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Your Child

Tips to Keep Your Child’s Room Allergen-Free

2:15

Symptoms such as sneezing, stuffy or runny nose, watery eyes and itchy nose, throat and eyes or roof of the mouth are common in children that suffer from respiratory allergies. If you’re looking for ways to help reduce your child’s exposure to allergens that hide within homes, one place you can start is in his or her bedroom. 

Typical allergens include: dust mites, pet dander, pollen, mold and pests.

Dust Mites- Dr. David Stukus, associate professor of pediatrics in the division of allergy and immunology at Nationwide Children’s Hospital in Columbus, Ohio, offers these suggestions for reducing dust mites:

·      Use zippered, dust mite-proof bed covers. These covers are made of materials with pores that are too small to let dust mites and their waste products through, according to the Asthma and Allergy Foundation of America (AAFA). They should cover the mattress, box spring, and all pillows on the bed.

·      Wash bed linens at least once a week. This should be done using a hot water setting to kill and remove as many dust mites as possible, as well as the skin cells they feed on. The water should be at least 130 degrees Fahrenheit, according to the AAFA.

·      Remove or treat stuffed animals. “Ideally, stuffed animals should be removed from the bed completely,” Stukus says. An alternative solution is to keep one favorite stuffed toy on the bed and put it in the freezer for 24 hours once a week, then put it through a dryer cycle to kill and remove dust mites.

·       Remove carpets. Dust mites can thrive in carpeting. Avoid wall-to-wall carpeting and opt for hardwood floors or throw rugs instead. Just make sure to regularly wash or dry clean throw rugs, notes the American Academy of Allergy Asthma & Immunology. Dust mites can also hide in curtains, blinds, and upholstered furniture, according to the AAFA, so you may also want to avoid having these in your child’s room.

Pet Dander – Some breed may be touted as a “hypoallergenic dog or cat,” but Stukus says there is no such thing. Any animal can bring dander into the house. To keep dander out of your child’s room, try these steps:

·      The first step is to keep pets out of your child’s bedroom. It’s not as easy as it sounds, especially when your child becomes attached to a family pet. “Any access to animals, even for limited periods of time, will increase the dander levels in the room,” Stukus says. Depending on how serious your child’s symptoms are, you may want to consider not having a pet.

·      If you decide that having a pet is ok, Stukus suggests that you bathe your pet once or twice a week. “Families usually laugh when I suggest this,” Stukus says, but it’s an effective way to reduce dander.” Some pets can handle a bath that often, but others will develop skin conditions from excess cleaning. Discuss your pet’s breed and care with a veterinarian before trying this.

·       Vacuum and dust the room at least weekly. This can help remove any dander that makes its way into the bedroom. The American College of Allergy, Asthma & Immunology recommends using a vacuum with a HEPA filter to reduce pet dander, as well as other allergens.

Pollen - One of the worse allergens is pollen. There’s no hiding from it but there are ways to help make the bedroom a “safe zone” when the pollen count is high.

·      Keep the windows closed. It may be tempting to open the window when the weather is cool and the idea of a little breeze to air things out sounds appealing, but even short periods of an open window can let pollen into the room.

·      Use air conditioning.  This can help filter pollen out of the air and provide a comfortable room temperature when days and evenings are warm. When winter sets in, pollen is usually not a problem.

Mold- In the early 2000s, a toxic mold panic swept the nation. Today, a lot more is understood about the various types of mold. While mold can become a problem, it’s a common substance. “Mold is everywhere in our world, but it rarely poses a problem unless you have obvious overgrowth,” Stukus says. This is often visible in the form of large stains or black spots on drywall or other surfaces.

·      If you notice mold in your child’s bedroom, treat the source of the moisture.

·      Excess mold is almost always caused by an errant source of water, such as a leak from the outside or a pipe inside the house. In some cases, you may also need to remove and replace the mold-covered surface in the room.

Pests – Many people aren’t aware of how cockroaches (and even ladybugs) can cause a respiratory illness. If insects or other pests are a problem in your child’s bedroom:

·      Keep food and drinks out of the bedroom. “Cockroaches generally congregate towards areas with water and food,” Stukus says, which is why they’re typically found in kitchens and bathrooms.

