Allergy & Asthma Care of Fairfield County

Early life skin contact with peanut may increase risk of peanut allergy

A recent study published in Allergy, the European Allergy Journal, found that early life skin exposure to peanut may increase the risk of peanut allergy. Researchers at the Guy’s and St. Thomas’ NHS Foundation Trust, St. Thomas’ Hospital in London, looked at the blood cells of children with peanut allergy and compared them to children who are not allergic to peanuts. They found immunologic signals on peanut reactive lymphocytes, white blood cells involved in allergy, that point to skin as the first site of exposure to peanut. (Chan SM, Turcanu V, Stephens AC, Fox AT, Grieve AP, Lack G. Cutaneous lymphocyte antigen and α4β7 T-lymphocyte responses are associated with peanut allergy and tolerance in children. Allergy, Vol. 67, Issue 3, pages 336-342, March 2012)

Dr. Irena Veksler of Allergy & Asthma Care of Fairfield County comments: "Previous studies have found evidence that early skin exposure to peanut allergens may increase the risk of peanut allergy, and this study provide evidence of an immunologic mechanism for these findings. This is an exciting area of research that will hopefully lead to further understanding of how people develop new food allergies."

CT Magazine again names Dr. Backman a Top Doc

Kenneth Backman, MD, who is board certified in Adult and Pediatric Allergy and Immunology, has again been selected as one of the "Top Doctors In Connecticut" by Connecticut Magazine. Dr. Backman received his bachelor of science in Biology with distinction from Yale University, and his medical degree from Cornell University Medical College. Allergy and Asthma Care of Fairfield County is located in Fairfield and Monroe. Connecticut Magazine Top Docs 2012

Sublingual Immunotherapy drops - still little evidence for effectiveness in US

March 7, 2012 (Orlando, Florida) — A keen interest in sublingual immunotherapy (SLIT) for allergy is evident here at the American Academy of Allergy, Asthma and Immunology (AAAAI) 2012 Annual Meeting, but the reported increased use of this therapy in nonresearch settings is "disturbing," according to one expert who spoke at the meeting." SLIT is used in many parts of the world. It is commonly used in Europe, but in the United States, there are no FDA [US Food and Drug Administration]-approved SLIT medications," explained Michael Blaiss, MD, speaking at a State-of-the Art session on SLIT in the United States. Dr. Blaiss, who is a clinical professor of pediatrics and medicine at the University of Tennessee Health Sciences Center in Memphis, said it is disturbing to witness the use of SLIT in the "remote practice of allergy," meaning by nonallergists. "Even more disturbing to me is seeing more and more board-certified allergists doing SLIT off-label in the United States." I think it's still less than 10%, but we do know there's a growing use of SLIT by groups of otolaryngologists around the country, and by family physicians," he told Medscape Medical News. About 6% of allergists use SLIT, according to 2 surveys — one conducted in early 2007 by the American College of Allergy, Asthma, and Immunology and the other conducted in late 2009 by the Joint Council of Allergy, Asthma, and Immunology, he noted. "There are lots of people giving extracts that are approved for subcutaneous use...sublingually. I have concerns about that because we don't know the true efficacy or the true safety," he said. Many studies have found that these low doses are ineffective.

In the United States, most SLIT is being used (non-approved) for allergic nasal disease; much less is being used for food allergy, confirmed Wesley Burks, MD, president-elect of AAAAI and chief of pediatric allergy and immunology at Duke University in Durham, North Carolina. Dr. Burks is involved in several trials of SLIT — for milk and for peanut allergy — but he said it will be important to confirm its safety before people think about using SLIT in clinical practice. "What we don't really understand is the safety profile. It was originally thought to be very benign. What we've seen in our studies, although the numbers are small, is that there are a few people who really will have systemic allergic reactions to it. If they take the drops and they cough or they aspirate in any way, you can have a serious systemic allergic reaction. It has happened in several instances," he warned. In addition to questions about safety, there is the question about efficacy, said Dr. Blaiss.

"Patients need to be informed this is off-label; it's not approved by the FDA and we don't have clear data that this particular product has the levels of allergen that will work to control the condition. What the studies show is that if [the patient] isn't given enough of the allergen, [he/she] is not going to show clinical benefit." He sees a long road ahead before SLIT is approved by the FDA. "It's really still not clear from the FDA what is going to be required for the approval of SLIT in the United States. There's a much higher hurdle, compared with typical treatments and medication [in allergy], because what we're talking about here is not a medication — we're really talking about a vaccine."For vaccines, the FDA is going to set a higher standard as far as efficacy and safety, Dr. Blaiss said. With few good studies to date, many questions remain, such as the optimal dose and when it should be given, particularly with seasonal allergies, he said. "Most of our patients are polysensitized; when we're treating subcutaneously, they are getting multiple different allergens. What happens when we do this with SLIT? One study showed that the efficacy was not the same when SLIT used multiple allergens."

If and when the FDA starts to move in the area of immunotherapy, approval will likely come first for oral (tablet) immunotherapy, Dr. Blaiss said. Either way, the concept of immunotherapy is an exciting one because of its disease-modifying potential, he explained. "Can the use of SLIT in children with atopic rhinitis prevent or block the atopic march? Can it prevent the development of asthma and other allergies? The future for us and SLIT...is definitely exciting," he said. American Academy of Allergy, Asthma, and Immunology Annual Meeting, Orlando, Florida, March 2012

Dr. Irena Veksler of Allergy & Asthma Care comments:"Sublingual immunotherapy drops remain unproven, and the extracts used (off-label) in this country have been shown to be ineffective for allergies. While some unscrupulous offices may offer this treatment, until highly potent drops are available and proven safe and effective, this treatment should not be used in the United States. If and when these effective extracts are available, we will be thrilled to offer them to our patients."

Reflux meds no help for children with asthma

According to a study published in the January 25 issue of the Journal of the American Medical Assocation (JAMA), the commonly used reflux medication lansoprazole (Prevacid), part of the family of medications known as proton pump inhibitors (PPIs,) does not help control asthma in children who do not experience reflux symptoms. A previous study found that esomeprazole (Nexium,) another PPI, did not help asthma in adults.

 Children with asthma that is difficult to control are often prescribed these medications, with the hope that control of "silent" reflux will help improve asthma control. This study, unfortunately, found that this practice is ineffective in children who have not displayed signs of reflux related symptoms. Even when looking only at children with proven reflux by pH probe monitoring, there was no improvement seen in asthma control when taking PPIs. Since children in this study who were taking reflux medicine had a higher rate of respiratory infection, and showed a trend toward an increased rate of activity-related bone fractures, this treatment may be incurring some risk without clear benefit. Martinez FD "Children, asthma, and proton pump inhibitors: costs and perils of therapeutic creep" JAMA 2012; 307: 406-407.

Dr. Kenneth Backman of Allergy & Asthma Care points out: "While this is only one pediatric study, it raises important questions about the clinical benefit of PPIs in asthma control, when patients do not experience reflux symptoms. If asthma improvement is not clearly seen on PPI treatment, it is worth considering a trial off these medications."

Epipen cap warning issued by distributor

Taking the cap off an EpiPen incorrectly when treating a severe food allergy could potentially result in failure to deliver the drug, the distributor of the device says.

Health Canada said Friday that Pfizer Canada, distributor of the EpiPen and EpiPen Jr autoinjectors, says the blue safety cap on the device should be removed by pulling the cap straight up while holding the orange tip downward.

"It has recently come to our attention that removal of the blue safety cap the wrong way by pulling it sideways or bending and twisting it off may prevent the device from working properly and potentially result in failure to deliver the drug," the company said in a release Thursday.

The company also said patients should:

• Continue to carry their EpiPen or EpiPen Jr at all times.
• The blue safety cap should not be removed until you need to use the medication.

Patients are advised to review the safety information regularly and check that the device hasn’t been unintentionally activated, Health Canada said

Allergy injections as effective as medication as early as first season

A recent study published in the Journal of Allergy and Clinical Immunology (JACI) found that allergen specific immunotherapy (allergy injections) were at least as effective as medications as early as the first season of treatment. The study involved a review of meta-analyses (large scale statistical analyses) of large well controlled tirals of immunotherapy. They analyzed outcomes of the patients involved in the studies, comparing those on medication vs. those on allergen injections. Improvement on immunotherapy exceeded that of several medications, and was similar to mometasone nasal sprays, even during the first season of treatment. (JACI October 2011, pp791-799)

Dr. Kenneth Backman comments: "The effectiveness of allergy injections has been demonstrated in many well controlled trials, and we know that over time, the improvement often exceeds that seen with medications alone. We also know that the effects often persist for many years after injections are discontinued, and this long-lasting effect is a major advantage of allergen immunotherapy over other treatment options. This study demonstrates that effectiveness can be seen within the first season of treatment, which is faster than we often expect. Of course, some patients may not see improvement for over a year, but most will see marked improvement in symptoms within 1 1/2 years." Please call Allergy & Asthma Care of Fairfield County for more information about allergy treatment options.

Mold exposure during infancy increases asthma risk

ARLINGTON HEIGHTS, Ill. (August 2, 2011) – Infants who live in “moldy” homes are three times more likely to develop asthma by age 7—an age that children can be accurately diagnosed with the condition. Study results are published in the August issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).

“Early life exposure to mold seems to play a critical role in childhood asthma development,” says Tiina Reponen, PhD, lead study author and University of Cincinnati (UC) professor of environmental health. “Genetic factors are also important to consider in asthma risk, since infants whose parents have an allergy or asthma are at the greatest risk of developing asthma.”

UC and Cincinnati Children’s Hospital Medical Center researchers analyzed seven years of comprehensive data for 176 children to evaluate the effects of mold exposure in early life. The children were part of the Cincinnati Childhood Allergy and Air Pollution Study (CCAAPS), a long-term population-based study that included more than 700 children from the Greater Cincinnati area. CCAAPS looked at the effects of environmental particles on childhood respiratory health and allergy development. Participants were identified during infancy as at high risk to develop allergies based on family medical history.

Eighteen percent of children enrolled in CCAAPS were found to be asthmatic at age 7. It is estimated that about 9 percent of school-age children in the United States will develop asthma; however, studies have shown that rates are often higher in children from poor, urban families.

”The symptoms of pediatric asthma range from a nagging cough that lingers for days or weeks to sudden episodes of shortness of breath and wheezing that require emergency treatment,” says allergist David Bernstein, MD, study co-author, UC professor of internal medicine and ACAAI fellow. “If a young child’s symptoms persist and keep coming back, that’s a clue that it could be asthma.”

According to the ACAAI, common symptoms of asthma include:

• Coughing, especially at night
• Wheezing or whistling sound, especially when breathing out
• Trouble breathing or fast breathing that causes the skin around the ribs or neck to pull in tightly
• Frequent colds that settle in the chest

“This study should motivate expectant parents—especially if they have a family history of allergy or asthma—to correct water damage and reduce the mold burden in their homes to protect the respiratory health of their children,” adds Reponen.

Be food allergy ready this school year

Starting the conversation with schools about food allergy preparedness can be a challenge, but it's an essential step in creating a safe and healthy environment for everyone. The Food Allergy Initiative and the Food Allergy & Anaphylaxis Network have teamed up to create new training and preparedness programs for teachers, administrators, and school personnel. Find it at allergyready.com.

Dr. Kenneth Backmand of Allergy & Asthma Care of Fairfield County comments: "This is a wonderful resource for school personnel to become familiar with the complex and very important issues surrounding food allergy in school."

"Hypoallergenic" dogs not really hypoallergenic

If you are thinking about adopting a dog and someone in your household suffers from pet allergies, you may have been told that certain breeds, including the Portuguese water dog made famous when it was adopted by the Obamas, are less likely to cause symptoms. But this is likely a myth, a recent study suggests.

In the study, owners of poodles, schnauzers, and even Portuguese water dogs, widely promoted as hypoallergenic, have the same amount of a dog allergen known as "Can f 1" in their homes as owners of dogs not typically billed as hypoallergenic.

