March 13, 2015

Study Questions Accepted Practice for Avoiding Peanut Allergy

Peanut butter is to childhood as beer is to frat parties, but common practice for avoiding peanut allergies has been to keep some kids from eating the popular legume and its various products.

But an impressive new study has shown that the opposite behavior — early, regular exposure to peanuts — might help wee ones avoid the allergy after all. Published in the New England Journal of Medicine (NEJM), the research, according to its lead author showed “an 80% preventive effect” from a study with “an extremely rigorous design,” as reported by

Among the subjects who had a negative result on a skin-prick test for peanut allergy when they were 4 to 11 months old, nearly 14 in 100 who avoided peanuts had become allergic by the time they were 5 years old. But only about 2 in 100 subjects who regularly ate peanuts became allergic.

And among the kids who had a positive skin-prick test, more than 1 in 3 who avoided peanuts were allergic at age 5, compared with about 1 in 10 who had consumed peanuts or peanut products.

Still, the NEJM was cautious: "The question of whether early exposure or avoidance is the better strategy to prevent food allergies remains open," the authors wrote. But elimination diets consistently have not prevented allergies, so even though strict avoidance of the suspected food has been standard practice, this study really questions the wisdom of that approach.

Earlier research hinted at the new results. Jewish children living in Britain who seldom ate peanut products early in life had 10 times the rate of peanut allergy than their Israeli counterparts, who been given peanut products when they were about 7 months old. Those researchers thought that maybe early exposure reduced the likelihood of the allergy developing, MedPageToday explained, so they designed the NEJM study, Learning Early about Peanut Allergy (LEAP), to test the hypothesis.

From 2006 to 2009, 640 infants who were considered to be at high risk for developing peanut allergy because they already had severe eczema or egg allergy were studied. They all got an allergy skin-prick test; 530 were negative (that is, indicating no allergy), and 98 who had a reaction as large as 4 mm in diameter were considered to have a low-positive test. Children who reacted with a skin mark larger than 4 mm were excluded from peanut exposure for safety concerns, as they were considered too high risk to test further.

So the caveat here would be that if your child shows a definite, significant sensitivity to peanuts in a preliminary test, it’s best not to give him or her peanut products. The exposure-as-defense, per this study, applies only to kids with no or only minor risk of allergy.

When the kids remaining in the study were 5 years old, they were given peanut products to eat. Adverse events that occurred more often in the consumption group included upper respiratory tract infections, gastroenteritis (digestive problems), skin infections, rash and conjunctivitis (pink eye), but most were mild or moderate.

Peanut allergies have quadrupled in the last 13 years, so the LEAP results are compelling, and some allergists/immunologists advocate developing new guidelines to address them. As the NEJM author said, "Soon after weaning peanuts should be added to the diet,” except for high-risk infants (including those with severe eczema), for whom skin-prick testing is required.

What if your child already is allergic? That’s tricky these days, when some schools even prohibit kids from bringing peanut butter from home. As Dr. Jeffrey M. Drazen, editor-in-chief of the NEJM said in a media briefing, "We've figured out how to prevent and lower the incidence of peanut allergy, but we already have a bunch of kids who are allergic to peanuts. How are we going to help kids get their peanuts early while not contaminating those children with peanut allergy. It's going to be a tough problem for the PTA.”

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December 5, 2014

Misleading Claims of Protection Against Allergy and Eczema

If you think a label claiming that the product is hypoallergenic will protect your kids against allergic reactions, think again. Research published in the Journal of Allergy and Clinical Immunology showed that a lot of products marketed for kids with itchy skin often contain ingredients that cause the very problem they’re promoted to address.

As explained in a story by Reuters, labels with the word “hypoallergenic,” which means unlikely to cause or designed to reduce an allergic reaction, are not regulated by the FDA. That means there’s no oversight of the claim and nothing to enforce its veracity.

