Trick or Treat: Food Allergies Can Ruin the Treat

Halloween is just a few days away and your school-age patients will surely be getting ready to go trick or treating. It’s customary for parents to warn their children to bring home their candies to be checked for safety — this is especially important for children who have food allergies.

The danger with food-allergic patients is that often the ingredients they’re allergic to are either unrecognized or hidden in a seemingly innocent recipe. One of my peanut-allergic pediatric patients once attended a celebration at a local ice cream parlor. He and his mother were careful to order an ice cream sundae without nuts. However, half-way through his delicious treat he told his mother his stomach hurt and he soon began to vomit. The mother called my office and I immediately sent him to the nearest emergency room and met the family there. It turns out, at the bottom of the ice cream sundae were Reese’s pieces — chocolate candies with peanuts inside. My patient was developing an anaphylactic reaction but fortunately — with aggressive treatment — the attack was reversed.

It is not uncommon for allergic patients with a food allergy to react to more than one food. The AllerVision skin testing food panel in the basic kit is designed to help you identify reactions to some of the most common offenders. For a wider range of allergens, including the ones most likely to cause anaphylaxis, you should turn to the extended food allergen panel. This will allow you to pick from a variety of items and customize the test specifically for each patient. It is important to correlate the positive test scores with a thorough history to make sure genuine clinical allergy exists and not just sensitization, which is a positive test without a likely confirming history. If the food allergy testing leads to ambiguous clinical allergy, it is wise to refer to a specialist for further evaluation.

If you would like to read more about the latest in peanut allergy diagnosis, you may want to look at the October 2013 issue in Consultant for Pediatricians. I wrote an article discussing which are the key proteins that predict a more severe peanut allergy reaction.

Halloween can be a lot less scary for everyone if food allergy reactions are prevented!

– Dr. Dean Mitchell

Allervision Updates: Useful Tips for Everyday Practice

Allervision Updates is a resource for medical practices that are clients of Allervision, and their patients. My name is Dean Mitchell, and I am a board-certified allergist who joined the Allervision team in September. My background has been in private practice for 21 years, and for most of those two decades I have taught at Columbia College of Physicians and Surgeons and most recently at Touro College of Osteopathic Medicine in New York city. My special interest over the past 15 years has been in sublingual allergy immunotherapy. I wrote a book in 2006, Dr. Dean Mitchell’s Allergy and Asthma Solution (Marlowe) that discusses in detail my experience with using allergy testing and specifically sublingual allergy drops to help patients suffering with airborne allergens and asthma.

A house dust mite seen under magnification.

Enough about me, I am excited to bring to you the information that you can incorporate into your daily practice when seeing allergy patients.

Today’s Update will cover House Dust Mites. There are many patients who realize that they sneeze, get congested, itch or even wheeze in dusty environments. Lots of individuals think that’s a normal response to dust exposure — but it isn’t. Yes, anyone can have a few sneezes when they wipe up some dust, but allergic patients keep on sneezing for hours. House dust mites are hard to avoid because they thrive on human scales, so the bedroom, and more specifically the bed, is a primary source of dust exposure.

Step 1: Educate your patients who test positive to dust mites to encase their mattress and pillow cases with hypoallergenic plastic covers. (There are several companies they can visit and order from online.) The nice thing about these mattress and pillow cases is that they reduce the dust exposure all night long — and patients will see results within a month.

The problem with dust mites is that they exist in so many places: airplanes are dust mite heaven, with all the upholstered seats; hotels, no matter how swanky, are filled with dust mites. So, for your patients who travel for work and feel like they’re always getting sick on trips, you need to tell them about the benefits of  allergen immunotherapy. They can truly benefit by strengthening their immune system via allergy shots or drops. I highly recommend drops for patients frequently on the road because they are self-administered and safe.

Asthmatic patients are also typically allergic to dust mites. If you find asthmatic patients who test positive for dust mites, you should advise them that a key study has shown that it’s possible to reverse asthma to dust mites by using allergy drops.(G.W. Canonica and G.Passalacqua, Non-injection Routes of Immunotherapy, Journal of Allergy and Clinical Immunology. 111(2003):437-48.)

Please put your patients at ease when they get defensive and say, ” I have a very clean house and don’t have dust mites.” Assure them that dust mites infest everyone’s home; it’s no reflection on one’s housekeeping skills. What’s most important is that there’s no reason to suffer when prevention and treatment are available and easy.

Fall Leaves Lead to Mold Allergies

Raking leaves can stir up mold
which could trigger allergies.

The weather has been beautiful the past few weeks: crisp fall days with lots of foliage on the trees. Then it falls to the ground, giving many homeowners the added weekend job of raking up leaves. From an allergy perspective, the problem with those leaves is that they decompose and become a perfect breeding ground for mold spores. The mold spores become airborne and trigger numerous types of allergy symptoms from sinus pressure, swelling around the eyes, and asthma in many patients. Mold counts don’t get the same press as high pollen counts, but with climate change and with super storms increasing in frequency, we are seeing mold counts climbing and staying around longer. Autumn has been well recognized as the time when rising mold counts trigger asthma. The New England Journal of Medicine documented this precise connection several years ago involving the mold Alternaria.

The Allervision panel of skin testing includes the key molds you should be knowledgeable about: Alternaria , Cladysporium, Aspergillus and Penicillium.

Alternaria is one of the best understood and most important molds that causes allergic diseases. Patients with mold allergy will commonly complain of sneezing or shortness of breath after raking leaves. I’ll never forget one patient I took care of who suffered from mold allergy with severe sinus pressure for years. His job was with the Parks Department and guess what his duty was… he operated the machine that collected the leaves off the ground at the parks in town. Fortunately, I treated him with allergy immunotherapy and he was able to continue his job.

Four Aspergillus colonies grown at 37°C for three days on rich media. Clockwise (from top left): an Aspergillus nidulans laboratory strain; a similar strain with a mutation in the yA marker gene involved in green pigmentation; an Aspergillus oryzae strain used in soy fermentation; the Aspergillus oryzae strain that had its genome sequenced, RIB40. Background is black card. Originally scanned 20 Aug 2008. (Photo credit: Wikipedia)

Aspergillus is another mold that frequently causes allergic sinus disease and asthma exacerbation. There is a disease called Allergic BronchoPulmonary Aspergillosis; these patients tend to have steroid-dependent asthma. You typically find a high total IgE (over 2,000) and elevated eosinophil counts. Keep an eye out for your patients who test positive to this mold and have the above lab findings. They also typically have bronchiectasis on a chest x-ray.

Cladysporium and Penicillium are the other common molds. Please explain to the patients that testing positive to Penicillium doesn’t mean you are allergic to Penicillin the antibiotic — that’s a different test.

Avoiding mold is difficult, but there are some ways to decrease exposure in the home. If patients smell mold, or mildew as they call, it in their home,  I would advise they hire a professional to eradicate it.  Also, they should be aware of the humidity in their home; mold loves humidity over 50%. Your patients can purchase a $15 dollar Hygrometer which gives a simple reading.

I would also consider the option of allergy immunotherapy for  patients with mold allergy. I have treated many patients just for this specific allergy problem with excellent results and the patients were very grateful.

– Dr. Dean Mitchell