – While about 5 to 8 percent of children have food allergies, many are misdiagnosed due to testing that isn’t called for. That can lead to unnecessarily cutting foods out of a child’s diet, which can negatively affect their nutritional health. Blood and skin prick tests are very helpful, but only if your child has already had a reaction to a food, not by themselves. It’s important to work with an allergist to diagnose food allergies. If your child does have a food allergy, make sure the school is fully informed. Work with your allergist and school staff to have an action plan that lists the foods your child is allergic to, what treatment needs to be given, as well as emergency contact information.

Are allergens hiding at school? – You probably know where allergens are found in and around your home. There may also be some hidden allergens at school that cause sneezing and wheezing. Your child could be allergic to the classroom pet, or to the dander from another child’s pet that was carried in on their clothing or backpack. Pollen and dust settle in the classroom, and if not cleaned properly, can set off symptoms. Is the classroom window open? It could be bringing in pollen. If a child says they are coughing during the school day, having difficulty breathing, have a rash, runny nose, or are sneezing, these could be signs they are allergic to something in school.

Consult the expert! – Make an appointment with us before school starts. An allergist can confirm what is causing symptoms and show you how to avoid triggers. For children with especially troublesome allergies, we may prescribe immunotherapy (allergy shots or tablets) which can change the course of, and lessen the intensity of how an allergy develops. If your child takes medicine, we will make sure prescriptions are the right dose for their size, and are up-to-date.  Kids who have asthma who see an allergist have 77 percent fewer days out of school.

If your child is experiencing allergy and asthma symptoms, make an appointment with us to develop a treatment plan and eliminate symptoms.

Half of Kids Who Needed Epinephrine Didn't Get it Before a Trip to the ER

Anyone suffering a severe allergic reaction (anaphylaxis) should receive epinephrine as quickly as possible. A new study showed that even kids who were prescribed an epinephrine auto injector didn’t receive the life-saving medication when they needed it.

The study in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI) examined 408 patient records for children seen in an emergency department (ED) or urgent care (UC) setting for anaphylaxis. The records showed fewer than half the children received epinephrine prior to arriving at the ED or UC even though approximately 65 percent had a known history of anaphylaxis, and 47 percent had been prescribed epinephrine.

“We found kids who had a reaction at home were less likely to receive epinephrine than kids who had a reaction at school,” says allergist Melissa Robinson, DO, ACAAI member and lead author of the study. “Treatment with epinephrine is often delayed or avoided by parents and caregivers. And sometimes antihistamines are used even though they are not an appropriate treatment.”

Once they arrived at the ED/UC, only 50 percent of all patients received epinephrine. That number includes even those that got epinephrine before arrival. Because the study examined only if kids received epinephrine upon arrival at the ED/UC, there is no information on the reasons epinephrine wasn’t given. The study did determine that children who received epinephrine prior to arrival were less likely to be treated with epinephrine once they arrived. Kids who received epinephrine prior to arrival were also more likely to be sent home compared to those who didn’t.

“Allergists want parents, caregivers and emergency responders to know epinephrine should always be the first line of defense when treating anaphylaxis,” says allergist David Stukus, member of the ACAAI Public Relations Committee and co-author of the study. “Our study found that only two-thirds of those who had an epinephrine prescription had their auto injector available at the time of their allergic reaction. It’s vital to keep your epinephrine with you if you suffer from any sort of severe allergy. Anaphylaxis symptoms occur suddenly and can progress quickly.  Always have a second dose with you and, when in doubt, administer it too.  Anaphylaxis can be deadly if left untreated.”

Anyone seen for anaphylaxis in the ED/UC needs to be referred to an allergist for a follow up visit. Allergists provide the most comprehensive follow-up care and guidance for severe allergic reactions. If you have questions regarding anaphylaxis or food allergy please call 317-708-2839.

FAQs regarding Insect Sting Allergies

What should I do if a bee stings me and when should I see an allergist?