·      Fix water leaks. If cockroaches or other pests are found in your child’s bedroom despite the absence of food and beverages, then you may have water leakage that needs to be fixed. This can be a problem in certain public and rental housing, he says.

If you need to contact your landlord about fixing a problem related to your child’s allergies, it’s a good idea to include as much documentation as possible, including a letter from an allergist, Stukus says.

Can children outgrow allergies? Sometimes. Respiratory allergies such as seasonal allergic rhinitis (hay fever) can fade over time or improve.

The first step in helping your child cope with allergies is to have him or her tested for allergens to find out what triggers a reaction. Your pediatrician or allergist will then be able to prescribe medications and or provide more information on other treatments or solutions.

Story source: Quinn Phillips, https://www.everydayhealth.com/hs/managing-respiratory-allergies-children/keep-bedroom-allergy-free/

Daily Dose

Allergy Season

1:30 to read

Allergy season is here and if your child is known to have seasonal allergic rhinitis (nasal congestion, runny nose, itchy nose and sneezing) during the fall months, it is time to begin the use of their intra-nasal steroids and oral antihistamine on a daily basis.  It is also easy to begin therapy for suspected allergic rhinitis as both nasal steroid sprays and non-sedating antihistamines are available over the counter, and there are many choices as well (liquids, chewables, and pills).

 

Interestingly, I just read an article from a study done in India which looked at Vitamin D levels in children with allergic rhinitis.  It was a small study, only 42 children, between the ages of 5-15 years were followed. The authors looked at nasal symptom scores in children who were maintained on their allergic rhinitis protocol but one group received a Vitamin D supplement as well. 

 

Vitamin D is known to have effects on T and B cells which may link Vitamin D to immune related conditions and allergies. There are many interesting studies involving Vitamin D and the role it plays in our daily lives and there continues to be a lot of controversy on the topic as well. 

 

But, with that being said, in this study children who received Vitamin D supplementation (400-800 IU per day depending on age of the child) not only had higher Vitamin D levels, they also had lower nasal symptom scores. 

 

Of course in the study they looked at Vitamin D levels pre and post treatment. But it would seem to me (being an allergy sufferer myself) that adding a daily dose of Vitamin D to my allergy regimen couldn’t hurt.  

 

There continues to be an increase in allergic disease around the world and at the same time, more and more people are seeking protection from the sun (from which we make cutaneous Vitamin D). Sun protection continues to be a good idea too. Of course, this is only one study, and further research with greater study participants are necessary. But in the meantime, you might discuss adding a dose of Vitamin D to your child’s allergy regimen with your pediatrician. 

 

Your Baby

“Furry Pets” May Help Kids Avoid Some Allergies

2:00

You might think that having pets would be a nightmare if you have small children with a family history of allergies. A new study says that furry pets may actually help protect children against some allergies.

The infants’ mothers had a history of allergy, so the babies were at increased risk too, and it was once thought that pets might be a trigger for allergies in such children, the authors point out in the Journal of Allergy and Clinical Immunology.

“Earlier it was thought that exposure to pets early in childhood was a risk factor for developing allergic disease,” said Dr. Merja Nermes of the University of Turku in Finland, who coauthored the research letter. “Later epidemiologic studies have given contradictory results and even suggested that early exposure to pets may be protective against allergies, though the mechanisms of this protective effect have remained elusive.”

Adding pet microbes to the infant intestinal biome may strengthen the immune system, she told Reuters Health by email.

The study team collected fecal samples from diapers when the babies were one month of age and these were tested for the DNA of two types of Bifidobacteria that are found specifically in animal guts: B. thermophilum and B. pseudolongum.

One third of infants from the pet-exposed group had animal-specific bifidobacteria in their fecal samples, compared to 14 percent of the comparison group. It’s not clear where the infants without furry pets at home acquired their gut bacteria, the authors write.

When the babies were six months old they had skin prick tests to assess allergies to cow’s milk, egg white, flours, cod, soybeans, birch, grasses, cat, dog, potato, banana and other allergens.