The study tested products that might be used by children with eczema, a red, itchy skin condition common among children, but which can strike anyone at any time. It’s chronic, and tends to flare up, then die down without any clear cause. There is no cure for the long-lasting condition, known formally as atopic dermatitis.

Eczema affects nearly 18 million people in the U.S.

“Kids who have eczema or atopic dermatitis use more lotions and creams and ointments, …,” Carsten Hamann told Reuters. He’s the medical student who was lead author of the study. “Ostensibly, their caregivers who purchase these products to use on the kids' skin, give preference to products using these meaningless marketing terms.”

His team tested 187 cosmetic products sold in six different stores in California. They looked for any of the 80 most common known allergens identified by the North American Contact Dermatitis Group.

All of the products tested were promoted as safe for use by children, and all were labeled as “hypoallergenic,” “dermatologist recommended/tested,” “fragrance-free” or “paraben free.”

  • Nearly 9 in 10 products contained at least one allergen.

  • More than 6 in 10 contained two or more, and more than 1 in 10 contained five or more.

  • The average number of allergens per product was 2.4.

  • Preservatives and fragrances accounted for nearly 6 in 10, and 3 in 10 allergens, respectively.

  • One in 10 products contained methylisothizolinone, a preservative the European Union plans to ban because it can cause severe skin irritation, according to the researchers.

Doctors usually advise eczema patients to use moisturizer on inflamed skin, but a lot of people with eczema also suffer from so-called “contact allergies.” That is, they might have allergic reactions to substances that touch their skin, including fragrances and preservatives.

“It would be very difficult for even the most caring, intelligent and well-read parent to know the names of 80-plus allergens and their synonyms,” Hamann told Reuters, “let alone compare that list of allergens to a 15-plus long ingredient list on the back of a pediatric product.”

The study wasn’t universally embraced. Dr. Donald Belsito, Professor of Dermatology at Columbia University Medical Center in New York, commented to Reuters Health that the study “misrepresents a lot of these chemicals because they’re listing the frequency with which they were found in a product, not the frequency at which they cause allergy. … Many of the chemicals on that list are very, very rare causes of allergy.”

Another skin disease specialist, Dr. Michael Ardern-Jones from the University of Southampton in the U.K., noted the difficulty of defining terms associated with allergies. “Almost any chemical compound could be implicated as an allergen, so it is almost impossible for a cream to be truly nonallergic,” he told Reuters. “… as there is no true ‘hypoallergenic’ cream, there is no agreed meaning of ‘hypoallergenic.’”

But the greater point is that consumers — parents — believe that something called “hypoallergenic” offers a degree of protection. And with or without this study, it doesn’t, because there is no regulatory standard or oversight for the claim.

Both experts recommend treating eczema with ointments rather than creams and lotions, which contain water and therefore also must contain preservatives. That makes them more likely to contain allergens.

Belsito recommends petroleum-based products such as Vasoline, and advises keeping skincare products simple. Ardern-Jones said that prescription moisturizers generally are reliable, and advises against using products that contain fragrance and color, and that lack a list of ingredients.

The National Eczema Association reviews products and, according to Reuters, “is a more reliable resource than the product labels.”

To learn more about an additional risk factor for children developing eczema, see our blog, “Early Use of Antibiotics May Lead to Eczema Later”

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September 12, 2014

Weight Gain Makes Kids More Vulnerable to Asthma

Asthma and obesity are common problems among U.S. children, and a new report in the Annals of Allergy, Asthma & Immunology ponders how obesity contributes to childhood asthma.

Nearly 7 million U.S. children have asthma, and more 12 million kids from 2 to 9 years old are obese. According to the American College of Allergy, Asthma and Immunology (ACAAI), obese children have an increased risk of developing asthma. An ACAAI news release accompanying the journal report acknowledges link between childhood obesity and asthma, but said research hadn’t determined which condition generally occurs first, or whether one causes the other.

This study suggests that being overweight comes first, although the connection is complex and many factors have yet to be examined.

