Asthma Allergies Children parent's web guide

Asthma Allergies Children | is a website devoted to ideas that are within the guidelines set by accredited medical authorities for treatment of asthma and allergies.

Admin

Home Air Filters–What Works Best?

By

I wanted your advice as I am looking into buying new air purifiers in connection with my son’s asthma/allergies. I have heard that I should NOT purchase one that works with ions (ionic technology). Am I wrong?
The ones I bought about four years ago are a bit noisy. So I am planning to purchase the latest
technology. Before I purchase them, I want to make sure that the ionic ones will not be a
problem. One other advantage is that I will not have to change any filters, which I have been doing every 2-3 months, but just clean the blades regularly; also, they are supposedly very quiet. Since I have a
small apartment, I cannot afford to have something bulky and big. Hence, am thinking of something sleek that does not necessary have to be placed in the middle of room (as per the current ones). Please advise.
–Ms. D

Sorry to disappoint you. All air purifiers must be HEPA (High Efficiency Particle Air filters). The ones about which wrote are sub-standard – easier to care for – but not good products. Call 1-800-ALLERGY. That is the simple fact.

–Dr. Ehrlich
{Note: For more on air filters click here}

Shellfish problems and iodinated contrast media (“x-ray dye”)

By

(This was written in response to Dr. Ehrlich’s post, “The Relevant Allergist,” which mentioned the persistent myth that shellfish-allergic patients will react to the iodine in dye used during x-rays, by a board-certified radiologist who practices in upstate New York.)

Radiologists years ago considered a patient’s history of an allergic reaction to shellfish as a contraindication to giving contrast for an IVP (kidney study), angiogram, CT (a.k.a. cat scan), or other radiologic studies. I say “years ago” because I have been in practice for 30 years and it was dogma when I started.

Because lots of radiology is about science, later studies were done that showed no connection between a patient’s shrimp “allergy” and the incidence of contrast reactions. The American College of Radiology produces a 98-page contrast manual. Its latest iteration Version 6 was issued in 1998. If you search it for the word “shellfish” you find only one mention on page 13:

The predictive value of specific allergies, such as those to shellfish or dairy products, previously thought to be helpful, is now recognized to be unreliable.

We don’t really understand contrast allergies or if they are even allergies at all. My patients who have broken out in hives with an injection may have no hives the next time. There is no definite connection between the hives and the anaphylactic reactions. Generally patients with lots of allergies are more likely to have reactions to contrast. If the benefit of the injection is very great, I go ahead and inject those with a history of hives. If the patient says his tongue swelled up and he can’t remember what happened before he woke up in the ER, I don’t inject unless the patient has been pre-treated with whatever combination of steroids and antihistamines is in vogue. If the patient has had a really bad contrast reaction, any future study requiring an injection ought to be done not in an outpatient office but in a real hospital with an emergency room.

All this being said, I have seen only 4 serious contrast reactions in my 30 years. They all did well. One did indeed have a shellfish history. Her reaction was not to injected “dye” but to the mixture of water and 2 tablespoons of water soluble contrast given by mouth. Because of the shrimp history we had no intention of injecting her. It did not protect her from the profound diarrhea she experienced.

Dr. A

U.K. “Market Basket” of Goods

By

By Dr. Paul Ehrlich
I noticed in our “News” page here at AsthmaAllergiesChildren (AAC for short) that the United Kingdom has included in its “market basket” ( a consumer cost-of-living measurement) a bottle of allergy medication. As a physician I spent some time in London in the 70’s, and over the years since I have followed changes in English medical practice, particularly regarding my own specialty. When a New York patient went to London to work for a bank, he informed me that English doctors have stopped immunotherapy (allergy injections) because some people were reacting to the shots in undesirable ways. I’m sure that the rates there were no higher than they are here, and that they were helping lots more people than they were hurting, but whoever decides these things on behalf of the National Health Services was convinced they weren’t worth it. I disagree.

Still, I am pleased to see that the 20% of the UK population who have allergic disorders are treating themselves to the extent that allergy medication would be included in the market basket. Allergies and asthma are becoming more pervasive, and maybe specialty treatment will make a comeback. By the way, garlic bread is also new to the list, while lipstick is gone.

Integrated Asthma Care

By

By Dr. Larry Chiaramonte
In the past two years we have come through a bruising debate about how to reform the health care system in this country. As someone who has worked on treatment of allergy and asthma, both in the trenches of clinical and hospital practice and in research, I have watched this train wreck happening. Yet, what we have learned about the treatment of allergies and asthma has much to teach about the treatment of chronic asthma and that knowledge can be applied to treatment of other chronic disease in America as the details of health reform take shape.