At six months of age, 19 infants had reactions to at least one of the allergens tested. None of these infants had B. thermophilum bacteria in their fecal samples.

Other studies have pointed out the connection between kids exposed to farm animals and household pets and building a better immune system.

“When infants and furry pets live in a close contact in the same household, transfer of microbiota between pets and infants occurs,” Nermes said. “For example, when a dog licks the infant´s face or hand, the pet-derived microbiota can end up via the mouth into the infant´s intestine.”

Human-specific Bifidobacteria have beneficial health effects, and animal-specific strains may also be beneficial, she said. It is still unclear, however, if exposure to these bacteria protects against allergies later in life, she said.

“Future research is needed to assess if these infants develop less atopic dermatitis, asthma or allergic rhinitis later,” she said.

Nermes also noted that she believes pediatricians should not discourage pregnant women or parents of infants from having pets in order to prevent allergies.

“If a family with a pregnant mother or an infant wants to have a pet, the family can be encouraged to have one, because the development of allergic disease cannot be prevented by avoiding pets,” she said.

Source: Kathryn Doyle, http://www.reuters.com/article/2015/09/10/us-health-allergy-pet-microbes-idUSKCN0RA2CK20150910

 

 

Daily Dose

Special Series: Allergies

1.30 to read

We've had plenty of questions about allergies this time of year, and with so many already suffering, we decide to put together a series on what you need to know to help your family survive allergy season. 

It is the season for allergic rhinitis (inflammation of the nasal passages) which are triggered by tree pollens and grasses as spring blows in.  Allergy symptoms affect about 1:5 people and the first symptoms often begin in childhood. Children typically develop symptoms of allergic rhinitis between the ages of 3–4 years. Many of these children might have shown symptoms of eczema (atopic dermatitis) and asthma at even younger ages. If one parent has allergies, there is about a 40-50% chance that their child may also be allergic and if two allergic persons marry (guess you should ask about that while dating), then there is a 70-80% chance that their children will also be allergic. 

It also seems that early exposure to cigarette smoke, cat dander and house dust mites may promote other allergic symptoms later in life. (Another great reason not to smoke if you have children) The most common symptoms of an allergy are complaints of an itchy nose, watery and red eyes, sneezing, runny nose (typically clear), post nasal drip and cough.  These allergic symptoms are brought on by the release of histamines in the body after exposure to the allergen, such as inhaled pollens.  

While allergic symptoms have been labeled, “hay fever” this is an inappropriate term as allergies do not cause a fever and the child is not necessarily allergic to hay. There are also different pollens responsible for allergic symptoms at different times of the year. Children that develop seasonal allergies have several characteristic physical findings. They may have allergic “shiners” which are darkened areas beneath the lower eyelid from swelling, they also often have a crease across their nasal bridge (termed the allergic salute) which occurs due to constant rubbing of the nose. You can often see the child rub their little watery eyes while you are examining them and they often have a clear, watery nasal discharge.  Some of these allergic children will also have a cough and may even be wheezing.  They often look rather uncomfortable rather than sick as with a cold. 

There are many different treatment options for controlling allergic rhinitis.  The first is to control the environment as much as possible by closing windows and turning on the AC in order that the airborne allergens do not blow into the house. After your child has been playing outdoors have them come in and shower to remove the pollens from their hair and body (not a favorite pastime for little boys). You can also watch the pollen count for your area and limit a child’s time outdoors on especially high pollen count days. Medical treatment of allergic rhinitis coming up in part 2 of our special series. Send your question to Dr. Sue!

Daily Dose

Allergy Nasal Sprays

1:30 to read

Since we are in the throes of allergy season (even though there was a recent late snow event in the midwest and northeast) I thought I would provide some additional information on steroid nasal sprays.  In fact, the climate changes that we are seeing are predicted to increase the length of pollinating seasons and therefore increase the amount of pollen produced, which will only make those with allergies (and children with developing allergies) even more miserable with symptoms of runny nose, sneezing, throat clearing and itchy eyes.  

Although I recently discussed the use of non sedating and sedating anti-histamines for intermittent allergy symptoms, the use of intranasal steroids have been found to be far more effective in controlling allergy symptoms.  The first thing to remember is that unlike an antihistamine, intranasal steroids require several days of consistent use before you will see any real change in allergy symptoms (I must repeat that line 10 times a day, especially to my teenage patients who want instant gratification!).  For anyone who knows the season for their allergies (depending on the pollen one is sensitive to), I recommend starting the intranasal steroid spray 1-2 weeks before their symptoms typically begin. (Which means if you are allergic to tree pollens - you should have already started by now). Using the nasal spray daily and continuing throughout the allergy season will provide the best results.  Watching the pollen counts in your area will be important to time the use of intranasal steroids.

Although some children seem to be more sensitive about using a intranasal steroid spray, it is well tolerated by most with few side effects.  Prescription intranasal steroid sprays have been approved for use in children as young as 2 years and the over the counter sprays for children 4 years and older.  The most commonly reported side effects are nasal irritation, burning and bloody noses.  I always try to show my patients how to use the spray properly and to “aim” the spray towards the outer aspect of the inside of the nostril rather than towards the septum (middle) which may help reduce irritation and bloody noses. By spraying towards the outer aspect you also maximize the amount of area that is covered by the spray.  Everyone seems to have their “favorite” intranasal steroid as some are an aqueous spray and others are an aerosolized puff….but in many cases the product choice may be based on the age of the patient, prescription vs OTC, insurance coverage and cost.  Although there are many to choose from there have been no head to head studies with these medications and their efficacy is generally thought to be comparable….but discuss your choices with your own pediatrician.

Lastly, there was a study done in 2014 published in The Journal of Allergy and Clinical Immunology, which measured growth rates in children between 5 and 8 years of age who were treated with an intranasal steroid (specifically fluticasone furcate - Veramyst ) as compared to a placebo. The study did show a significant improvement in nasal allergy symptom scores, but there was a 0.27 cm (0.65 inch ) reduction in growth rate over the course of the year as compared to placebo.  Due to this study, I use the lowest effective dose for the shortest amount of time in younger patients, and explain the reasoning to their parents.  Again, you can read the study and discuss this with your pediatrician before beginning intranasal steroids.   

Just make sure you use the intranasal spray consistently during the height of allergy season…I tell my own family, it doesn’t work as well if it sits on the counter for a few days between use!

 

Daily Dose

Special Series: Food Allergies

2.00 to read

We continue our special series on allergies. This time we look at food allergies and how they are diagnosed.We continue our series on allergies and this time we shift the focus on food allergies. This topic was top of mind for a mom who sent us an email question via our free iPhone app. She wrote “could my 9 year old daughter be allergic to strawberries as she gets a stomach ache and sometimes vomits after she eats them?  She has not had problems eating strawberries before." This is very interesting because I have been reading & reviewing several articles on food allergies and their diagnosis.

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One was in JAMA (I saved the May  2010 issue for research) and another was in the March issue of Consultant for Pediatricians. Both of these articles emphasized that there continues to be a great deal of confusion and lack of uniformity for diagnosing food allergies. Food allergy is also not uniformly defined, but according to the National Institute of Allergy and Infectious Diseases (NIAID), it is an “adverse immune response that occurs on exposure to a given food and is distinct from other adverse responses to food such as food intolerance.”  Statistics show that somewhere between 1%-2% of the population may have food allergies.  It is also unclear if food allergies are on the rise, as data on this is conflicting. With all of that being said, it sounds more like this child has developed an intolerance to strawberries rather than an allergic response.  It would be important to get more history such as what else she has eaten with the strawberries when this occurs, if the symptoms are always the same and are there any other problems associated with the ingestion. Specifically, does she complain of hives, itching, swelling of her tongue, lips or difficulty breathing? Does she have problems with any other foods? I also wonder if she has the same symptoms if she picks fresh strawberries or if they are from the store or if they are frozen. In other words, like so many things in medicine a good history is probably the most important part of this “strawberry story”. If she continues to have problems and her symptoms, this sounds more like intolerance than a true allergic reaction she can just avoid the strawberries (not much fun, especially in the summer). She might also check with her pediatrician about doing a blood test for IgE antibodies to strawberries.  A food intolerance would not have an increase in IgE antibodies as it is not an allergic reaction.  If confusion persists she could be referred to a pediatric allergist for further evaluation and even an oral food challenge. There continues to be a great many studies surrounding the etiology of food allergies, and I will keep you posted as new information is presented. That's your daily dose for today.  We'll chat again tomorrow. What do you think?  Send your question or comment to me!

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Daily Dose

Peanut Allergies

1:30 to read

Did you see the New England Journal of Medicine article which was recently published regarding peanut allergy? Interestingly, the study out of the UK seemed to confirm what some of us “old school pediatricians” had thought... the previous recommendation that babies and toddlers avoid peanut products in the first year of life may actually lead to more peanut allergies in children who are already at risk for developing food allergies.

In the late 1990’s allergists were concerned about the rise in peanut allergies and recommendations were made to delay introduction of peanuts (as well as some other foods).  At the time it did seem strange seeing that children born prior to this were raised on peanut butter...but like many things, nothing stays the same, right?

But over the years, the increase in peanut allergies continued, despite the fact that mothers were not eating peanut products during their pregnancy or while breast feeding and parents were delaying the introduction of peanut products until their child was 2 years of age. When the data from this period was analyzed, instead of seeing a decrease in children with peanut allergies... the incidence of peanut allergies continued to increase.

So, in 2008 the AAP changed their recommendations and again encouraged parents to let their children eat peanut products in the first year of life just NO peanuts due to the choking hazard.  But many parents continued to be wary...in fact some, who had no history suggesting allergies ( eczema, wheezing, family history of food allergies), would actually bring peanut butter to my office for a trial. One mother came for a quick “house call” one day and I handed her child (who was 20 months at the time) a peanut butter cracker I was eating and her mother “freaked out”.  Fortunately, the child loved the cracker and no issues with peanut butter either. She was thrilled when she left with another cracker in hand 

This article was just the first of many studies being undertaken to “help solve the puzzle of food allergies”. There is so much about this topic on the horizon but in the meantime, if your child does not have a  history to suggest allergies I would try introducing peanut butter, almond butter, as well as eggs and dairy to your child. If you have a family history of food allergies, or concerns talk to your doctor about beginning these foods earlier than later even if that is in a controlled situation in the pediatrician’s or allergist’s office.

I can’t wait to give baby granddaughter some of these foods as well (she just started to get some veggies) and peanut butter is not far behind.  I did “sneak” her a morsel of pancake the other morning...you should have seen that smile.

Your Baby

High-Sugar Intake During Mom’s Pregnancy May Double Child’s Risk of Asthma

2:00

It’s no secret that moms-to-be often develop a sweet tooth during pregnancy, but new information suggests high-sugar foods and drinks may double their child’s risk for developing asthma and allergies later in life.

Researchers from Queen Mary University of London used data gathered from nearly 9,000 mother-child pairs in the Avon Longitudinal Study of Parents and Children, an ongoing research project that tracks the health of families with children born between April 1, 1991, and December 31, 1992.

During the study, the participating pregnant women were asked about their weekly intake of certain foods and specific food items including sugar, coffee and tea. Their responses were used to calculate their intake of added sugar.

The researchers only saw weak evidence to suggest a link between women’s added sugar intake and their children’s chances of developing asthma overall. But when they looked specifically at allergic asthma—in which an asthma diagnosis is accompanied by a positive skin test for allergens—the link was much stronger. Children whose moms were in the top fifth for added sugar during pregnancy were twice as likely to have allergic asthma when compared to children whose moms were in the bottom fifth.

Children of mothers with the high-sugar diets were 38% more likely to test positive for an allergen and 73% more likely to test positive for more than one allergen, compared to those kids whose moms stayed away from added sugar.

"The dramatic 'epidemic' of asthma and allergies in the West in the last 50 years is still largely unexplained -- one potential culprit is a change in diet," said Annabelle Bedard, lead author and a postdoctoral fellow at Queen Mary's Centre for Primary Care and Public Health Blizard Institute. "Intake of free sugar and high fructose corn syrup has increased substantially over this period."