What you do about a bee or any insect sting depends on your body’s reaction. A normal (non-allergic) reaction involves pain or discomfort, as well as swelling or redness in the area where you were stung. If the stinger is still in your skin, remove it by scraping the area with a straight edge such as a credit card. Don’t pinch the stinger or use tweezers because that could release more venom. Ice the area to control swelling, and elevate the arm or leg, if that’s where you were stung. Acetaminophen or ibuprofen may help ease pain. (Do not give aspirin to anyone under age 19.) For itchiness, you can take an antihistamine, ice the area, or apply calamine lotion. Though “normal” reactions are not considered life-threatening, avoiding a future sting is usually a good idea.

The second type of response is like the first type of non-allergic reaction. However, it is a larger local reaction that causes swelling, generally more than 3 inches, around the sting. For example, a sting on the front of your arm could cause your whole arm to swell. Remove the stinger and treat the swelling, pain, and itch with a combination of ice, elevation and antihistamines. The swelling usually peaks two to three days after the sting and can last a week or more. Like the first reaction, this is not life-threatening. However, you may have considerable pain and swelling that lasts for days in the area you were stung.

The last, and most dangerous response is a severe allergic or anaphylactic, life-threatening reaction. It is the most serious and needs immediate medical attention. Symptoms range from mild hives or itching, to severe reactions, including shock or loss of airway potentially resulting in suffocation, which can be life-threatening. If you know you have a severe allergy to an insect sting, you should always carry your epinephrine auto injector (EAI) and be evaluated by an allergist skilled in the management of insect allergy. If you are stung, use your EAI, call 911 and get to the nearest emergency facility at the first sign of anaphylaxis, even if you have already administered epinephrine.

How do I know if I’ve had an allergic reaction to an insect sting?

Symptoms of an allergic reaction can range from mild to severe. They may include the following (either alone or in combination): Hives, Itchiness, Flushing, Swelling in areas away from the sting, Dizziness or a sharp drop in blood pressure, A hoarse voice, coughing, swelling of the tongue or difficulty swallowing, Abdominal cramping, vomiting, intense nausea or diarrhea, Unconsciousness or cardiac arrest, Anaphylaxis is a severe life-threatening allergic reaction that impairs breathing, causes a sudden drop in blood pressure and can send the body into shock. It can occur within minutes of a sting. A dose of epinephrine (adrenaline), typically administered in an auto-injector, and immediate medical attention are required.

Who is affected by allergies to insect stings?

Allergic reactions to stings can occur even after many normal reactions to stings, and at any age.   Estimates show that potentially life-threatening allergic reactions to insect venom occur in 0.4 percent to 0.8 percent of children and 3 percent of adults.

Can I get rid of my insect sting allergy?

Yes. For long-term protection, an allergist can treat you with allergy shots (immunotherapy), which builds tolerance over time and provides up to 98% protection if you get stung again. In addition to reducing the risk of systemic reaction to future stings, venom immunotherapy significantly improves quality of life. This is especially true for active individuals where jobs or recreational activities take them outdoors. The length of venom immunotherapy is usually three to five years, but it can be continued indefinitely depending on how severe past reactions have been, and the risk of future stings.

Do I need to have an epinephrine auto-injector?

It depends on your risk factors including your history of reaction to an insect sting. Your allergist will determine if you are at high risk of a severe allergic reaction and prescribe an epinephrine auto-injector if needed.

When is the best time to introduce Peanut-containing foods?

The wait is over for parents who’ve been wanting to know how and when to introduce peanut-containing foods to their infants to prevent peanut allergy. New, updated guidelines from the National Institute of Allergy and Infectious Diseases (NIAID), published today, define high, moderate and low-risk infants for developing peanut allergy, and how to proceed with introduction based on risk.

“This update to the peanut guidelines offers a lot of promise,” says allergist Stephen Tilles, MD, president of the American College of Allergy, Asthma and Immunology (ACAAI). “Peanut allergy has literally become an epidemic in recent years, and now we have a clear roadmap to prevent many new cases moving forward. The Learning Early About Peanut allergy (LEAP) study, the study that paved the way for the updated guidelines, has had a dramatic impact on day-to-day patient care. In fact, during my career as an allergist I cannot think of a single publication with more of an impact.”