At present the treatment of asthma in America is extremely fragmented. The emergency room, primary care physician, pulmonary specialist, allergists, hospitals and intensive care units, and the labs that provide support work still largely function independently with their own bottom lines the focus of their attention. The result is the familiar, sad scorecard: 17% of GDP, half again as high as the next highest country, Switzerland, with administrative costs as high as 30%. I also suspect that some costs will get higher in the short term as different players jockey for advantage. Implementing electronic records and other changes will be expensive and take a long time. Practices will combine to better afford these changes, but they will also gain bargaining power for higher fees.

It is critical that with all this finance-oriented activity, we not lose track of the goal of better patient outcomes. With a chronic disease like asthma, we would be best served by creating focused facilities that offer one-stop convenient inexpensive care, as described by Regina Herzlinger of Harvard Business School describes in her book Market Driven Medical Care, where best practices are routine, where communication of patient information is exchanged instantaneously among medical personnel, and where professionals are paid for better outcomes, not for procedures. I have no doubt that the rewards in cost savings, and in better public and individual health, would be considerable. Dr. Ehrlich and I see evidence every day that suggests this would happen. Herzlinger points out that 80% of the total cost of asthma care is caused by the worst 20% of asthmatics. An integrated facility will allow a more intense focus on these patients, and it would prevent patients in lesser stages of disease from joining that unfortunate group. The buzzword now is “medical home.” Sounds great in theory, but I’m still concerned that these organizations will still miss the point of dedicated asthma care and amplify the mistakes that have aggravated our asthma epidemic.

The Relevant Allergist

By

Dr. Paul Ehrlich

When I ponder what role the allergist has to play in the contemporary medical environment, I don’t have to think about it very long before something comes up in the popular press or in practice that renews my sense of mission. To wit, there are many myths about allergies that take hold not just among the lay public but among physicians as well that have been disproved and yet persist.

Two examples have come up recently. One appears in the “In the News” section of this website because it came up in a New York Times column. There is a stubborn misconception that people with seafood allergies react to iodine, and thus shouldn’t be injected with the dye that MDs use for CT scans. (For my unmediated response to this tall tale, click here.) As I said in that letter, reputable doctors from my own esteemed NYU Hospital continue to refer patients to me under this illusion.

Let’s get this straight. Iodine, which is also added to table salt, has nothing to do with allergies. Tell your radiologist!

The other came up when the mother of a four-year old told me that he had never been vaccinated for measles, mumps, and rubella (MMR) because the pediatrician told her not to–the vaccine is egg based (like all vaccinations) and he is allergic to eggs.

The myth that these vaccines are dangerous for egg-allergic children was debunked in 1995 in a paper by a group that included Dr. Hugh Sampson, now at Mt. Sinai, Dr. Wesley Burks at Duke, and other top people. These basic vaccinations are a critical part of pediatric public health, yet they have a bad name because of some bad science, although this is just one of the little lies, not the big one. As Larry and I write in our book, food allergies are tricky enough when in the hands of doctors who know what they’re doing. In the hands of this pediatrician, the conditions are ripe for all kinds of serious problems, such as malnutrition, as well as susceptibility to MMR, three real diseases.

Asthma and Allergies—The Big Picture

By

By Mark Ballow, M.D. and President of the American Academy of Allergy, Asthma and Immunology (AAAAI)

Chances are everyone knows someone who suffers from symptoms of allergies or asthma. Take allergic rhinitis. This chronic condition affects between 10 and 30 percent of all adults, and as many as 40 percent of children. It accounts for approximately 1.5 million school days missed per year and approximately 28 million days of lost productivity. And, the problem is growing. There has been a 100 percent increase in the prevalence of allergic rhinitis in each of the last three decades in developed countries.

Or asthma. Government data show that in 2006 an estimated 12.4 million Americans had an asthma attack. Nearly 4.1 million of these breathtaking attacks were in children. The majority of these resulted in lost work or school days. Nearly $20 billion is spent annually on asthma alone.

Over 4000 patients die each year from asthma.

These are chronic conditions without cures. Yet, symptoms can
be controlled, health care dollars can be saved and people with asthma or
allergies can lead healthier lives. Proper diagnosis and effective disease man-
agement are essential; and we all have roles to play.

