Time to Re-Test for Food Allergies?

by Kelley Lindberg


My son’s best friend was re-tested for food allergies two weeks ago. We were all anxiously awaiting the results. He’s been allergic to several foods since he was a baby, and every time he’s re-tested, we all keep our fingers crossed that he’ll have outgrown even one or two. Although he’s 13, we were once again hoping he’d outgrow some of them this time.

So the big day came, and he went to a trusted board-certified allergist for a skin-prick test.

What the doctor learned is that he is still extremely reactive to milk, eggs, peanuts, tree nuts, fish, and shellfish. We all have to admit, we were keeping our fingers crossed, and the fact that he is still allergic to so many foods is disappointing, even though we were emotionally prepared for that. And to add insult to injury, it looks like he might be allergic to flax now. (There is a greater risk for being allergic to flax if you’re already allergic to peanuts, I’ve heard.)

On the other hand, the doctor said it looks like our friend might be able to try raw tomatoes and sesame seeds in a food challenge to see if he can tolerate them now. So we were happy about that!

When it comes to food allergies, we are more than ready to celebrate even small victories. Being able to eat salsa made with fresh tomatoes will be a real treat for this boy (who loves commercial salsa with its high-heat processed tomatoes, which he can tolerate). And being able to tolerate sesame seeds will make finding safe hamburger buns a little easier for him, too.

So even though his big allergies (milk, eggs, nuts, fish) didn’t go away and he might have gained a new one, at least this time we’ve got a couple of his food allergies that we can be optimistic about. And if he has developed an allergy to flax, it’s better to find out in the doctor’s office and prepare for it, than have a sudden reaction somewhere and not have a clue what’s causing it.

His experience is a good reminder of how important it is to periodically re-test for food allergies, no matter how old the child (or adult) is.

Most allergists recommend children get re-tested once a year, but check with your allergist for your own particular needs. If it’s been over a year, it’s probably time to schedule a test with your allergist. Even if your child hasn’t outgrown any of his or her allergies, at least you’ll know for certain, and that brings its own type of confidence. And you never know… if he or she has outgrown one or more of her food allergies, that might make life just a little easier (and tastier) for both of you!

And that’s something worth celebrating.

Latest Study on Allergies and Allergy Testing

by Kelley Lindberg


Last month, a new study on allergy testing from Quest Diagnostics, manufacturer of the ImmunoCAP® IgE blood test for allergy diagnostic testing, was released. Quest Diagnostics used its access to the largest national database of allergy blood test results – with results from two million patient encounters – to analyze the effect of allergies on the health of Americans. The 4-year study didn’t measure the prevalence of allergies in the general population (plenty of other studies have done that). Instead, it looked at people who were already suspected of having allergies (both food and environmental allergies), in an effort to see how allergies are changing or affecting the allergic population.

Some of the study’s key findings include:

• The overall sensitization rate (patients having an allergen-specific IgE) increased by 5.8% over 4 years.
• The number of patients tested for allergies increased over those 4 years by 19%, which Quest says is significantly faster than the growth in general laboratory testing.
• Sensitization to ragweed and mold is increasing rapidly, which is consistent with other studies that show climate change may be linked to an increase in environmental allergies (because of the change in growing habits of plants, for example).
• Men showed higher sensitization rates than women.
• Children showed higher sensitization rates than adults.
• Peanuts were the most common food allergen in kids who were tested for food allergies, with 30% of the kids under 5 years of age and nearly 25% of the kids from 6 to 18 testing positive for peanut.
• Patients with asthma have more allergies (averaging 4.1 allergens per person) than patients without asthma (averaging 3.4 allergens).

Another interesting part of the study is that it confirms the “Allergy March,” which shows a disease progression where children with sensitivities often develop different allergic diseases as they mature, for example: moving from a single food allergy in childhood, to environmental allergies, to asthma.

In most cases, this study seems to be confirming what we already know or at last suspected about allergies and allergy testing from smaller studies. This study is significant, however, because of the sheer size of the patient base, and the fact that it used blood tests rather than patient-response surveys for its data.

To read the complete study and learn more about its findings, click Quest Diagnostics Health Trends Allergy Report 2011, “Allergies Across America.”

Reading Past the NY Times Headline

by Kelley Lindberg


This week, several friends have forwarded me the New York Times story, “Doubt Is Cast on Many Reports of Food Allergies.”

Stories like this make me sigh. On the one hand, the information in the story is accurate. On the other hand, the headline appears intended to fuel controversy, not spread helpful information. A better, more constructive headline would have been something like:

     “Think You Have Food Allergies? See a Specialist before Panicking”

or perhaps:

     “Diagnosing Food Allergies is Tricky – It May Take More Than a Skin Test.”