According to the new guidelines, an infant at high risk of developing peanut allergy is one with severe eczema and/or egg allergy. The guidelines recommend introduction of peanut-containing foods as early as 4-6 months for high-risk infants who have already started solid foods, after determining that it is safe to do so. 

“If your child is determined to be high risk, the new guidelines recommend evaluation by an allergy specialist, which may involve peanut allergy testing, followed by trying peanut for the first time in the specialist’s office,” says allergist Matthew Greenhawt, MD, MBA, MSc, ACAAI Food Allergy Committee chair, and a co-author of the guidelines. “If a child is tested and found to have peanut sensitization, meaning they have a positive allergy test to peanut, from that positive test alone we still don’t know if they’re truly allergic. Peanut allergy is only diagnosed if there is both a positive test and a history of developing symptoms after eating peanut-containing foods.” 

A positive test alone is a poor indicator of allergy, and studies have shown infants who have a peanut sensitivity aren’t necessarily allergic. “In fact in the LEAP study, infants sensitized to peanuts showed the most benefit from early introduction of peanut-containing foods,” says Dr. Greenhawt. The updated guidelines recommend that Infants with a positive peanut skin test have peanut fed to them the first time in the specialist’s office. Some infants may have a large reaction to the skin test (8 mm or larger) which could indicate they are already peanut allergic.  “An allergist may decide not to have the child try peanut at all if they have a very large reaction to the skin test. Instead, they might advise that the child avoid peanuts completely due to the strong chance of a pre-existing peanut allergy. Other allergists may still proceed with a peanut challenge after explaining the risks and benefits to the parents.”

Moderate risk children – those with mild to moderate eczema who have already started solid foods – do not need an evaluation. These infants can have peanut-containing foods introduced at home by their parents starting around six months of age. Parents can always consult with their primary health care provider if they have questions on how to proceed. Low risk children with no eczema or egg allergy can be introduced to peanut-containing foods according to the family’s preference, also around 6 months.

The new guidelines offer several peanut-containing food suggestions as well as methods to introduce age-appropriate peanut-containing foods to infants who have already eaten solid foods. It is extremely important parents understand the choking hazard posed by whole peanuts and to not give whole peanuts to infants. Peanut-containing foods should not be the first solid food your infant tries, and an introduction should be made only when your child is healthy. Do not do the first feeding if he or she has a cold, vomiting, diarrhea or other illness.

“The guidelines are an important step toward changing how people view food allergy prevention, particularly for peanut allergy,” says Dr. Tilles. “They offer a way for parents to introduce peanut-containing foods to reduce the risk of developing peanut allergy.”

The guidelines are simultaneously being published in Annals of Allergy, Asthma and Immunology, the ACAAI’s scientific publication, and several other scientific journals.

To learn more, watch “Peanuts and your baby: How to introduce the two.” For more information about allergies, please contact our office at 317-706-2839.

Is it safe to get up close and personal with food allergies?

Allergists realize people who are severely allergic to a food can experience great anxiety when encountering the food in any form. Kids, in particular, can get extremely nervous about the idea of being close to someone eating peanuts or peanut butter.

An article in Annals of Allergy, Asthma and Immunology, the scientific publication of the American College of Allergy, Asthma and Immunology (ACAAI), illustrates most kids can be near food allergy triggers without fear.

“We developed the proximity food challenge to help ease anxiety in kids with food allergies,” says allergist Chitra Dinakar, MD, ACAAI Fellow and lead author of the article. “The challenge allows kids with food allergies – such as to peanut butter or milk – to not only be in the same room with the food, but also to breathe in the air and have the food placed on their skin. Kids see for themselves it is safe to be near their food allergen as long as they don’t eat it or get it into their eyes, nose or scraped skin. It’s a great relief.”