The American Academy of Allergy and Immunology recently renewed our commitment to better care with a special supplement in the Wall St. Journal during Asthma and Allergy Awareness month, this past May. You may link to through the AAAAI website at AAAAI.org. But the battle for better allergy and asthma care must be fought on many fronts, and that is why I welcome the entry of Asthma Allergies Children: A Parent’s Guide and AsthmaAllergiesChildren.com, particularly since Dr. Paul Ehrlich was a fellow in training with me at Walter Reed Hospital back during the Vietnam War. I certainly hope that this new approach of book and website will help spread the message that we board-certified allergists have been telling the world for so many years. Namely, that well-controlled allergies and asthma can save lives, money, and greatly increase the prospects that our children will be happier and more productive throughout their lifetimes.

Dr. Mark Ballow

Dr. Ballow is board certified in pediatrics and allergy and immunology. He received his medical training at Yale, University of Chicago, and the University of Minnesota. He recently retired from the medical faculty at the State University of New York at Buffalo and is currently President of the American Academy of Allergy, Asthma and Immunology.

How to Read a Food Label—It’s harder than you think

By

By Kathy Franklin
Examine the Entire Package—- My son once got sick after eating an ice cream sandwich. Had he forgotten to check the ingredients? No, he had read them carefully. Twice. What he hadn’t noticed was a second set of ingredients on the other side of the wrapper. There was one list for the ice cream, and a separate list of ingredients for the chocolate wafers. Likewise, not all companies put the allergen statement, “May Contain Traces of …” directly below the ingredients. Check the whole package.

Read the Label Three Times—- Read the ingredients at the store when you select the product. Read it again when you unpack your groceries at home. Read it a third time before serving. We’ve found allergens the third time that we didn’t catch the first or second. An even better idea is to read it with your child, or your allergic guest, before serving. It will get them in the habit of always checking before eating.

Consider the Source—- General Mills, Kraft, and Hershey’s are wonderful about food allergies. They use state-of-the-art preparation methods to ensure there’s no cross-contamination. But beware of “Granny Mae’s Homemade Apple Pie” or “Aunt Ida’s Organic Banana Bread”, sold at your local farmer’s market or the neighborhood deli, hand-wrapped in plastic. These producers typically don’t have the resources to make products on separate lines, nor the legal staff to research the intricacies of the latest food labeling laws. I found a lovely apple pie at a nearby green market, delighted that it was safe for my child, according to the ingredient label. But the crust was suspiciously shiny, so I asked the seller if she was sure there was no egg wash. “No, if it’s not on the label, then there are no eggs.” I had her double-check with her boss, who said, “Oh, yes, of course, there’s an egg wash on top, but just a little bit.” Why wasn’t that on the label? “Because it’s such a small amount, and it’s on the pie, not in the pie.”

Next time: Reading Ingredients on Soap, Cosmetics, Sunscreen and Body Lotions – You Won’t Believe What’s in There!

Parents mailbag

By

EF writes: My two-year old son was just diagnosed with peanut and tree nut allergies. Since I am new to this, I have several questions.

1. Is there a different trigger level for the allergy flare up in each individual? Can or will new blood tests show this level?

First of all, good luck. We and our colleagues in the specialty of Allergy and Immunology will do our best for you and your child.

30% of the standard blood tests which are reported as positive are really falsely positive, and, therefore, the true gold standard for testing in allergy becomes the double-blind placebo controlled food challenge, known as DBPCFC for short, although the abbreviation is hard to memorize. What you really want to know is whether we can do a test which will tell us whether we can accurately predict the severity of food allergy, and the answer is “they are working on it”, but as of yet “no.”

2. What is the best way to talk to my child about this allergy, what is the best age to start educating him, and what advice do you have for talking to others about it?

Most parents find that by three years of age the children understand that certain foods are not good for them, and they can learn quite early to ask anyone who offers them food of any sort, “Does it have, (food type) in it?” The broader answer to the question, explain to each child and anyone who cares for her/him the consequences of eating a food to which they are allergic. And don’t sugar coat it. By now, most pre-schools are conditioned to be sensitive to the needs of food allergic children. Closer to home, babysitters and grandparents require special attention in this regard.


For a very sympathetic discussion of these issues, see “Guide to the Worry Years” and the rest of “Food, Glorious Food?” Chapter 5 of Asthma Allergies Children: A Parent’s Guide, and Chapter 14, “Mom and the Rest of the Family.”

3. Show me a detailed/comprehensive list of OK FOODS to eat.

No can do. It all depends on the history and the tests. There may even be a tree nut or two that this child can eat.


