Friday, 22 May 2015 07:00

How Epinephrine Reverses Anaphylaxis

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How Epinephrine Reverses Anaphylaxis Anaphylaxis is an extremely severe allergic reaction, where the immune system releases histamine, basophils, mast cells, and other substances. The excessive reaction of the immune system to an allergen causes tightening of airways and difficulty breathing. Anaphylaxis can be fatal if not properly treated. Once it is clear that a patient is experiencing anaphylaxis, epinephrine is generally administered. People with extreme allergies often carry EpiPens, which facilitate a simple injection of epinephrine. EpiPens often save lives because there is a limited amount of time from the onset of anaphylaxis and death. For those who cannot get to the emergency room fast enough, an EpiPen makes all the difference.

Symptoms and Diagnosis of Anaphylaxis

While difficulty breathing and swallowing, as well as chest tightness are common and recognizable signs of anaphylaxis, there are several other symptoms that can indicate an anaphylactic reaction. These include: cough, diarrhea, anxiety, skin redness, slurred speech, swelling of the face, wheezing, unconsciousness, nausea, vomiting, hives, nasal congestion, and abdominal pain.

Some drugs can cause symptoms that are similar to those experienced during anaphylaxis. These drugs include aspirin, morphine, and x-ray dye. When people suffer anaphylactic-like symptoms in response to these drugs, they are not enduring an immune reaction like that which occurs in response to an allergen.

There are two main features of anaphylaxis: one is respiratory difficulty, which can occur as a result of asthma or laryngeal swelling, and the other is hypotension, which can present as loss of consciousness, collapse, or fainting. Anaphylaxis occurring without hypotension generally indicates the immediate use of epinephrine intramuscularly. However, epinephrine that occurs with hypotension is better treated with intravenously.

Anaphylaxis is usually diagnosed based on observation of clinical features consistent with the symptoms described above. However, there are also two biomarkers that can be tested for in the laboratory: histamine level and tryptase level. However, these tests cannot be performed rapidly and are not always available. Further, tests for histamine and typtase levels are not specific to anaphylaxis, as these levels can rise due to other conditions as well. Thus, it is most often the case that physicians and patients recognize the onset of anaphylaxis without biological tests.

Treating Anaphylaxis: The Power of Epinephrine

Epinephrine, also known as adrenaline, helps reverse anaphylaxis by stimulating different adrenoreceptors. For instance, epinephrine stimulates a adrenoreceptors and thereby increases the resistance of peripheral vasculature. When the resistance of this vasculature increases, blood pressure improves and swelling reduces. When epinephrine stimulates b2 adrenoreceptors, bronchodilation occurs and swelling is further reduced.

Beta blockers reduce the effects of adrenaline and can therefore make anaphylaxis worse. They can also limit the ability of epinephrine to reverse an anaphylactic reaction. Other limitations in the treatment of anaphylaxis unfortunately derive from improper administration of epinephrine. Often epinephrine is not administered fast to enough to have maximal benefit, which can result from lack of availability of epinephrine (often due to never filling a prescription or not physically carrying an EpiPen) or lack of recognition of anaphylactic symptoms. Patients also frequently report being too scared to self-administer epinephrine with an EpiPen.

Knowing when and how to use the EpiPen for safe and precise delivery of epinephrine is critical during an anaphylactic reaction. There has been significant criticism of health care providers’ care of patients who are at risk for anaphylaxis. Of particular concern is that medical professionals tend not to properly train patients on how to use an EpiPen should they need one. Additionally, medical professionals and patients alike tend not to know the details of the dosing of epinephrine, which is also critical to the successful and safe reversal of anaphylaxis. Propoer training in this respect could significantly enhance the proper use of EpiPens, thereby saving more lives.

Though it can be critical to use epinephrine in response to anaphylaxis, doses that are too small or too large can themselves be life threatening. When epinephrine is administered intramuscularly, as it is with EpiPens, the proper dose for adults is 0.3 to 0.5 mL for a 1:1000 solution. Overdose is particularly risky when epinephrine is given intravenously. Those who are most vulnerable to the adverse overdose effects of epinephrine are the elderly and those with cardiovascular disease or hypertension. Nonetheless, the benefits of using epinephrine in the face of anaphylaxis appear to far outweigh the risks of not using it, even at higher risk patients.

Other Considerations

Women suffer anaphylaxis more frequently than do men. People who suffer anaphylaxis from exposure to certain antigens are certainly at risk for future anaphylactic reactions, but the severity of their reactions is not predictive of the severity of future reactions. One reason for this is that the dose of allergen can impact the severity of reaction, and knowing the dose to which one was exposed can be difficult. In the long-term, however, the frequency and severity of anaphylactic episodes has been reported to decrease. Nevertheless, as anaphylaxis is a severe, potentially fatal condition that cannot always be reversed, it is important that patients acquire information on their allergies, understand their risks for developing anaphylaxis, and avoid allergens that could contribute to such a reaction.