As with most studies, a cause and effect was not established, only an association. The study’s authors believe that the association is strong enough to warrant further investigation.

Lead researcher Professor Seif Shaheen  said: "We cannot say on the basis of these observations that a high intake of sugar by mothers in pregnancy is definitely causing allergy and allergic asthma in their offspring.

"However, given the extremely high consumption of sugar in the West, we will certainly be investigating this hypothesis further with some urgency.”

There are many health reasons why pregnant women should limit their intake of high-calorie and sugary foods and drinks. This research suggests that it may be prudent for the health of their unborn child as well.

Story sources: Susan Scutti, http://edition.cnn.com/2017/07/05/health/sugar-pregnancy-child-allergy-asthma-study/index.html

 Henry Bodkin, http://www.telegraph.co.uk/science/2017/07/06/high-sugar-intake-pregnancy-linked-double-risk-child-asthma/

Your Baby

Special Baby Formulas Don’t Prevent Asthma, Allergies

2:00

Parents that have a baby at risk or allergies, asthma or type-1 Diabetes sometimes turn to hydrolyzed milk formulas in hopes of lowering their infant’s risk of developing these problems.

A new review of the data on hydrolyzed formulas finds that there is no evidence that they actually protect children from these types of autoimmune disorders.

"We found no consistent evidence to support a protective role for partially or extensively hydrolyzed formula," concluded a team led by Robert Boyle of Imperial College London in England.

"Our findings conflict with current international guidelines, in which hydrolyzed formula is widely recommended for young formula-fed infants with a family history of allergic disease," the study authors added.

In the study, Boyle's team looked at data from 37 studies that together included more than 19,000 participants and were conducted between 1946 and 2015.

The investigators found that infants who received hydrolyzed cow's milk formula did not have a lower risk of asthma, allergies (such as eczema, hay fever, food allergies) or type 1 diabetes compared to those who received human breast milk or a standard cow's milk formula.

The researchers also found no evidence to support an FDA-approved claim that a partially hydrolyzed formula could reduce the risk of the skin disorder eczema, or another conclusion that hydrolyzed formula could prevent an allergy to cow's milk.

Other experts in the United States said that the finding casts doubt on the usefulness of these kinds of specialized products.

"Allergies and autoimmune diseases [such as asthma, and type 1 diabetes] are on the rise and it would be nice if we did have a clear route to preventing them," said Dr. Ron Marino, associate chair of pediatrics at Winthrop-University Hospital in Mineola, N.Y.

"Unfortunately, despite U.S. Food and Drug Administration support [for hydrolyzed formula], the data are not compelling," he said.

Dr. Punita Ponda is assistant chief of allergy and immunology at Northwell Health in Great Neck, N.Y. She stressed that when it comes to infant feeding, breast milk is by far the healthiest option.

However, "current mainstream guidelines for infant formula do recommend that parents consider using hypoallergenic formula if a close family member -- like an older brother or sister -- has a food allergy," she said. That was based on prior studies supporting some kind of protective effect, Ponda said.

Protein hydrolysate formulas were first introduced in the 1940s for babies who could not tolerate the milk protein in cow’s milk.

Protein hydrolyzed formulas are formulas composed of proteins that are partially broken down or “hydrolyzed.” They are also called hydrolysates.

There are two broad categories of protein hydrolysates:

•       Partially hydrolyzed formulas (pHF)

•       Extensively hydrolyzed formulas (eHF)

Both partially and extensively hydrolyzed protein formulas are based on casein or whey, which are proteins found in milk.  

Hydrolyzed formulas have had the protein chains broken down into shorter and more easy-to -digest chains. The more extensively hydrolyzed the formula, the fewer potentially allergenic compounds remain.

Hydrolyzed formulas are also more expensive than regular cow’s milk formulas and often harder to find.

The researchers review was published March 08, 2016 in the BMJ.

Story sources: Robert Preidt, http://www.webmd.com/parenting/baby/news/20160308/special-infant-formulas-dont-shield-against-asthma-allergies-study

Victoria Groce, http://foodallergies.about.com/od/adultfoodallergies/p/hypoallergenic.htm

 

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