4. What research is being done to get closer to a cure?

There’s too much to describe here, but Food Allergy Initiative and Food Allergy and Anaphylaxis Network (FAAN) will keep you up to date. Research on one drug that was considered promising for peanut allergy has been discontinued for economic reasons. In the meantime, teach your son, his caregivers, and your family well.

(Note: These questions were answered by Dr. Larry Chiaramonte)

Childhood Allergy to a Medicine

By

Q: What do I do with a patient who reports having had an “allergy” to a medicine as a
child that is unknown or so long ago that no one seems to remember
what it was except that the patient was told “never to take it”. They
don’t recall going to the emergency room, shortness of breath /
hives, or any obvious life-threatening reaction. Typically this
relates to antibiotics.

–Dr. L

Dear Dr. L,
I learned from Dr. Stan Fine who wrote a paper attempting to answer this question. He studied what happened to patients on a second exposure after an immediate, severe systemic reaction to penicillin. The lapsed time from the first reaction WAS EXTREMELY IMPORTANT. In a five-year time interval after the first exposure roughly one half [50%] of patients lost their sensitivity. In a second five year interval another 50% lost their sensitivity, in other words in a ten-year time interval only 25% kept their sensitivity.

This is an area where the physician’s clinical judgment of the risk /benefit ratio is the determining factor. In this situation, severe reaction to a second exposure is highly unlikely, but why take any chance if there are substitute drugs available?

In my role as director of an allergy-immunology training program we received multiple referrals of patients, who clearly had severe immediate systemic reactions to an antibiotic, but who also required its use. We used rush desensitization; starting with an infinitesimally small dose; increasing it by roughly 50% every fifteen minutes if no reaction occurred. After about eight hours at the patient’s bedside we would reach the recommended dose without a reaction. As long as patients continuously had the antibiotic in their systems they could safely receive the therapeutic dose. So in expert hands in the hospital it is possible to give an antibiotic that might have caused a severe, immediate, systemic reaction. Rush desensitization is like major surgery; not used lightly.
–Dr. Chiaramonte

Health Care System Fixes

By

Dr. Larry Chiaramonte

The American health care system has been on an unsustainable course. While most of the debate has concentrated on big fixes, there clearly exist in every specialty individual “fixes” that could collectively save the country as a whole, and millions of individual patients, a great deal of financial and personal misery. An example of this was the Op-Ed piece in the New York Times by Richard J. Ablin, the man who discovered prostate-specific antigen, an enzyme made by the prostate, which became the basis for a test administered to 30 million American men at a direct cost of $3 billion. But this is just the tip of the iceberg, because it results in billions more in unwarranted treatment and the medical consequences, such as impotence and urinary disruptions, affecting 47 men for every one whose life is saved.

In the field of allergy, the same law of large numbers also applies. The American Academy of Allergy and Immunology estimates that expert care for moderate and severe asthma can reduce hospitalizations for asthma by an average of 77% and can reduce emergency room visits for asthma by an average of 53% and save as much as $1.3 billion in annual direct costs for hospital and emergency care costs.

They estimate that current patterns of care for asthma accounts for: 5,000 deaths per year–1 death per 2,400 asthmatics per year; hospitalization 500,000 per year–4 admissions per 100 asthmatics; emergency care –1,500,000 per year: 12 ER visits per 100 asthmatics, plus millions of school and work absences, and limitation of function. (more…)

What does this mean to the individual child with moderate or severe asthma? Referral to a specialist, “might be accompanied by an increase in medication costs of 6-24%, but expert care would be expected to save approximately $1.3 billion [$1.8 billion today] in direct costs for hospitalization and ER visits (the reduction expected if patients at risk were referred for expert care).”

Or take immunotherapy, which is only available from specialists: “Immunotherapy can be expected to reduce the need for medications for allergic rhinitis or asthma, or both, by more than 50%. Current total direct costs for immunotherapy at Emory University in 1996 average approximately $800 for the first year [$1083 now] and $170 for the next 2 to 4 years [$236 now]. After 3 to 5 years, immunotherapy usually is halted. Clearly, the costs of immunotherapy are soon balanced by large reductions in costs for medication.”

The late Senator Everett Dirksen used to say of the federal budget, “a billion here and a billion there—pretty soon you’re talking about real money.”

The point is this—we have billions and billions of dollars of waste in our health care system because we let it operate on automatic pilot, and still it adds up to the 37tth best health are in the world.

SiteLock
%d bloggers like this: