Weekly Tip

Does Booze Make a Food Allergy Reaction Worse? In Allergic Living, Dr. Scott Sicherer explains to a college student that alcohol is one of several co-factors that can enhance a reaction.  “The three most common co-factors are: exercise, non-steroidal anti-inflammatory drugs (or NSAIDs, including aspirin and ibuprofen), and alcohol.” More

The Question of Whether Coconuts Are a “Tree Nut” or Not is a Perennial Dr. Scott Sicherer answered the question at Allergic Living: “Despite its name, coconut is not actually a nut, but a fruit. Regardless, the Food and Drug Administration considers it a tree nut, which is why it’s included in U.S. labeling laws. It is difficult to assess the risk of coconut allergy among those with tree-nut allergies because allergic individuals may become wary of coconut and avoid it. Still, coconut allergy appears rare, and uncommon even among those with tree-nut allergies.” More here.
And read our review of Sicherer’s encyclopedic book Food Allergies here.

If Antihistamines Like Claritin or Zyrtec Make Your Child “Spacy” try Allegra instead. It’s not as strong.

Composting Tips for People with Food Allergies
(SATURDAY, July 14–HealthDay News) The American Academy of Allergy, Asthma & Immunology (AAAAI) recommends precautions for people with food allergies for composting food safely.
• Wear a pollen mask to prevent inhaling any particles.
• Cover scratches or open wounds with goggles, gloves or long sleeve shirts and pants.
• Keep in mind the possible effects of heat on food because like cooking, the heat from composting could have an unforeseen effect on the allergic properties of foods.
They should also be careful when coming into contact with people who have been composting.
More

Why is mold a bigger problem today than 20 years ago?
New construction methods and materials were developed to comply with Title 24 of the United States Code of Federal Regulations (1978), focusing on energy conservation. The new building methods and construction materials do not allow buildings to ventilate, or breathe as freely as before. The result is that moisture can become trapped, providing the basis for mold growth. When a house is built on a concrete slab, the concrete emits moisture depending upon surrounding conditions. Concrete slabs are porous, allowing moisture present in the soil beneath the slab to migrate into the living area above. Even homes in dry areas like Arizona can develop mold problems in wall cavities and crawl spaces caused by temperature and humidity differences. Air conditioning, improperly vented bathroom exhausts or clogged dryer vents can be the culprit. Legal issues attributed to mold are now in the news more than ever before. Owners selling or renting properties are being held responsible for not informing tenants as to possible mold problems. Mold can grow from minor water problems as simple as wet indoor plant baskets or wet laundry hung indoors to larger problems such as plumbing failures and roof leaks. As a result, the responsibility for keeping track of potential mold growth problems becomes more important than ever before.

This fascinating tidbit comes from the website of 1800gotmold.com, founded by Jason Earle
Founder and CEO of Mycelium Holdings LLC who has a piece on environmental causes of asthma on Huffington Post, here.

When Your Child Has Both Food Allergies and Asthma, Be Sure to Give Epi for Anaphylaxis, Not Albuterol Anaphylaxis affects two or more systems, one of which can be the airways, and you can only treat all of them with injectable epinephrine. Most food-allergy fatalities occur when the patient has both food allergies and asthma.

Linda Coss, cookbook author and all-around food allergy expert, says: Be aware that “low-fat” or “reduced-fat” versions of products often have different ingredients than the “regular” versions of the same products. As always, ALWAYS READ THE INGREDIENTS. EVERY TIME. NO EXCEPTIONS!

7 Tips for Allergy-free Winter by the American College of Allergy, Asthma and Immunology (ACAAI):

1. Reduce humidity (moisture) in your home to keep dust mites in check. Maintain humidity below 50-55%. Don’t use a humidifier or a vaporizer.

2. Filter out dust and other allergens by installing a high efficiency furnace filter with a MERV rating of 11 or 12. Change it every 3 months.

3. Banish allergens from the bedroom (where you spend a third of your life). Keep pets and their dander out, and encase mattresses and pillows with dust-mite proof covers. Limit curtains – use blinds that can be washed instead.

4. Keep your home clean. Wear a NIOSH-rated N95 mask while dusting. Wash bedding and stuffed animals in hot water every 14 days and use a vacuum with a HEPA filter.

5. Turn on the fan or open the window to reduce mold growth in bathrooms (while bathing) and kitchens (while cooking). Wear latex-free gloves and clean visible mold with a 5% beach solution and detergent.

6. Don’t overlook the garage if it’s attached to the house – noxious odors or fumes can trigger asthma. Move insecticides, stored gasoline and other irritants to a shed. Don’t start the car and let it run in the garage.

7. Box up books and knick-knacks and limit the number of indoor plants. When you are buying new furniture, like chairs or sofas, opt for leather or other nonporous surfaces to make cleaning easier.

(Courtesy, Allergy Notes)

A Mom, the blogger Always Sick Chick, has a novel idea for “saving” Halloween for her food-allergic children.

“Last year, we took our kids out to Trick-or-Treat. We explained that most of the candy they got wouldn’t be safe for them to eat with their peanut, tree nut, dairy and egg allergies. So we were sure to buy extra candy that was safe so we could exchange it for the unsafe candy. My husband took the unsafe candy to work with him the next day to share with his co-workers and the kids still got candy they could safely enjoy.

“This was a great compromise for the kids. They could still participate in the Halloween tradition of going door to door in their costumes, greeting the neighbors with ‘Trick or Treat! and enjoying the other costumes the other kids were wearing. We all had a great time.”

For this and more ideas, including saving your child’s teeth from the ravages of Halloween, go here.

If you are going to music festivals this summer, take your asthma meds
The Asthma Society of Ireland issued a recommendation this week in advance of a festival that outdoor events are rife with asthma and allergy triggers. “Possible asthma triggers include weather changes, dust, pollen, molds, air pollutants such as cigarette smoke, aerosols and dry ice, exercise and alcohol, all of which are part of the festival environment.”
More

Most commercial ant traps contain peanuts as bait. Elizabeth Goldenberg of Onespotallergy.com writes about it here. She recommends mixing baking soda and sugar and putting it in those out-of-the way places ants like. They will be drawn to the sugar and then “explode.”

Asthma Warm-ups for Winter Athletics

We have a couple of suggestions regarding what to do before exercising outdoors in cool weather, one that involves medicine and equipment and one that does not. Simply take a few laps in a warm gym before going outside. The flow of air in and out of the airways cools the lungs before they warm up again with exercise. If an asthmatic goes directly from warm inside
temperatures to cold outside temperatures, the shock causes bronchospasm. It is better to gradually pre-cool the airways with an indoor warm-up so that the contrast will not be so great.
The other is to take Proventil or another beta-agonist spray twenty minutes before exercise to prevent bronchial spasms and to wear a facemask of the kind used by carpenters to trap and pre-warm air, then engage in a normal warm-up. Studies have shown that rapid cooling of the airways followed by re-warming causes coughing in some and wheezing in others. Warmed and moistened air will minimize this response, which is why asthmatics have few
wheezing problems swimming in pools, where the water is continually evaporating.

Bad Pollen Allergies? Avoid exercise first thing in the morning or early evening. Trees pollinate early in the morning before the sun gets to them and after it starts to go down. Bad news for students and working people.

Allergy Symptom Pop Quiz
If your daughter rubs the tip of her nose with her index finger and then with the palm of the hand upward towards her forehead, it means:

A. She is coming down with a cold.
B. She has disobeyed mommy and put beans in her nose.
C. She is performing what allergists call an “allergic salute.”

This is a classic “allergic salute”. It is a specific behavior that all trained allergists recognize, but that might look like nothing out of the ordinary to a parent or pediatrician.
(For the whole quiz, see chapter 11, Asthma Allergies Children: a parent’s guide.)

Tattoos
As fathers and as physicians, we have noted the fad of tattooing with skeptical eyes. If your children have allergies, you have a new argument against it—if you are given a say in the matter. The New England Journal of Medicine (July 2, 2009) noted the following: intense itching that doesn’t respond to topical and intralesional steroids or laser therapy, necessitating skin excision and grafts. “Hypersensitivity to red pigments is most common, especially those containing mercuric sulfide (cinnabar).”

IDEAS FOR TURNING FOOD AND MEALTIME INTO POSITIVES FOR THE WHOLE FAMILY
Food allergies can complicate life for everyone. Here are some tips for involving everyone
Teach everyone to read labels—not just the child with allergies.
Line up the cans and boxes and go over the ingredients. This will not
only help the children with their reading but it will foster a sense of
solidarity among family members.
Take everyone shopping. Armed with their new vocabulary, a
shopping trip can be almost like a treasure hunt.
Cook together. Small children can learn their way around a
kitchen starting with simple tasks like tearing up lettuce for
salads. There are myriad reasons to justify early cooking lessons—
training fine motor skills, teaching process by following recipes,
forging habits of greater cooperation, and on and on. But mostly,
it can be a lot of fun.
For more ideas about managing allergic family life, see chapter 14, Asthma Allergies Children: a parent’s guide.