The study is published online in the American Journal of Rhinology and Allergy. Researchers collected dust samples from 173 homes taken one month after a newborn was brought home. The samples were collected from the carpet or floor in the baby's bedroom. Data were analyzed from homes with one dog only. The study included 60 dog breeds, 11 of which are often promoted as hypoallergenic. The researchers found that 94.2% of homes showed detectable levels of the allergen, and there were no significant differences between breeds.

Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County points out: "We've known for years that dog breeds labeled 'hypoallergenic' had never been proven to be so. This label has typically been given by breeders to dogs that don't shed. However, since the allergen comes from the saliva and dander, which all dogs have, even hypoallergenic dogs can unfortunately cause allergy symptoms."

Prevalence and severity of food allergies in the US

Previous attempts at quantifying the scope of food allergies among U.S. children have produced a wide range of estimates, from 2% to 8%. From a public health standpoint, getting more details on the main causes of causes of food allergies, and precise demographics of those afflicted, is crucial. A 2011 study published in the journal Pediatrics, “The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States,” analyzed data collected on nearly 40,000 children, as reported by adults in their households. Both unconfirmed cases of allergies that were reported along with convincing evidence and cases confirmed by a medical professional were counted and analyzed.

The study’s findings include:

• 8% of children had at least one food allergy, a projected total of 5.9 million children across the U.S. population
• 2.4% of the children in the study had multiple food allergies, nearly one-third of those with allergies.
• The prevalence of severe food allergies among the children studied was 3.1%, or 38.7% of the children with allergies.
• Peanut allergies were the most common at 2% of the children in the study. The next most prevalent were milk and shellfish, with rates of 1.7% and 1.4%, respectively.
• The likelihood of food allergies among Asian and black children was higher than that for white children. The odds of having a food allergy were “significantly lower” among children in households with annual incomes below $50,000.
• The chances of a confirmed food allergy were lower for black, Hispanic and Asian children compared to white children.
• Severe food allergies were more prevalent among male children and those who had multiple allergies.

Subcutaneous immunotherapy (allergy shots) can work quickly

NEW YORK (Reuters Health) Jun 07 - Subcutaneous immunotherapy (SCIT) is at least as effective as drug therapy in controlling seasonal allergic rhinitis, even in the first season after treatment starts, a new review indicates.Total nasal symptom scores were reduced with SCIT by 34.7% compared to placebo, by 31.7% with mometasone versus placebo, and by 6.3% with montelukast versus placebo, the researchers report.

Writing in the Journal of Allergy and Clinical Immunology online May 27, Dr. Paolo M. Matricardi, with Charite Medical University in Berlin, Germany and colleagues point out that subcutaneous immunotherapy is generally regarded as slow-acting and a second-line option if pharmacotherapy isn't effective or tolerated. However, they wondered if that "slow acting" reputation was really deserved.

In reviewing the published evidence, the authors found only four head-to-head comparison trials, so they also included placebo controlled trials of SCIT and of antihistamines, nasal corticosteroids, or leukotriene antagonists. In all, 42 trials that measured total nasal symptom scores or total symptom scores during the first pollen season after starting treatment were included. Total symptom scores were reduced by 32.9% with SCIT and by 12.0% with desloratadine, relative to placebo.

"We can conclude that SCIT has not only a disease-modifying and long-term effect... but also has a rather powerful antisymptomatic effect starting as early as the first season after treatment onset," Dr. Matricardi and colleagues write. They add, "Our results support the novel concept that cost/benefit analysis of specific immunotherapy in patients with SAR (seasonal allergic rhinitis) should take into account not only its long-term efficacy but also its short-term effect on symptoms."

Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County comments:"We have long known that while we counsel patients that it may take 1 to 2 years to see good effect, some patients will see benefits from allergen immunotherapy much sooner. This study confirms that rapid effects can be seen. Even better results are seen after several seasons on injections."

SOURCE: http://bit.ly/mJmors ;J Allergy Clin Immunol 2011.