The report showed that rapid growth in body mass index (BMI) during the first 2 years of life increased the risk of asthma until kids were 6 years old. Previous studies showed that the onset and duration of obesity and the ratio of lean tissue to excess fat can affect lung function. (See our blog, “Fast Food Diet Shows Link to Breathing Problems.”)

But practitioners often don’t know if the constricted airways characteristic of asthma makes kids unwilling to exercise, and therefore gain unhealthy amounts of weight, or if being overweight narrows airways, prompting the development of asthma.

“Most kids who suffer from asthma also have allergies,” Michael Foggs, MD, and president of ACAAI, said in the news release. “These allergic responses in the lung can lead to symptoms of allergy. Coughing, wheezing and shortness of breath are all symptoms that make exercise harder.”

The ACAAI says that children with asthma and other allergic diseases should be able to participate in any sport they want to as long as their condition is monitored and controlled. If they show symptoms of asthma during or immediately following exercise, it’s an indication that their condition is not being properly controlled.

In other words, asthma shouldn’t be so severe that it restricts a kid from being active; it’s a condition that can be managed and accommodated.

For advice from allergists about dealing with your child’s asthma, link here. To learn more generally about asthma and allergic conditions, and to locate an allergist in your area, link here. For information about hospital treatment of children with asthma, see our blog, “Assessing the Quality of Hospital Care for Children with Asthma.”

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May 17, 2013

Why the Pacifier Shouldn’t Be Too ‘Clean’

It’s a Pavlovian response—you lick your thumb to clean the pureed peas off your baby’s face. But licking her pacifier clean after she knocked it onto the floor? Ewwww.

Get over it. According to a new study in the journal Pediatrics, that’s exactly what you should do. Parents who perform this protective act might be reducing the kid’s risk of developing allergies.

As explained on, the study suggests that transferring the microbes in your mouth to your baby’s mouth could modify its population of bacteria and cultivate a broader immune response to future invaders.

The researchers looked at kids who were 18 months and 36 months. In the younger group, children born to parents who said they cleaned their child's pacifier with their mouths were less likely than those born to parents who cleaned it with water to have asthma and eczema. At 36 months, the association remained for eczema, but not for asthma.

The benefit of this “oral hygiene,” the researchers suggest, might extend to a kid’s nether regions—because the baby swallows the newly transferred parental bacteria, they could affect the microbiology in the intestines, which could improve general gut tolerance.

Infants with less diversity among their gut microbes, according to MedPage Today, are more likely to develop allergies. That suggests that exposing youngsters to a wider variety of microbes could promote immune system function.

As Dr. Amal Assa'ad of Cincinnati Children's Hospital Medical Center told MedPageToday, "[W]e have to let nature play out a little bit and not be too clean and not be forming artificial barriers in the connection between the mother and the infant and the parents and the infant."

"We have to at some point reach a balance where we're making sure we're not predisposing [infants] to infections at the same time [we're making] sure we're giving them what they were naturally expected to get from the parents ... so we end up with a balanced body that doesn't veer towards allergies and doesn't veer towards serious infections and harm."

It’s interesting that, according to the study, the method of birth (cesarean or vaginal) was related to the likelihood of a parent sucking on the pacifier. Vaginal delivery and parental pacifier sucking independently were associated with a reduced likelihood of developing eczema; babies delivered vaginally and whose parents licked their pacifiers had a lower incidence of eczema.

The theory is that vaginal delivery, which also transfers bacteria from mother to infant, has a beneficial effect on allergy resistance.

Regarding the “ick” factor, and the concern that transferring a pacifier from a parent's
mouth to a child's could spread respiratory infection, the study showed no difference in the rate of such infections based on pacifier cleaning practices.

Keep in mind that this study had a relatively small sample size (184 kids), and that it’s relatively difficult to diagnose asthma in early childhood. So a larger study also involving older children is necessary to replicate—and confirm—these results.

