Don’t Let Your Babies Have Allergy Testing

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This month, the National Institute of Allergy and Infectious Diseases published new guidelines for when peanut should be given to infants. The hope is that fewer children will develop peanut allergy as a result of these new recommendations

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The revision of its guidelines for the introduction of allergenic foods was prompted by the startling results of a study published in 2015 called the LEAP (Learning Early about Peanut Allergy) trial. In this study children between 4 and 11 months of age who were considered to be at high risk for developing allergy to peanut were divided into two groups. One group was given peanut to eat on a regular basis while the other group avoided peanut-containing food.   At 60 months of age both groups underwent a food challenge with peanut.

The peanut food challenge was positive in 13.7 % of the children that avoided peanut but only 1.9% in the group that ate peanuts regularly. In children that had a positive allergy skin test reaction to peanut before the study, the results were even more impressive. There was a 70% reduction in the prevalence of peanut allergy in the group given peanut compared with the peanut avoidance group.  In other words, children who were given peanut-containing foods to eat on a regular basis at a young age were significantly less likely to develop peanut allergy.

Here are the New Guidelines

  1. In children who have severe eczema, egg allergy (defined as a history of an allergic reaction to egg and a positive allergy skin prick or a positive oral egg food challenge result), or both, either a blood test or skin test for peanut should be performed. If the peanut allergy test is positive, the child should be referred to an allergy specialist for evaluation and possible oral food challenge with peanut.
  1. Children who have mild to moderate eczema (not severe) should have peanut-containing foods introduced at around 6 month of age
  1. In children who do not have eczema or history of food allergy, peanut should be introduced in an “age appropriate manner in accordance with family preferences and cultural practices”

Take Home Message

There is strong evidence that early introduction of allergenic foods such as peanut protects children from developing food allergy and delaying introduction of allergenic foods may increase the risk of severe food allergy.

Children who do not have severe eczema or a clear history of egg allergy SHOULD NOT have a blood test for food allergy.  The high rate of false positive results in these tests may delay the introduction of allergenic foods and can therefore cause the problem they are trying to prevent.

Children with a history of severe eczema or egg allergy (or any other food allergy) should be referred to an allergy specialist for further evaluation.

Brian Millhollon, MD

 

 

Goodbye Pecos Road: Our Lungs Will Miss You

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For many years, residents of the shinny new master-planned communities of Mountain Park Ranch, The Foothills, and Club West in Ahwatukee had only one way in or out of their neighborhood, giving it the distinction of being called (not so fondly) the largest cul-de-sac in America. To get to work you had your choice of using either Chandler Blvd or Ray Road, two giant arms of a horse shoe-shaped loop, both with a million cars stopped at a million red lights, all trying to get to the interstate at the same time every morning and back to home and supper at the same time every evening.   This tedious, wearisome daily exercise in commuter angst was the one thing that made many homeowners seriously question the wisdom of moving to Ahwatukee.

Then Pecos Road opened up: Ten miles of four-lane heaven connecting the outer frontier of Ahwatukee to Interstate 10 with only three lights.   Like most residents of The Foothills or Clubwest, Pecos Road was my daily commute. I was greeted with hopeful sunrises over the East Valley each morning and contemplative sunsets over the Estrella Mountains and Gila River Indian Reservation in the evening.

pecos sign3I took up cycling 5 years ago (mid-life crisis or early onset dementia?) and like most of the local lycra-ed community trying their best to out-pedal old age, Pecos Road became my second home; the place for serious training when long intervals were needed or to join friends for group rides and the occasional kamikaze sprint at the roads end. On Pecos you could spread you wings and fly for miles.

In less than a year from now, all that will change and Pecos Road will be no more, replaced by a freeway that will provide a bypass route for an endless line of trucks plodding West or East on Interstate 10.

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The passing of Pecos Road and the coming of the trucks was on my mind today when I read two articles in the Journal of Allergy, Asthma, and Immunology about the harmful effects of living close to a busy freeway.

The first: Inhalation of diesel exhaust and allergen alters human bronchial epithelium DNA methylation, presents evidence that exposure to diesel particles and common environmental allergens, such as pollen and mold, can alter the DNA of the lung.   This change can produce lasting effects on gene expression, cell function, and health. In other words, exposure to diesel particles can alter your DNA in such a way that you develop allergies or asthma, even if you, or your relatives, never had allergies before.

The number of people with allergies and asthma has increased significantly over the past several decades – a rise that has occurred almost exclusively in industrialized countries.   Since exposure to air pollution is one of the factors that characterizes life in the developed countries, the alteration of our DNA by diesel particles may be one of the mechanisms responsible for the world-wide asthma and allergy epidemic.

The second article, Traffic-related air pollution exposure is associated with allergic sensitization, asthma, and poor lung function in middle age, reports more bad news for communities planted close to major freeways.   Numerous studies have shown exposure to traffic-related air pollution to be associated with respiratory problems in children. This study, however, focused on the effect of air pollution on middle aged adults. The researchers concluded that even relatively low levels of air pollution during middle age is associated with increased risk of allergic sensitization, asthma, and diminished lung function.

The growing body of information documenting the harmful effects of traffic-related air pollution is certainly concerning to residents of any community located close to a major freeway. It doesn’t help that in Ahwatukee, these harmful health effects compound the growing sense of loss that many feel as they watch progress take away an old friend.

Brian Millhollon, MD