Does Your Child Have Allergies?… Are You Sure?

Allergies can cause a wide variety of symptoms, many of which you might not expect.

Allergies can cause a wide variety of symptoms, many of which you might not expect.

Viruses, bacteria, allergens — there’s any number of small organisms that can make children feel bad. Often the hardest part of treatment is determining the true cause of your child’s illness. For instance, is the latest ear infections the result of a “bug” going around day care or is grass pollen triggering an allergy?

Compounding the situation, allergies manifest themselves in many different ways. Of course, everyone knows that allergies can cause sniffles, watery eyes and sneezing. But here’s a list of other common, though often undiagnosed allergy symptoms in kids:

  • Asthma
  • Frequent ear infections
  • Sinus headaches
  • Nasal polyps
  • Conjunctivitis (eye irritation)
  • Skin rashes and eczema
  • Mental problems such as confusion, slow thinking, depression and forgetfulness
  • Respiratory effects including endless colds, chronic cough, recurrent bronchitis
  • ADHD (Attention Deficit / Hyperactive Disorder)

That’s right,  allergies can even trigger ADHD. So, what do you do? The first step is a full allergy evaluation by a qualified medical provider. An allergy test alone — even a skin test, the gold standard — is not enough; it can show that your child is sensitive to an allergen but not determine if that is causing symptoms. Your provider should conduct a full health history. The results, in conjunction with your answers to when and where your child exhibits symptoms, can help determine if his or her maladies are allergies or something else.

One key to remember is that if your child’s ailments come and go regularly, or if they stay around constantly, there’s a good chance allergies are to blame. If they’re “one and done,” it may be just the cold going around. When in doubt, ask your provider for a full allergy evaluation. To find an AllerVision-affiliated doctor who is qualified to do this, click here.

Allervision logo color

When Pollen Strikes!

When the wind blows, the pollen inside these sacks will be released, filling the air for miles.

When the wind blows, the pollen inside these sacks will be released, filling the air for miles.

One of the major causes of allergic disease, such as allergic rhinitis (also known as hay fever), is airborne pollen. All plants produce some pollen as part of their reproductive cycle. There are thousands of plant species that grow in the United States but only a small number of those are significant sources of allergenic pollen. Plants that DO produce important allergens have several characteristics in common: First, they are wind pollinated rather than insect pollinated. Next, they produce pollen that is buoyant and is spread readily by the wind. Because wind pollination is relatively inefficient, these types of plants have to produce huge quantities of pollen to keep their species alive.

To be clinically important, allergenic plants must be abundant in an area. Trees such as oak and maple grow over hundreds of acres with pollen traveling up to 200 miles; ragweed can colonize large fields and affect patients for many miles around; and grass allergens can cover hundreds of acres. Despite what your nose and eyes may suggest, brightly colored flowers are rarely allergenic. Often they are insect pollinated, and they typically don’t produce pollen that can be spread by the wind. However, the pollen from allergenically important plants lands all over their beautiful flowers, and THAT pollen is what your body rejects when you stop to smell the roses. Those pollens are also often at least part of the cause of your allergic symptoms when you snuggle up to your favorite pet. Fur is a great landing spot for all kinds of pollen!

Tree pollen allergy affects millions of people. Many allergenic trees are abundant and large, shedding and spreading huge quantities of pollen. Typically, trees shed their pollen in the spring and are the first species each year to affect patients. In warmer climates, like California and Florida, pollen season often begins in February. With the late winter on the east coast this year, pollen season there is just reaching full swing.

Because pollen can travel so far, it can be difficult to determine the exact cause of your allergies. That’s where an allergy test and evaluation comes in. We encourage you to ask your doctor about an allergy skin test — a painless procedure than can tell you in just 15 minutes specifically what you are allergic to. If your doctor doesn’t offer this test in his or her office, AllerVision can help you find one who does — or can talk to your doctor on your behalf.

If pollen is the cause of your allergies, it’s virtually impossible to avoid. You can take medication to temporarily alleviate symptoms. But with medication you’re only covering the symptoms up, and next time you encounter the pollen you’ll have the same reaction. Immunotherapy, on the other hand, teaches your immune system to ignore the pollen and thereby puts your allergies into remission — usually for years or decades. You can learn more about immunotherapy here.

Pollen from trees, grasses and weeds are likely to keep your immune system busy until the fall or winter, and then return again next year. Now that you know what you’re up against, you may want to ask your provider about immunotherapy — so you can enjoy the great outdoors instead of suffering from it.

Allervision logo color

This blog includes information from ALK-Abelló “Virtual Pollen Guide” DVD, used with permission. The company offers a helpful patient education website at fightthecauseofallergy.org

 

Top 7 Questions (and Answers) About Allergy Skin Testing

After antigens are applied to a patient's back, her skin reacts with bumps and/or wheals — and possibly itchiness. Once the test is complete, in 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

After antigens are applied to a patient’s back, her skin reacts with bumps and/or wheals — and, possibly, itchiness. After about 15 minutes, the provider wipes away the antigens are the reaction(s) fade away.