But, for now, if you think it’s better to wash your kid’s pacifier under the tap than in your saliva, it’s probably time to think again.

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January 11, 2013

A Profile of Kids at Risk of Being Bullied

It’s no surprise that vulnerable kids are ripe for bullying. Two recent studies found that children who suffer from food allergies and those involved in weight-loss programs reported being bullied by their peers. But it might surprise that those who are victimized because of their weight are sometimes bullied by their parents.

Both studies were published in the journal Pediatrics, here and here.

In one study, nearly one-third of children with food allergies reported bullying or harassment specifically related to their allergy, often involving threats with food. In the weight study, nearly two-thirds of teens at weight-loss camps reported weight-related victimization.

Bullying can cause great harm. See our post about the connection between bullying and suicide. Less dire consequences include social isolation, poor academic performance, depression, anxiety and chronic health problems.

As described on, surveys of 251 food allergy patients ages 8 to 17 and their parents were analyzed at a single allergy clinic.

Forty-five in 100 of the kids and 36 in 100 of their parents reported bullying or harassment. Eight in 10 bullies were classmates, and 6 in 10 bullying incidents happened at school. Verbal teasing was common, as was waving the allergen in front of the child; 12 in 100 kids had been forced to touch the food to which they were allergic.

Most of the bullied kids said they had reported the bullying, but parents knew in only about half the cases. When the parents did know, the situation improved for the kids.

The weight study included 361 kids ages 14 to 18 surveyed online while they attended two national weight-loss camps. One-third of the respondents were in the normal weight range; nearly one-quarter were overweight and 4 in 10 were obese. The first group represents many kids who previously had lost significant amounts of weight and had returned to the program for maintenance.

The more the kids weighed, the better their chances at being bullied, although many of the normal weight groups remained at risk.

Bullying came in the form of teasing, relational victimization (behavior aimed at damaging relationships or one's social reputation), cyberbullying and physical aggression. The most common bullies were:

  • peers (9 in 10)

  • friends (7 in 10)

  • physical education teachers or sport coaches (4 in 10)

  • parents (nearly 4 in 10)

  • teachers (1 in 4)

The researchers said that some of the adults might have been well-meaning, but made clear that any bullying can be extremely damaging. As MedPageToday summarized, bullying has immediate and long-term effects, both physical and emotional.

The researchers concluded that pediatricians and other caregivers should become front-line interveners when a patient presents with symptoms or stories of bullying. That means helping kids and their parents anticipate and handle incidents, and teaching parents how to recognize bullying clues.

Even if your kid isn’t talking, sometimes you can recognize if he or she has been bullied. Physical clues include unexplained bruises, cuts and scratches; behavioral clues are avoiding school and social events, substance abuse, anxiety and depression. In addition, kids might have chronic headaches or stomach aches.

Simply realizing that if your child suffers from food allergies or excessive weight, he or she is particularly at risk; you can help him or her be prepared for what might occur.

If the bullying occurs at school and at home, the researchers said that "healthcare providers may be among their only remaining allies."

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October 5, 2012

How to Treat Anaphylaxis When Kids Are at School

It might be the result of a bee sting or the ingestion of a peanut, but whatever the cause, when anaphylaxis occurs it can be life-threatening.

Anaphylaxis is an acute allergic reaction to a specific antigen (food, pollen, drugs, etc.); it’s the immune system’s whole-body response to the presence of an allergen it perceives as a threat. Symptoms generally occur immediately after exposure and might include respiratory distress, swelling of the lips, eyes and throat, rash, low blood pressure, bleeding and/or vomiting. It can result in cardiac arrest.

Parents of children with known allergies should ensure that their child’s school authorities are aware of the allergy and have a prescription on file for epinephrine in case of emergency. (Epinephrine is the hormone adrenaline and is the primary treatment for anaphylaxis.)

Epinephrine is generally safe, with few adverse effects, if given even when it is not needed.