Tree pollen season is winding down, but grass pollen remains high

While tree pollen season is winding down, grass pollen is still going strong. If you are allergic to grass pollen, continue taking your medication through the end of June. If you're not sure what pollens you're allergic to, consider allergy testing to learn exactly what allergens are causing your symptoms. For future seasons, the best plan is to start your medications in advance of the pollen season. Schedule an appointment for next winter, or July if you suffer from fall pollen allergies, to prepare a medication plan.

Severe pollen season a sign of things to come

The 2011 spring allergy season is shaping up to be a miserable one, with pollen levels reaching record highs, thanks to heavy winter snows, early spring rains, and an early spring warm-up. Sound familiar? Just a year ago, the 2010 allergy season was the "worst on record" for many of the same reasons. So should we expect each spring allergy season to be worse than the last, in an eternal one-upmanship that sends us running for the tissue box or the asthma inhaler?

Probably so. And the pattern could hold true for fall allergies as well. A study published in January's Proceedings of the National Academy of Sciences found that the length of ragweed season in various areas of the country increased by as much as 27 days between 1995 and 2009. The culprit? Climate change, the researchers said.

"The seasons are getting longer — they're starting earlier and pollens are getting released earlier," says Stanley Fineman, MD, president-elect of the American College of Allergy, Asthma and Immunology and an allergist at the Atlanta Allergy and Asthma Clinic. "And not only is there warmer weather, there tends to be more CO2 in atmosphere." CO2, or carbon dioxide, feeds plants and leads to a greater release of pollen, and sometimes that pollen is more potent and more allergenic than it was when there was less CO2 in the atmosphere.

Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County points out that it's important to keep allergies from getting out of control. "When allergies flare, people feel fatigued, with less energy than usual, often from poor quality of sleep resulting from congestion...Allergies can lead to sinusitis, asthma flares, ear infections, and other medical problems. They also cause reduction in school or work quality, and many absences." Dr. Backman points out that excellent treatments are available, and recommends seeing your allergist to accurately diagnose and treat your allergies.

CT Magazine Lists Dr. Backman

Kenneth Backman, MD, who is board certified in Adult and Pediatric Allergy and Immunology, has again been selected as one of the "Top Doctors In Connecticut" by Connecticut Magazine. Dr. Backman received his bachelor of science in Biology with distinction from Yale University, and his medical degree from Cornell University Medical College. Allergy and Asthma Care of Fairfield County is located in Fairfield and Monroe. CT Magazine Top Docs 2011

Oral immunotherapy not ready for prime time

From the 2011 Annual meeting of the Academy of Allergy, Asthma, and Immunology(AAAAI):

Immunotherapy may hold the edge for treating children's food allergies but it isn't ready for prime time yet, as presented at the recent AAAAI meeting. In oral immunotherapy, small doses of the allergy-causing food progressively raised to boost immune tolerance can take the form of either a liquid held under the tongue and then swallowed -- sublingual immunotherapy -- or solid forms taken orally.

The oral form is furthest along in clinical studies and also appears more promising for efficacy, leading allergist A. Wesley Burks, MD, of Duke University Medical Center explained to MedPage Today Senior Staff Writer Crystal Phend.His group presented results from the first head-to-head comparison of the two forms of immunotherapy, which suggested oral immunotherapy desensitizes children's milk allergies better than sublingual immunotherapy. But both forms remain experimental for food allergies, Burks said.

The risk of serious reactions when giving children doses of the foods they are allergic to means that these treatments need to be carried out only under careful medical supervision, Burks said. Further study is also needed before widespread use in clinical practice, he warned.

Dr. Kenneth Backman of Allergy & Asthma care points out that immunotherapy to foods is still investigational and requires additional study. "While some studies have been promising, all studies have been small. Much larger studies need to be performed to confirm safety and efficacy before this treatment should be offered outside controlled clinical trials at academic centers. There may be significant risks of side effects, including dangerous allergic reactions and possible new-onset allergic diseases of the gastrointestinal tract, such as eosinophilic esophagitis."

