It is with great happiness that I update an earlier blog posted several months ago with the news that patients with food allergies now have a law that helps them afford their treatment. On Friday March 28th, Governor Jay Inslee signed a law that makes Washington the most recent state in the country to set a mandate for medical coverage of elemental formulas in the treatment of Eosinophilic GI disorders (EGIDs). EGIDs are a severe form of gastrointestinal inflammation that results from food allergy.
A 4 week-old infant and his mother came to my office last week. The mother had started seeing small flecks of blood and stringy mucous in the infant’s diapers a week prior. The baby was fine in every other way, breast feeding normally, and looked quite healthy when I examined him.
I diagnosed the infant as having cow’s milk protein-induced proctocolitis, the term referring to allergic inflammation of the lower gastrointestinal tract from exposure to cow’s milk.
This is a diagnosis I make often. Here's what you should know about infants with milk allergies:
- It’s more common than you think. 2-3% of infants in the U.S. are allergic to cow’s milk protein. It is even more common in infants with eczema or who have parents or siblings with allergies.
- It’s seen in breast fed babies. Over 50% of infants with this condition are breast milk-fed infants. But remember, the babies are allergic to the dairy in their moms’ diets, not to their mothers’ breast milk per se!
- Switching to soy or goat’s milk doesn’t work. Over two-thirds of infants with cow’s milk protein allergy “cross-react” to soy protein (which means that they may not be truly allergic to soy protein, but their immune systems are just too “immature” to know the difference between the two). Similarly, if a mother switches from drinking cow’s milk to goat’s milk, it won’t help, because the source is still a “different species”; the infant’s immune system will still respond to the “foreign” protein.
- Treatment takes time. The inflammation resolves when all traces of cow’s milk (and soy), are removed from the infant’s diet. In the case of formula-fed infants, we switch to special hypoallergenic formulas. Typically after a successful switch, the bleeding stops within a week. However, with breast fed infants, the improvement can be a little slower. Since it can take up to 2 weeks for the dairy in a mother’s diet to circulate into her breast milk, the full effects may not been seen for up to a couple weeks.
- Allergy testing is not recommended. The type of allergy that ...
Gluten is a hot topic these days, and is hitting the headlines again. Why? At the American College of Allergy, Asthma, and Immunology annual meeting, Dr. David Stukus (a pediatric allergist) set out to clarify frequent myths that he encounters in his practice. So, why is he saying that gluten allergies do not exist?
Gluten is a protein found in foods processed from wheat and related grain products. In celiac sprue (affecting up to 1% of adults), gluten intake leads to damage of the small intestine, impairing its ability to absorb nutrients. I like to imagine that a healthy small intestine is like a shag carpet, and small intestine affected by active celiac sprue is more like a tile floor. Celiac sprue is not a gluten allergy, but rather an autoimmune condition where the gluten is triggering an inflammatory response in the body.
Studies find that ...
Although it’s hard to avoid everything that triggers fall allergies, there are many things that can be done to limit or treat the side effects so everyone can enjoy the season.
What allergies present in the fall?
Dirt-based molds are the main trigger of fall outdoor allergies. Mold is in decaying that plant material in yards and parks, as well as in pumpkin patches, hay and barns. Because we tend to close up our homes as the weather gets worse, inside allergens may get worse. Indoor mold, dust mites and our pets can trigger symptoms.
How do I know I have fall allergies?
Symptoms are the same as you might experience in the spring. Congestion, sneezing, post-nasal drip and itchy, watery eyes are the most common signs of fall allergies.
How can I limit allergens and reduce allergy symptoms?
Food allergies have been on the rise in recent years. Studies suggest that up to 1 in 13 children are affected by a food allergy. Egg and cow’s milk are the most common food allergies for infants and toddlers. Fortunately, most children will lose a milk or egg allergy by the time they enter school. Peanut and tree nut allergies are also becoming more common. Unfortunately, only 10-20% of children will ever outgrow a nut allergy.
Currently there is no cure for food allergies. Instead, doctors rely on an accurate diagnosis, avoiding food triggers, and being prepared in the event of a severe reaction. Making the situation more challenging, nearly half of children with a food allergy may be at risk for a potentially life-threatening reaction called anaphylaxis.
Symptoms of anaphylaxis may include:
- hives or itchy welts
- vomiting or diarrhea
- difficulty breathing (cough, wheeze or shortness of breath)
- dizziness or passing out
During a severe food allergy reaction, epinephrine (“adrenaline”) can be a life-saving medication. Epinephrine is typically injected into a thigh muscle with an “auto-injector” device like EpiPen® or Auvi-Q™. Oral antihistamines like Benadryl, Allegra, or Zyrtec can help with some anaphylaxis symptoms, but are not considered life-saving treatment.
Emergency Epinephrine in Schools
Until recently, only certain students in Washington State could receive a life-saving epinephrine injection while at school. They needed to be diagnosed with a food allergy and already have an epinephrine injector in the health room. However, some students may not have an injector at school, or they have their first serious allergic reaction while at school. In that case, the school could only call 911 and hope they arrived in time to save a life.
In January 2013...
Nasal congestion is an extremely common complaint that brings patients in to see their physician. Often times congestion is temporarily associated with the common cold or infrequent sinus infections. Nasal congestion can in some patients be more of a chronic daily problem that impairs quality of life, sleep, and exercise tolerance. Sometimes congestion is not a daily problem but a frequently recurring problem associated with frequent bouts of sinusitis.
Frequent causes of nasal congestion include:
- Deviated nasal septum sometimes also associated with a crooked nose
- Uncontrolled and undiagnosed allergies
- Recurring sinus infections
- Enlarged structures in the nose called turbinates which can block one’s breathing
There are many treatment options for chronic nasal congestion, both medical and surgical. Evaluating which....
Eosinophilic Gastrointestinal Disorders (“EGIDs”) are a severe form of gastrointestinal inflammation that results from food allergy. Children and adults in the U.S. are increasingly being diagnosed with this condition that unfortunately requires strict elimination diets, and many times, a life-long inability to eat foods that most of us take for granted each day, including dairy, wheat, soy, and eggs.
For children requiring such restrictive diets, pediatric gastroenterologists like me work hard to find adequate alternate sources of nutrition. For my patients with EGIDs, I often prescribe special “elemental formulas” as a treatment to both heal the intestinal inflammation and prevent further harm. These formulas are completely allergen-free while meeting 100% of a child’s nutritional needs.
However, in the state of Washington, most ....