In our last post, we explained why nearly every doctor should offer allergy skin testing. (If you missed it, click here.) Here are patients’ top seven questions about the test.

1) Should I have an allergy skin test? Allergies cause many more symptoms than the average person realizes, including rashes (dermatitis), sinus infections, migraine headaches, dizziness, conjunctivitis, respiratory problems, fatigue, muscle and joint pain, and the list goes on. If you get any of these symptoms regularly, you should discuss the possibility of allergies with your doctor, who will likely suggest the test and a review of your health history.

2) Can my child have the test? The test is safe for children as well as seniors. In fact, it is appropriate for virtually everyone, with the exception of pregnant women, patients with unexplained episodes of anaphylaxis, patients with active hives or active severe asthma symptoms, and people with significantly suppressed immune systems.

3) What does it test for? AllerVision-affiliated providers test for a wide variety of airborne antigens common to your region of the country — such as pollen from local trees, grasses and molds — as well as molds, dust, animal dander, cockroaches and certain foods. If you suspect allergies to specific foods, your provider may test you separately for those individual items.

4) What happens during the test?  Your provider presses several plastic applicators coated with antigens onto your back. As your skin reacts to certain antigens, you may feel itchiness. After 15 minutes, the provider measures any bumps (or “wheals”) that develop — indicating positive results — and record them. Then he or she cleans your back to relieve any discomfort.

5) Does it hurt? No. You’ll temporarily feel minor pressure from the tines of the testing devices as they’re applied, but they don’t penetrate your skin and they’re specially-designed to prevent pain. Even young children rarely complain. Itching caused by positive results begins to resolve as soon as the antigens are wiped away.

6) Is there anything I need to do to prepare? The most important thing to remember is that you shouldn’t take antihistamines for three days before testing because they can prevent the very reactions your provider needs to see. Also, be sure to inform your provider if you’re pregnant, have asthma, are suffering from severe illness, or have experienced a strong allergic reaction.

7) How long does it take to get results? In just 15 minutes, your doctor will have a clear picture of your allergic reactions so you can plan and begin a treatment program immediately.

 

The Important Difference Between Clinical Allergy and Allergy Sensitization

A doctor's review of patients' medical history is as important as skin test results in diagnosing clinical allergies.

A doctor’s review of patients’ medical history is as important as skin test results in diagnosing clinical allergies.

I’m sure you have patients come into your office and say: “I was once tested by an allergist and told I was allergic to everything green!” I’m  always dismayed when I hear that patients were given results in this manner. Almost no one is allergic to “everything green.” Patients may be sensitized to multiple allergens but most likely they’re not allergic to them all. Making the distinction between clinical allergy and allergy sensitization requires the doctor to study each patient’s health history in conjunction with allergy test results.

Let’s demonstrate with a food allergy example… A patient visited my office and told me that he attended a party and ate a piece of cake. Within 15 minutes, he developed hives (urticarial) all over his body. He wasn’t sure what was in the cake but was worried about what he should avoid in the future. I tested him and the results showed a positive for tree nuts — walnuts, cashews and pistachios. The skin tests also showed positive for milk and eggs, but he told me that he eats eggs and drinks milk all the time without a problem. We found out that the cake contained walnuts, so I diagnosed him with walnut and tree nut allergy. I explained that his positive allergy tests to egg and milk demonstrated that he has allergic sensitization to the raw pure proteins in those foods, but, with no clinical complaints, he can still continue to eat them.

Here is another example of a potentially confusing situation that you may encounter using the AllerVision skin testing panels: you test a patient and find she is allergic to several tree pollens, grass pollens and ragweed pollen. The patient’s history says she only has symptoms in the spring — from March until June. She has no symptoms in the fall. My assessment would be that she has clinical allergy to the spring pollens, trees and grasses, and allergic sensitization to ragweed. This distinction becomes important not just in educating the patient, but in determining the patient’s course of immunotherapy. In this case, you might decide to treat the patient for the trees and grasses but leave the weeds out of the equation.

The allergy world is buzzing with research on diagnostic techniques to delineate clinical allergies more clearly. One company is working on a blood test that involves Resolve Component Testing. That measures a protein called Ara h2 — highly specific for peanut allergy. Preliminary studies indicate 95% accuracy. In the meantime, don’t forget the importance of clinical history in conducting the “detective work” required to distinguish clinical allergy from allergy sensitization. And remember that, as always, the AllerVision clinical team is available to work with you and discuss your cases any time you have questions.

Dr. Dean Mitchell

Allervision logo color

Anaphylaxis, The True Allergic Emergency – What You Need to Know

Anaphylaxis, which comes from the Greek term “reverse protection,” is the most

There are many possible signs of anaphylaxis...