Food allergies cause an ER visit every 3 minutes

Food allergies may cause many more visits to the emergency room than previously believed, according to a new study published in the  Journal of Allergy & Clinical Immunology. The research team, led by Sunday Clark, MPH, of the University of Pittsburgh, found that food-allergic reactions caused more than 7 million ER visits from 2001 to 2005-an average of 203,000 visits each year. Anaphylaxis, a potentially life-threatening reaction, accounted for some 90,000 visits annually. This means that every three minutes, a food-allergic reaction sends an American adult or child to the ER, while an emergency room visit for food-related anaphylaxis occurs every six minutes. A 1999 study estimated that food-induced anaphylaxis resulted in some 30,000 ER visits each year-a third of the number reported in the current study. 

Dr. Katherine Bloom of Allergy & Asthma Care of Fairfield County points out that "all allergic diseases are on the rise, and this is certainly true of food allergy. Whether this increase in ER visits is due to the overall increase in food allergies, or due to a worsening of the reactions that do occur, will require further study. The most important thing is for people to accurately identify their food allergies and carefully avoid those foods. Seeing an allergist is an essential part of this process."

Albuterol inhalation solution recalled due to mislabeling

Ritedose is voluntarily recalling 0.083% albuterol sulfate inhalation solution in 3-mL single-use dose vials because some vials are embossed with incorrect concentration information, the US Food and Drug Administration (FDA) announced today.

The product package makes the mislabeling even more confusing. The single-use dose vials are wrapped in protective foil inside a shelf carton. Single-use vials with an actual concentration of 2.5 mg/3 mL are incorrectly embossed with a concentration of 0.5 mg/3 mL. The correct concentration of 2.5 mg/3 mL, however, appears on the protective foil and shelf carton.

Clinicians who read the incorrect concentration embossed on the vials may mistakenly adjust the volume of the product upward, resulting in an administered dose that is 5 times the recommended one. This error is more likely in hospital settings, where the inhalation-solution vials often are not accompanied by the rest of the packaging.

Patients should return the albuterol inhalation solution to the medical practice, pharmacy, or hospital where they obtained it.

More information about today’s announcement, including lot numbers of the product under recall, is available on the FDA Website. Clinicians and patients also can contact Ritedose by telephone at 1-803-935-3995 or by email at recall@ritedose.com.

Damp house linked to kids' risk of nasal allergies

The following is taken from the American College of Allergy, Asthma, and Immunology website: Children who live in damp, water-damaged homes may be more likely than other kids to develop nasal allergies, according to a population-based prospective cohort study in American Journal of Epidemiology. Researchers at the Institute of Health Sciences in Oulu, Finland, followed 1,863 children (who were 1 to 7 years old at baseline) from Espoo, Finland, for six years.  Among the children whose parents reported dampness in the home, 16 percent went on to be diagnosed with allergic rhinitis during the next six years, compared with just under 12 percent of children whose parents reported no dampness.  Those whose parents reported any mold or water damage in the home at study outset were 55 percent more likely than other children to develop allergic rhinitis.

Dr. Irena Veksler of Allergy & Asthma care of Fairfield County points out that dampness promotes the growth of mold and dust mites. "It is important to dry up any moisture and eliminate the souce of water in the home. If allergic nasal symptoms or asthma develop, consider seeking an allergist for testing and appropriate treatment. "

 

Asthma attacks from allergies send kids to ICU

November 3, 2010 - Children whose asthma attacks are triggered by allergic reactions are much more likely to wind up being treated in intensive care units for severe symptoms of asthma, a new study shows. Researchers at Connecticut Children's Medical Center studied data on 188 children who were admitted to the hospital for asthma attacks between July 2008 and July 2009. They report that 30% of those children, 57 of them, had symptoms so severe that they were admitted to the ICU. The study showed that children admitted to the ICU were significantly more likely to have had their asthma attack triggered by allergies. Also, children admitted to the ICU had been sick for shorter periods, on average, than those hospitalized but not admitted to the ICU, implying more rapid and severe exacerbations.

The researchers report that month of hospital admission was a significant factor in the severity of attacks. In August and October, children admitted to the hospital were much more likely to be admitted to the ICU as compared with other months. The researchers conclude that allergic reactions, possible from season change, may increase the incidence of severe asthma attacks. This study was presented during CHEST 2010, the annual meeting of the American College of Chest Physicians. 

Dr. Kenneth Backman points out:"the above referenced study emphasizes the importance of identifying allergies in asthma patients, and treating allergies appropriately to help prevent asthma attacks."

Egg allergic patients can safely receive influenza vaccine

It is influenza season, and current CDC guidelines recommend that all individuals over 6 months of age receive the influenza vaccine. In the past, it was advised that egg allergic patients either skip the vaccine, or be tested by an allergist to determine if they could safely receive the vaccine. Recent guidelines from the American Academy of Allergy, Asthma, and Immunology recommend a protocol whereby nearly all egg allergic patients can safely receive the influenza vaccine. Dr. Kenneth Backman of Allergy & Asthma Care of Fairfield County states, "with the recent guidelines, egg allergic patients no longer need worry about an allergic reaction to the influenza vaccine when administered appropriately." Allergy & Asthma Care currently has influenza vaccine available, and can administer the vaccine using the latest protocol. Call (203) 259-7070 today.

Select lots of Advair Diskus recalled

Recently, batches of Advair Diskus inhalers that had been reported stolen have been found on the prescription market. Because these inhalers were stolen, the safety and effectiveness of the involved inhalers cannot be assured. Advair Diskus is an inhaled medication used in the treatment of asthma and COPD. The affected lot numbers of Advair Diskus are:

Advair Diskus 250/50 (NDC 0173-0696-00), Lot 9ZP2255, Exp: Sep 2010

Advair Diskus 500/50 (NDC 0173-0697-00), Lot 9ZP3325, Exp: Sep 2010

Drs. Backman, Veksler, and Bloom of Allergy and Asthma Care of Fairfield County urge patients who take Advair to check their inhalers immediately. If you find that you are in possession of one of the involved lot numbers, stop using it immediately and contact GlaxoSmithKline's Customer Response Center at 888-825-5249.

Oral peanut immunotherapy - promising, but not ready for clinical use

The only treatment for peanut allergy, or any food allergy, is strict avoidance. However, accidental ingestion can lead to reactions, sometimes serious. In the July issue of the Journal of Allergy and Clinical Immunology, Blumchen et al reported a study of oral immunotherapy to peanut and children with a history of peanut induced anaphylaxis.Children underwent a rapid build-up protocol, and then a longer protocol with biweekly dose increases. Eventually, 14 of 23 patients tolerated a protective dose of at least 500 mg of peanut. However, mild to moderate side effects were common, and several reactions occurred. An editorial in the same journal issue, written by some of the most prominent food allergy researchers in the the country, stated the following: "Although everyone involved in patient care and in novel therapeutic research would like a treatment option to offer individuals with food allergy, now is not the right time. Further studies are needed to address...outstanding issues to determine whether this type of therapy is appropriate for clinical use." Some of the outstanding issues raised by the editorialists included the appropriate dosing and dose frequency, the safety of the treatment, and the fact that most studies have excluded those patients with a history of very severe reactions.

Allergy & Asthma Care of Fairfield County points out that, at this time, no type of oral immunotherapy is approved in the United States. All oral or sublingual immunotherapy, whether to foods or environmental allergens, is currently investigational and not proven safe or effective. If and when these treatments are truly proven safe and effective, and are FDA approved for use in patients, Allergy & Asthma Care will be thrilled to offer them.

Adequate vitamin D may help with asthma control

Journal of Allergy & Clinical Immnology: Asthmatic children with vitamin D deficiency have more symptoms and use more corticosteroids, according to an April 12 online report in the Journal of Allergy & Clinical Immunology.The study also suggests that vitamin D supplements "might potentiate the anti-inflammatory function of corticosteroids in asthmatic patients and thereby act as a steroid-sparing agent," first author Dr. Daniel A. Searing told Reuters Health by email.

Dr. Searing and colleagues from National Jewish Health in Denver and University of Colorado Denver in Aurora analyzed serum levels of 25-hydroxyvitamin D in 100 asthmatic children up to 18 years old.The cohort was 79% white, 9% Native American or Alaska Native (including Hispanic), 6% African American, 3% Asian, and 4% mixed race. Forty-seven percent of the children had insufficient vitamin D levels (< 30 ng/mL), and 17% were in the deficient range (< 20 ng/mL). "This demonstrates that vitamin D insufficiency is common in children with asthma," Dr. Searing said.

