Archive for the 'Allergies' Category

Peanut Allergy Claims Another Life

Published on August 25, 2011 in Allergies and Food Allergies. 0 Comments

Fifteen-year-old Jharell Dillard from Lawerenceville, Georgia, died last week when he accidentally ate a cookie with peanuts. He had been shopping with his aunt at a local Wal-mart when he ran out to their car in the parking lot for a snack. When he realized the cookie had traces of peanut he ran to a nearby McDonalds to rinse his mouth out. He also took Benadryl, an over-the-counter antihistamine, but did not have his self-injectable epinephrine or Epipen. Reports indicate his tongue and throat swelled significantly before emergency services arrived. He was rushed to Walton County Medical Center and ultimately flown to Childrens Healthcare of Atlanta at Egleston where he passed.

Although Jharell and his family donated seven of his organs and have already helped save many lives, we’d like to help other individuals with food allergy avoid such a tragic outcome. Unfortunately, we are not in time for Tyler Davis, a 20-year-old student at Kennesaw State University who we just learned died also last week after ingesting a food he may have been allergic to.

Here are some important facts to remember about food allergy:

  1. Teenagers and adolescents tend to be noncompliant with medical recommendations and have historically been poor about regularly carrying their life-saving, self-administered epinephrine.
  2. Studies show that the earlier epinephrine is given for an acute reaction following an accidental ingestion the more likely it will be life-saving. Delayed administration of epinephrine may result in more severe and prolonged episodes of anaphylaxis.
  3. Benadryl does not treat anaphylaxis!
  4. Non-deadly food-induced anaphylaxis is the most common type of severe allergic reaction.
  5. Food allergy needs to be accurately diagnosed, which involves expert interpretation of  a patient’s clinical history, skin tests, blood tests, and occasionally, food challenge.
  6. No available cure is available for food allergy, so avoidance of culprit foods is key.
  7. Patients at the highest risk of death from a food-induced anaphylactic reaction are teenagers with a history of asthma who already know what they are allergic to.
  8. Close follow-up with an allergist is helpful.

Luckily, food-induced anaphylaxis resulting in death is relatively rare, claiming approximately 50 deaths per year in the United States. All-cause mortality from anaphylaxis is not accurately known but is likely around 1%.

At the Atlanta Allergy & Asthma Clinic we see patients with food allergy—and patients who think they have food allergy–on a daily basis. The diagnosis is not always simple and often requires our doctors to use a good clinical history, skin tests, blood tests, and food challenges to accurately advise patients on what foods to avoid.

If you or your friend or loved one has a food allergy, please make sure they see an allergist to ensure they are best prepared to avoid any culprit foods . . . and to treat themselves in case of an accidental exposure.

A Personal Note from Dr. Sheerin on Food Allergies

Published on August 25, 2011 in Allergies and Food Allergies. 1 Comment Tags: , , , , , .

I am an allergist who has personal interest in food allergy. Most of my patients know that I am allergic to shrimp and that my 13-year-old son is severely allergic to pine nuts. We do not live in fear and do not let food allergies dictate our lives. We go out to eat, shop at grocery stores and eat packaged foods. Like all other food allergy patients, we have learned to read labels and discuss our allergies with restaurant staff. In spite of this, we have had three reactions in restaurants to pine nuts and one to shellfish. Accidents happen even if you follow proper precautions. However, we always have injectable epinephrine and are prepared to use it. In fact, both my son and I have used our EpiPens, which resulted in immediate improvement in our symptoms. The most important message I try to give my patients is this: don’t leave home without it and don’t be afraid to use it. This is the lesson that has been well illustrated by the two recent deaths in Atlanta. These unfortunate young men knew they were allergic but did not have their injectable epinephrine. Timely use of epinephrine could have saved their lives.
As a woman I am not particularly challenged by the task of keeping an EpiPen with me. I keep it in my purse at all times. I do worry about my son, though, who keeps his in his backpack and at school. When he goes out without me, we are challenged with the best way for him to carry it because it doesn’t always fit easily in a pocket (and he’s very reluctant to use a fanny pack). To parents out there, stay on your teenagers to carry an EpiPen at all times. They are at the highest risk to die because they often do not read labels, forget their EpiPen and are more likely to dismiss symptoms. Teach their friends how to recognize symptoms and how to use the EpiPen. Having and using an EpiPen during a reaction can mean the difference between life and death.

The SLIT-uation.

Published on February 11, 2011 in Allergies, FDA, Immunotherapy and SLIT. 0 Comments Tags: , , , , , , , , , , , , , , , , , , , , , .

One of my patients with a significant history of allergies who had been repeatedly late for her weekly allergy shot asked me the other day in clinic whether we also offered sublingual immunotherapy or SLIT, the liquid allergy drops patients place under their tongue and then swallow. More and more allergy and ENT practices are making this alternate form of allergy immunotherapy available. Unfortunately, the FDA has not yet approved SLIT for use in the United States, although this method of allergy desensitization is commonly being used in Europe. Some doctors in the United States have been using the same allergy extract regularly approved for injections for sublingual treatments, although the doses administered sublingually are much higher.

And here lies the rub. Current studies on SLIT, most done in Europe, don’t delineate the precise, effective dose necessary for treatment success. In the U.S., such doses are regularly agreed upon for our much more commonly prescribed allergy shots. Further, most SLIT studies in Europe focus on patients who are mono-sensitized or allergic to only one allergen. Here in the U.S., patients are largely multi-sensitized or allergic to multiple different allergens. Most of our allergy shot patients are therefore prescribed allergy extract that consists of many different allergens, such as cat, dog, dust mite, tree, grass, mold and weed—not just grass extract alone, for example. We’re not sure yet whether mixing many different allergens together for SLIT would be as effective in treating multi-sensitized patients as one sublingual extract is in treating patients only allergic to one allergen. The one SLIT study done so far in the United States that looked at treating patients with multiple allergies revealed that mixing the allergens together blunted their efficacy.

Nonetheless, SLIT will likely become a commonly prescribed allergy treatment in the future. Like allergy shots, SLIT has been shown to be effective for treating allergic asthma and nasal and ocular allergies. Unlike allergy shots, SLIT can be administered at home and has a low risk for anaphylaxis, although serious allergic reactions have occurred. Recent evidence has even shown that both shots and sublingual drops might also help treat allergic patients with eczema or atopic dermatitis. As with allergy shots, SLIT has been shown to have long-lasting benefits, remaining effective years after patients have stopped the drops. Again, these promising results apply to mono-sensitized patients treated with allergic extract containing only one type of allergen and not necessarily to the multi-sensitized patient who predominates in the U.S.

Future SLIT studies will hopefully reveal how doctors can appropriately dose and mix relevant allergens to achieve the best treatment outcomes. Until that information is known, patients should understand that SLIT for patients with multiple allergies is in an investigational stage. Because SLIT is not FDA-approved it is not currently covered by insurance. Therefore doctors who provide this therapy do so off-label and so often charge cash. For all these reasons, the Atlanta Allergy & Asthma Clinic does not yet offer SLIT. As more information becomes available we may change our views, but for now, we prefer the tried and true.