Some people with food allergies cut back on social activities or flights for fear of coming into accidental contact with food allergens. Children with food allergies are occasionally assigned to separate “allergy-free” tables in the school lunchroom, leaving them feeling self-conscious, as well as anxious that being near the food could cause a reaction. Most people with food allergies only react to ingesting the allergen. Only a very small percentage of people have a severe reaction to breathing in dust or vapor from the allergen, for example, the protein from shelling peanuts or cooking shellfish.

“We’ve done dozens of proximity food challenges,” says allergist Jay Portnoy, MD, ACAAI past president and co-author of the article, “and the majority of children have not suffered a reaction. Actually, only one child had a hive appear. Most kids are initially scared, but when they don’t have a reaction, their fears are eased, and they have a new sense of freedom. They have more confidence in being a part of their community.”

If you have questions about food allergies, please call 317-708-2839.

Food Allergies versus Intolerance

Some of the symptoms of food intolerance and food allergy are similar, but the differences between the two are very important. Eating a food you are intolerant to can leave you feeling miserable. However, if you have a true food allergy, your body’s reaction to this food could be life-threatening. 

Digestive system versus immune system

A food intolerance response takes place in the digestive system. It occurs when you are unable to properly breakdown the food. This could be due to enzyme deficiencies, sensitivity to food additives or reactions to naturally occurring chemicals in foods. Often, people can eat small amounts of the food without causing problems. 

A food allergic reaction involves the immune system. Your immune system controls how your body defends itself. For instance, if you have an allergy to cow’s milk, your immune system identifies cow’s milk as an invader or allergen. Your immune system overreacts by producing antibodies called Immunoglobulin E (IgE). These antibodies travel to cells that release chemicals, causing an allergic reaction. Each type of IgE has a specific “radar” for each type of allergen. Unlike an intolerance to food, a food allergy can cause a serious or even life-threatening reaction by eating a microscopic amount, touching or inhaling the food. Symptoms of allergic reactions to foods are generally seen on the skin (hives, itchiness, swelling of the skin). Gastrointestinal symptoms may include vomiting and diarrhea. Respiratory symptoms may accompany skin and gastrointestinal symptoms, but don’t usually occur alone. Anaphylaxis (pronounced an-a-fi-LAK-sis) is a serious allergic reaction that happens very quickly. Symptoms of anaphylaxis may include difficulty breathing, dizziness or loss of consciousness. Without immediate treatment—an injection of epinephrine (adrenalin) and expert care—anaphylaxis can be fatal.

Oral Allergy Syndrome

Oral allergy syndrome causes itchiness in or around your mouth area after eating raw fruit or vegetables because the proteins in some fruits and vegetables are similar to proteins in some pollens. The proteins are not the same, but similar enough to confuse the immune system and cause symptoms. Not everyone who has seasonal allergies has oral allergy syndrome, but seasonal allergies are necessary for oral allergy syndrome to occur. 

For some people this may help explain seemingly mysterious reactions to certain foods -- for example, raw apples but not cooked apples. That's because there are proteins in raw apples that are very similar to the proteins in birch pollen. Cooking the offending fruits and vegetables will "denature" or change the shapes of these proteins, so people with oral allergy syndrome will usually be able to eat them without a problem.

Because the reaction is usually localized to the mouth area, including lips, tongue, and throat, some people will choose to ignore the symptoms and continue to eat offending foods. This of course depends on the severity of symptoms and how much the person enjoys eating the specific fruit or vegetable. Antihistamines can also be helpful in reducing more mild symptoms. 

It's important to let us know if you experience any other symptoms associated with eating raw fruits and vegetables because in rare cases people with oral allergy syndrome experience anaphylaxis, a life-threatening reaction that may include swelling, blocked airways, low blood pressure, anxiety, vomiting and diarrhea. The most severe reactions require the use of an injection of epinephrine to subside, which is why many people with food allergies carry auto-injectors for emergencies.