Allergy markers, including immunoglobulin E level (p = 0.01) and positive aeroallergen skin test responses (p = 0.02), were inversely correlated with vitamin D levels. In particular, allergies to dog and house dust mite were higher in patients with low vitamin D.Lower vitamin D levels were also significantly correlated with lower lung function. Use of inhaled and oral corticosteroids and long-acting beta agonists were all higher in patients with low vitamin D levels.

"Our findings suggest two possible explanations," senior author Dr. Donald Leung noted in a written statement. "It could be that lower vitamin D levels contribute to increasing asthma severity, which requires more corticosteroid therapy. Or, it may be that vitamin D directly affects steroid activity, and that low levels of vitamin D make the steroids less effective, thus requiring more medication for the same effect." What's needed next is to "investigate if vitamin D supplementation for asthmatic patients will lead to lower medication use and improved symptoms," Dr. Searing concludes."The relationship between corticosteroid medication use and lower vitamin D levels, especially also with our laboratory data showing the ability of vitamin D to enhance corticosteroid effects, shows a potential pathway for vitamin D's role in asthma," he added.

Drs. Backman, Bloom, and Veksler from Allergy & Asthma Care of Fairfield County wish to remind patients that this data does not prove that taking supplemental vitamin D will improve asthma control. However, many people in the Northeast are likely vitamin D deficient. It is strongly recommended that patients speak with their primary care physicians about their vitamin D status. Ensuring that you have adequate vitamin D levels certainly can't hurt, and may turn out to help, asthma control.

Can you outgrow a shrimp allergy?

Shellfish allergies are responsible for most emergency room department visits in food-allergic adults, and have generally been thought to be life-long.  But a new study, conducted by Rosalia Ayuso, MD, and colleagues at Mount Sinai, has found that sufferers may build up a tolerance to shrimp as they grow older.  This is the first study to show that sensitization to shrimp allergens is greater in children than in adults, and that it may decrease with age.  This study was sponsored by the Food Allergy Initiative, and more information about it can be found at the following link.
Read more.

Peanut allergy on the rise

The prevalence of peanut allergy among children tripled between 1997 and 2008, researchers found.Respondents to a telephone survey reported that 1.4% of children had peanut allergies, up from just 0.4% a decade earlier, Scott Sicherer, MD, of Mount Sinai School of Medicine in New York City, and colleagues reported in the May 12 issue of the Journal of Allergy and Clinical Immunology."Although the total population prevalence of self-reported peanut and/or tree nut allergy did not increase among adults since 1997, there was a significant rise in self-reported allergies among children," the researchers wrote.They conducted the phone survey in 2008 and compared those results with two prior surveys they had done -- one in 2002 and the other in 1997.

Peanut and tree nut allergies are the leading causes of fatal allergic reactions and are not typically outgrown, the researchers noted.In 2008, the researchers surveyed 5,300 homes, which included a total of 13,534 individuals.They found that the prevalence of combined peanut and tree allergies among children was 2.1%, compared with 0.6% in 1997.For peanut allergy alone, prevalence was 1.4%, compared with just 0.4% in 1997.Allergies to tree nuts alone increased to 1.1% in 2008, up from 0.2% in 1997.Tree and peanut allergies remained steady among adults, at a rate of 1.3%.The researchers also noted that the prevalence of peanut allergy among U.S. children is similar to estimates from Canada, Australia, and the U.K.

Its increase could be attributable to the "hygiene hypothesis" -- the idea that less exposure to allergens and bacteria in childhood leave the immune system underdeveloped and vulnerable, the researchers speculated.Or it could be the timing of when the food is introduced, or how the food is prepared, the researchers said. Roasted peanuts, for instance, have increased allergenicity because cooking changes the nature of the proteins in the nut.Either way, the prevalence "represents a significant health burden," and the researchers called for better strategies for prevention and treatment, "particularly if we will be seeing a significant increase of these persistent allergies with time."

The study was limited by self-report and problems with identifying "true" allergy.