But according to a recent story in the New York Times, school nurses can find themselves in a horrifying position if a child without such a prescription develops a sudden reaction to an undiagnosed allergy. If they inject epinephrine, they risk losing their nursing license for dispensing it without a prescription. Their only other option is to call 911 and hope the paramedics arrive in time.

Some states have passed laws to enable school caregivers to have epinephrine injectors on hand and to give a shot to any child with an emergency. Mylan, which markets Pfizer’s EpiPen, the most commonly used injector, is lobbying for such federal legislation. The company has lobbied individual state legislatures and has distributed free EpiPens this year to schools.

Sure, it’s a naked grab for market share, but it also makes medical sense.

As The Times reports, Mylan has spent millions on consumer advertising and has hired scores of sales representatives to help promote the product. It’s estimated that EpiPen sales will total $640 million this year, a 76 percent increase over last year, according to one analyst.

A study last year in the journal Pediatrics found that about 1 in 13 children had a food allergy, and nearly 40 percent of those with allergies had severe reactions.

Efforts to make epinephrine more widely available, The Times says, are an acknowledgment of the rising rates of food allergies among children and the handful of deaths from allergies across the country. Some children with known allergies carry their own epinephrine injectors to use themselves, if they’re old enough, or the devices are kept in their school nurse’s office.

It’s unclear why the rate of food allergies among children appears to be increasing. “I don’t think it’s overdiagnosis,” Dr. Scott H. Sicherer, a researcher at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in Manhattan, told The Times.

A Mylan executive said schools were just the first place to make emergency epinephrine injectors more widely available. The company would like to see them as available as defibrillators—in restaurants, airplanes and other public places.

The Food Allergy and Anaphylaxis Network (FAAN) has not taken a position on placing injectors in public places other than schools, and Sicherer wondered about their suitability in settings such as restaurants, where staff might not be able to tell the difference among choking, a heart attack or anaphylaxis.

Next month, Sanofi plans to introduce a rival epinephrine delivery device, and in 2015, Teva may win approval of a less expensive generic version of the EpiPen, according to The Times. Sanofi’s Auvi-Q features voice instructions and Teva’s product, if approved by the FDA would closely mimic the EpiPen design and, like a generic drug, could be substituted by pharmacists even if doctors prescribed the EpiPen.

To learn about the latest developments in food allergies, visit the NAAN site. To learn about the widespread practice of bogus testing, see our blog about free allergy tests. To learn about the early signs of allergy, see our blog here.

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July 18, 2011

Signs of Allergy Can Appear Early

The kid who started sneezing and itching and was diagnosed with an allergy when he was 3 might well have communicated sensitivity to the responsible allergens even before he could roll over.

A study in the American Journal of Respiratory and Critical Care Medicine indicates that an allergic future can signal itself within the first month of life, long before symptoms develop.

A certain protein expressed in infant urine predicted lung, nasal and skin irritation by the time children start school. The findings are useful, the researchers wrote, for prevention and to customize treatment when symptoms do manifest.

All of the infants in the study were symptom-free when they were tested at 1 month old. By the time they were a year old, 4% developed chronic respiratory problems (wheezing, coughing), and 27% developed eczema. By the time they were 6, 17% and 15% respectively developed those symptoms.

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October 22, 2008

More Food Allergies Among American Kids

A new federal report says that food allergies have risen 18% among American children in the last decade.

From the article:

Eight types of foods account for 90 percent of all food allergies -- milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Allergic reactions to these foods can range from a tingling sensation around the mouth and lips, to hives and even death, depending on the severity of the reaction, the report's authors said.

The report also said that children with food allergies are two to four times more likely to have asthma or other allergies, compared to children without food allergies.

As discussed in the article, there is much we don't know about allergies. We don't know where they come from or why some children do not outgrow the allergies by adulthood, which is what happens in the majority of cases.

The full report can be found at the CDC (Centers for Disease Control and Prevention) website: Food Allergies Among U.S. Children: Trends in Prevalence and Hospitalizations.

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