When Wetting Pajamas is a Good Thing
(More Ideas for Coping With Eczema)
Of all the pediatric problems that make it through my door, among the top 5 are those relating to eczema (aka atopic dermatitis). By the time these cases reach the allergist many of them have been told to 1) stop ingesting common allergenic food, 2) cut their fingernails to prevent excoriating the skin, 3) apply moisturizers creams and 4) apply cortisone creams. These remedies have their place.

There are two additional simple remedies I have learned from colleagues. Each is worth a try, although they aren’t guaranteed to work.

For what my patients call “Wet Pajamas”I give all the credit to a wonderful pediatrician and allergist, Dr. Anne-Marie Irani, at the medical school at Virginia Commonwealth University in Richmond (and the first medical school to which I was accepted, but did not go because unlike the pajamas, Richmond at that time was DRY).

The key is using all cotton. Bathe you your child as usual, pat dry and apply you hydrating cream, like Aquaphor, although many tell me Vaseline works just as well and is cheaper. Take a length of cotton gauze suitable for wrapping around area where the eczema is severe, such the back of the knees (popliteal fossae) or the elbows (antecubital fossae). Put the gauze in warm water and squeeze out the excess. Wrap those areas.

The next recommendation, which freaks out the parents and grandparents (“he’ll get pneumonia”, “get rid of that doctor” or “I’ll call that doctor and give him a piece of my mind”) is to wet the pajamas, squeeze them out and then dress the child. Over them put on dry cotton PJs (OK, Grandma?). Put the child to bed with the windows closed and the AC off.

Many of these children sleep more soundly, don’t scratch at night and their skin clears up markedly. Mothers tell me that their children ask for the wet pajamas.

It works with children of all ages, but by the time many children are into their two’s, they will make the decision whether to do it or not; at that age, let’s face it: you don’t want one more thing to argue about.

Years after hearing about wet pajamas from Dr. Irani, I met her in New York City at a dinner and told her how well it had worked. She agreed that it had been very successful in her patients as well and then proceeded to give me on oral addendum to the treatment.

“Paul, what do you do if there is eczema on the face?” she asked. I told her that I just used a lot of creams. Dr. Irani suggested wetting cotton gauze two by twos, placing stretchy plastic netting (available in stores for cushioning glass bottles) over the head and around the face after cutting an area for the nose, eyes and mouth (the children breathe fine, grandma). The wet cotton two by twos are then tucked underneath the netting touching the afflicted skin. Next, put the child to bed. The skin (now thoroughly moistened) looks better the next morning.

–Dr. Ehrlich

Keep Your Kid’s Sinuses Clear With Easy-to-Make Sinus Rinse
When sinuses are blocked the mucous membranes in the sinuses or Eustachian tubes are inflamed and producing mucus, either because of infection or allergy, dust and other foreign substances begin
to accumulate and aggravate the problem. Infection or allergy can spread, which can contribute to asthma. One inexpensive way to keep the sinuses clear is to use a high-concentration 2-3% saline solution sinus rinse, such as those marketed as SaltAire and Ocean, which come in convenient plastic squeeze bottle sor you can make it at home: 2 or 3 heaping teaspoons of Kosher or sea salt (no additives) and one level tablespoon of baking soda, mixed in a quart of tap water. Buy a plastic squeeze bottle or a 30-cc bulb syringe for easy administration.

School Allergy Season
With the advent of school next month and the history of respiratory problems which greet children when they start school keeping children free from common allergens already in the classrooms (ie, dust mites) or brought into the classroom (cat allergens from home) must be considered. Teachers must clean the classrooms, ask children who are allergic to cats to remove their clothing after returning home from school and staying home if they have a respiratory illness.

Parents always want their children to hit the ground running, but these respiratory illnesses can bring the first weeks of school to a standstill.

Video of Dr. Ehrlich discussing fall allergies with a group of blogging Moms can be found here, along with commentary by MomintheCity.com founder Kimberly Coleman.

For Eczema–Bleach In The Bathwater

Itching leads to scratching, and scratching leads to infection, which leads to more itching, scratching, and inflammation, which leads to…well, you get the point. Our colleagues in dermatology at NYU recommend a familiar disinfectant, used in a novel way: Clorox. Add half a cup to a cup of Clorox to a bathtub of water for toddlers and up—for infants in a bathinette, use just an ounce–bathe with the face out of the water for ten minutes and then rinse with clean water. Results can be dramatic.

Pollen

During tree-pollen time, yellow stuff that can make you sneeze accumulates on your car overnight. You can always park in a garage, or cover the car with a tarp. The real problem, however, comes when you drive with the windows and sunroof open—and after a long winter, that’s entirely understandable. However, at 50 miles an hour your nose just vacuums up more pollen. Turn on the AC instead.