There are many possible signs of anaphylaxis…

dangerous type of allergic reaction. It is described as a type 1 Hypersensitivity reaction that involves release of IgE triggered, most often, by a food, medication or insect sting. Anaphylaxis is a frightening reaction where a patient, who moments before appeared fine and healthy, almost within seconds can be wheezing, hypotensive, and covered with hives.

The foods most commonly associated with anaphylaxis in children are peanuts and tree nuts; in their adult counterparts it’s usually shellfish. The confusing part for patients and clinicians is that a food allergy can develop after eating a particular food on many occasions. However, once that threshold has been crossed, even a minute amount of that food can cause an explosive reaction. If a food is the suspected cause of anaphylaxis, but the specific food unclear, it’s wise to evaluate the patient through several steps.

Initially, I would recommend a panel of food allergy blood tests. ImmunoCap is a common one used by most labs to evaluate IgE reactions to specific foods. The results range from zero to six, with a score of at least two indicating a positive reaction. If there is a positive reaction to peanut, the allergy should be further explored by ordering a UKnow Peanut test which analyzes the proteins Ara h1,2&3, as well as Ara h8. My article in Consultant for Pediatricians, “Pinpointing the Proteins in Peanut Allergy,” explains why these proteins are important to predict the severity of peanut allergy. If, for some reason, the blood test is negative, I would recommend referral to an allergist for skin testing and/or oral challenge in case there is a hidden allergen that requires more extensive testing.

Any medication can cause an anaphylactic reaction however the common culprits are antibiotics and non-steroidal anti-inflammatory drugs. Many antibiotics are mold-based, which may be part of the reason for their allergenicity. In the past, beta-lactam antibiotics such as penicillin and related cephalosporins were the most likely offenders but today we also see anaphylaxis to the widely used category of quinolone antibiotics. To complicate matters, it is not unusual for a patient to have multiple antibiotic sensitivities; there is a genetic component to this reaction. While Pre Pen can be used to diagnose penicillin allergy (talk to your AllerVision representative for more information), there is no such test for most antibiotics, and a drug challenge may be required for conclusive diagnosis.

Non-steroidal medications, such as Advil, Motrin and Alleve, work by blocking the cyclo-oxygenase pathway and trigger release of leukotrienes which are potent mediators of anaphylaxis. In my experience, patients allergic to NSAIDS are usually unaware of the source of reaction until they suffer several episodes of anaphylaxis. Be on high alert for NSAID hypersensitivity when evaluating a patient for anaphylaxis or urticaria. Unfortunately, a drug challenge is the only conclusive test NSAID hypersensitivity.

The clinical diagnosis of anaphylaxis can be complicated. The World Allergy Organization recently came out with new criteria. Essentially, it includes exposure to a possible or known allergen and the finding of two or more clinical signs: urticarial, bronchospasm, gastrointestinal distress and cardiovascular collapse. In case of cardiovascular collapse, no additional signs are needed — call 911 and immediately transport the patient to the hospital.

While anaphylaxis is fairly rare with allergy injections, and exceedingly rare with allergy skin testing, it is important that you and your staff be prepared just in case. When a patient is in your office, the question of whether or not to treat a potential reaction is simplified, and doesn’t include an extensive review of the clinical findings nor consideration about number of signs. If you place an allergenic substance on the patient’s skin, or inject them with a substance you know they are allergic to, and they have a reaction anywhere other than the local site of exposure, TREAT THEM! Common signs to look out for are itching of hands and feet, or clearing of throat that wasn’t happening when the patient came in to the office. If you apply antigen to one area of the body, and the patient has symptoms somewhere else, you have to assume that the reaction has gone systemic and you should treat accordingly.

The initial treatment of anaphylaxis is unambiguous: epinephrine intramuscularly into the lateral thigh. Don’t play around with Benedryl! Don’t give a cortisone shot! Anaphylaxis progresses immediately, and neither antihistamine nor steroid drugs act on the spot to reverse the severe pathophysiological reaction. Deaths resulting from anaphylaxis happen when epinephrine is not administered in under 3o minutes from the onset of symptoms. If you are giving allergy injections in your office, you MUST have the patient wait 20 minutes in the office to make sure they don’t have an immediate allergic reaction. If they develop ANY sign or symptom within that time, administer epinephrine. The EpiPen is convenient for an office because it contains the 0.3 ml of epinephrine with the needle size for an intramuscular injection. It also comes as the EpiPen Jr. for children or infants less than 66 lbs. Once epinephrine has been given, the patient must be monitored for several hours to make sure there isn’t a biphasic reaction; this usually takes place in a hospital.

Anaphylaxis can be the most frightening of clinical reactions. The good news is with quick recognition and prompt treatment with epinephrine, you can be a real hero!

– Dr. Dean Mitchell

Allervision logo color