Many people think they have food allergies, while they probably have an intolerance or sensitivity instead – completely different diseases. For example, often people confuse lactose intolerance with a true milk allergy, yet they are completely different illnesses. With lactose intolerance, the body can’t digest milk proteins adequately. People with lactose intolerance can often tolerate small amounts of dairy, especially if it’s baked in something like bread. And they can often take a medication to help digest the milk proteins, which allows them to indulge in the occasional dairy treat. With a true milk allergy, the body’s immune system is involved, and medication can’t help. Lactose intolerance may give you an upset stomach, but it won’t send you into anaphylactic shock. A true milk allergy will.

And how many times have you heard someone complain that they’re allergic to cigarette smoke? It’s probably not a true allergy, but a different disease, such as reactive airway disease or asthma. It’s no less serious, but using the wrong name makes data difficult to track (leading to misleading reporting, like this article).

It’s also true that many general practice doctors are jumping on the bandwagon of skin-prick testing for everything, and calling any sign of a bump a positive test – end of discussion. General practitioners are great resources for many things – but you have to understand that they simply cannot have specialized, up-to-date knowledge about all possible human ailments. It’s not humanly possible to specialize in everything. They usually know a little bit about a lot of things. This can be vitally helpful when narrowing down possible causes of sickness and determining which type of specialist can help you further, but for anything as complicated and individual as food allergies, a board-certified allergist who keeps up with the latest allergy research, conferences, and journals is who you want to work with, not a busy general practitioner.

That’s because allergy testing is very much an art, not just a science. Interpreting results isn’t always cut-and-dried. Test results should be combined with careful analysis of the individual’s history, the family history, direct experiences, food challenges, and other aspects of your life that can help pinpoint exactly what is causing your problems.

I’ve met many people who are in the panicky “I’ve-just-been-diagnosed-and-I’m-allergic-to-everything!” stage. My first question is always “Who diagnosed you?” If it wasn’t a board-certified allergist, I strongly recommend they take the results to a board-certified specialist and continue digging. It’s not unheard of to have a positive skin-prick test to a food you’ve been eating without any problems. So eliminating the food without further research or testing may cause unnecessary stress at the grocery store or restaurant. Several of those people I’ve talked to have ended up working with an allergist and narrowing the list of what they’re really allergic to down to one, two, or three foods, making it easier to manage and less overwhelming. This might not hold true for everyone, but it’s common enough that it’s worth digging deeper.

So I think it’s important to find an allergist you trust and really work with him or her to get to the bottom of your true allergies.

The other interesting point in this article is its statistics, which may very well get lost in the “See? Those food allergy nutcases are making it all up” controversy:

• “While there is no doubt that people can be allergic to certain foods, with reproducible responses ranging from a rash to a severe life-threatening reaction, the true incidence of food allergies is only about 8 percent for children and less than 5 percent for adults, said Dr. Marc Riedl, an author of the new paper and an allergist and immunologist at the University of California, Los Angeles.”

ONLY 8% in children? The more usual statistics that get quoted are 3 – 5%. So while I often tell people that about 1 out of every 20 kids is estimated to have a food allergy, this article says it’s closer to 3 out of every 25. That’s three in every classroom, instead of one in every classroom.

The article’s wording sounds like it’s pooh-poohing the incidence of food allergies, but then it tosses out a pretty high percentage rate as if it’s nothing.

So… Here’s what we should take away from this article. Diagnosing food allergies is difficult and varies from individual to individual, so find yourself an allergist certified by the American Academy of Allergy, Asthma, & Immunology (AAAAI) to help you find out if you’re really suffering from food allergies and how to deal with them if you are. (Click here to search for a board-certified allergist on the AAAAI website). And don’t let people tell you food allergies are a hoax. Even this article’s statistics are alarming, despite its misdirecting headline.

Highlights from Dr. Jones’ Talk, Part 2

Last week, I wrote about some of the food allergy topics Dr. Douglas Jones covered at our July UFAN chapter meeting. This week, as promised, I’m sharing more.

FAHF-2 research: FAHF-2 is the Chinese herbal compound that is being studied to see if it really helps prevent anaphylactic reactions to peanuts. While the compound has shown remarkable success with mice, it’s only in Phase 1 of clinical trials with humans. So while we are all keeping our fingers crossed, it will be several years before we’ll have scientific evidence that it works as well in humans as it does in mice. (Several drugs for other diseases have been successful in mice, only to prove ineffective in humans, so it really is too early to tell.) Phase 1 gathers safety data only (does this compound harm the human body?) and doesn’t test whether the compound is actually doing what it’s supposed to do. Phase 2 will measure doses and their effect on the body (more safety studies). Phase 3 will finally address the drug’s actual effectiveness against allergies in a limited group of test subjects. Phase 4 will expand to include a much larger group of test subjects, and Dr. Jones hopes to be a part of that phase, should the compound make it that far.

Probiotics: At this point, studies seem to show that probiotics don’t perform any better than a placebo in preventing food allergies. They may help eczema acutely, but there is no lasting effect beyond a month. There is data that shows giving probiotics to a woman a month before delivery and to the newborn for the first six months of life helps reduce food allergy, but ONLY if the child was delivered via C-section. If it is a vaginal delivery, then probiotics do not seem to be any better than placebo. So at this point, Dr. Jones feels like probiotics are safe, they probably won’t hurt anything, but they probably won’t accomplish anything either. More testing is needed.

Blood Serum (IgE) Testing: Formerly known as RAST, these blood serum tests measure the level of IgE antibodies in the bloodstream. In general, higher numbers indicate the likelihood that the person will react to an allergen. But interpreting the numbers on a blood serum test becomes tricky because there are three different companies that build the testing machines, and a recent study showed that the numbers produced by the three different machines can be very inconsistent. So comparing numbers from the other two machines is a bit like comparing apples to oranges. Most studies for food allergy have been done on an ImmunoCAP® machine and those are the numbers that should be used in determining when a food is to be reintroduced by food challenge or not. In Utah, Quest Diagnostics is the only lab that uses the ImmunoCAP® machine, and they accept all insurances except IHC. Most doctors aren’t aware of which labs use which machines. So don’t try to compare your blood serum numbers to your neighbor’s numbers. It’s probably better to use the results as broad guidelines, not as a firm indication of whether it is appropriate to do a food challenge on the child. Food challenges should only be done by an allergist in their office.

Once again, I can’t thank Dr. Jones enough for coming to share his knowledge with all of us. If you want to contact his office for an appointment, here’s his information:

Dr. Douglas H. Jones, MD
Rocky Mountain Allergy, Asthma, Immunology
1660 W. Antelope Dr ., Suite 310
Layton , UT 84041
801-775-9800
www.RockyMountainAllergy.com

Highlights from Dr. Jones' Talk, Part 1

At our July UFAN chapter meeting, we were fortunate enough to have Dr. Douglas Jones come speak to our group about the latest food allergy news in testing, treatments, and research. As the only full-time board-certified allergist in Davis County, he discovered when he opened his practice almost a year ago that people in this area have a dire need for accurate, up-to-date information about food allergies. Our group was no exception – we may be more well-informed than many of the people he sees, but we were still anxious to learn more, and he obliged beautifully!

Dr. Jones covered a wide variety of topics for us, and delved into both the science and the regulations that affect research and testing. He covered so much that I’m going to mention a few highlights from his presentation this week, and more next week.

How early can children be tested for food allergies? Dr. Jones said there’s no specific limit on when a child can be tested. It’s more important to look at the child’s and family’s history of reactions, what they want to learn, the family’s needs, and so on. Theoretically, you can test anytime if the child’s history really warrants it, but it’s a case-by-case decision. Dr. Jones recommends retesting every 6 to 12 months for younger kids, less frequently for older kids.

Should you avoid common food allergens when pregnant or nursing to avoid causing your baby to have allergies? Dr. Jones doesn’t feel there’s enough good data to base a decision on. He says it’s probably more important to continue to eat a healthy diet and not worry so much about the allergens in it, because the fetus needs the nutrition. He stresses to mothers: “It’s not your fault!” As for nursing, there is some evidence to suggest nursing for 4-6 months may be beneficial. As far as mothers avoiding foods while nursing in an effort to try and prevent food allergies, there is no data to support this. If you can identify a pattern with nursing and reactions, then that’s one thing, but avoiding things to try to prevent allergies is not recommended. He says it could be more likely that children develop food allergies through accidental skin contact (Uncle Fred forgot to wash his hands after eating those peanuts) rather than through breast milk. Until there’s more data, it’s another case-by-case decision.

Eczema: Apart from Dr. Jones’ discussion, the group had a general discussion about eczema, and why so many pediatricians don’t seem to realize that most cases have an underlying root cause, and most often that root cause is food allergies. Dr. Jones didn’t have an answer for why this is unrecognized or ignored by primary care doctors. But, we all know people whose children have suffered for years with eczema, and their doctors have simply prescribed steroid creams and sent them away, before the parents finally went to an allergist and had their children tested. Often those children’s skin is clear in a matter of a couple of weeks after eliminating the offending food – often milk or eggs – from their diet. It's such a simple thing to test for and cure, yet these children suffer for years sometimes because their doctors don’t know or won’t accept that food allergies could be the cause.

For More Information: Dr. Jones recommended a book called Food Allergy Survival Guide, by Vesanto Melina, Dina Aronson, and Jo Stepaniak.

Those are some of the topics we discussed, and we all learned a tremendous amount. Next week I’ll write about more highlights from his talk, including blood serum testing, the latest news on the Chinese herbal study, and more. Many, many thanks to Dr. Jones for coming to share his knowledge with all of us. If you want to contact his office for an appointment, here’s his information:

Dr. Douglas H. Jones, MD
Rocky Mountain Allergy, Asthma, Immunology
1660 W. Antelope Dr ., Suite 310
Layton , UT 84041
801-775-9800
www.RockyMountainAllergy.com