Prevalence and Significance of Egg AllergyFor millions of people allergic to eggs, exposure to these agents can lead to severe and dangerous reactions. Children are much more likely than adults to suffer from egg allergies, and eggs are the second most common food that causes allergy in children, behind cow’s milk. In the United States, 1.5-3.2 percent of children are allergic to eggs, many of which are also allergic to milk. About half of those children diagnosed with egg allergy will outgrow the allergy by the age of 17. The American Academy of Allergy, Asthma, and Immunology has reported that of those children who do outgrow their egg allergy, approximately 45% outgrow it by the age of 5. The highest levels of antibodies against egg proteins were observed in these children around the age of 1.

Why do egg allergies occur?

Egg allergies occur when the immune system overreacts to substances contained in the white or the yolk of eggs. More often than not, egg allergies are a result of antibodies in the immune system that react to one of the proteins found in the egg white. These proteins are: ovomucoid, ovalbumin, ovotransferring, and lysosome. Of these proteins, ovomucoid is the one most likely to lead to an allergic reaction. Because egg whites cause the release of histamines, which are part of the immune system, non-allergic reactions can also occur in response to egg white exposure in what is referred to as egg white intolerance. In these cases, the immune reaction usually stays localized in the gastrointestinal tract. However, it can escalate to the point of anaphylaxis so, like egg allergies, must be taken seriously.

The egg yolk can also cause allergic reactions and tends to do so more often in adults than in children. The proteins in the egg yolk that can be problematic are: livetin, apovitillin, and phosvitin. For those who are allergic to a protein in egg whites can usually safely consume egg yolks, and those allergic to a protein in egg yolks can likely eat egg whites without difficulties. People with egg allergies can also usually tolerate egg substitutes.

Egg allergy diagnosis and treatment

Egg allergy diagnosis is usually made with skin prick testing or blood testing. Skin tests allow for the visual observation of inflammation in response to egg exposure, whereas blood tests can reveal the levels of relevant antibodies in the patient’s system in response to the food. There is no cure for egg allergies. Avoiding egg consumption is the most effective way to avoid allergic reactions, but accidental consumption does occur. If patients start feeling symptoms of anaphylaxis, such as a tightening throat, enlarged tongue, or difficulty breathing, epinephrine can be administered to reverse the dangerous reaction. It is therefore important that those with severe allergies to eggs carry an EpiPen.

Preventing egg allergies

Exposing young children to eggs can help protect them against an egg allergy. Specifically, giving infants cooked eggs around 4 to 6 months of age can potentially help safely introduce eggs and the associated proteins to the child’s immune system in a manner that will allow the immune system to subsequently recognize eggs and their proteins as innocuous.

A number of vaccines contain egg products and can cause reactions in those with egg allergies. In severe cases where patients cannot receive vaccines due to the egg products contained, physicians will likely recommend that all family members are vaccinated for the relevant condition to reduce the chances that the patient with suffer as a consequence of their lack of vaccination.

Other issues related to egg allergies

In addition to the dangerous results of egg exposure for those allergic to egg, other aversive reactions can also occur, such as urticaria and eczema, which are skin reactions that include rashes and hives and can itch and cause pain. A runny nose, sneezing, coughing, wheezing, and itchy, watery eyes can also result from egg allergy reactions.

Friday, 17 April 2015 07:00

Testing Your Kids for Allergies

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Testing Your Kids for AllergiesThese days, we hear a lot about kids developing allergies at a higher rate than in previous generations. Often, these allergies are quite serious. A common example is the peanut allergy that can be fatal if it leads to anaphylaxis, and the patient is not treated quickly enough. Given the growing number of allergies and associated anaphylaxis, many parents worry about how they can protect their children from these serious conditions.

When to Test Your Kids

First, it is never too early to test children for allergies. There is no minimum age for which testing is required. However, it is important to understand that allergies will not develop until people have been exposed to the allergens. In other words, children do not become allergic to pollen until they have been around pollen for a few springs. Similarly, they do not become allergic to peanuts until they have ingested peanut products. Testing too early may therefore lead parents to falsely believe that their children are protected from allergies, when they may simply not have had a chance to develop allergies yet. Indeed, many allergies do not present until adulthood, after significant exposure to an allergen has occurred over decades.

Testing your kids for allergies is therefore something you will want to do when true symptoms of allergy occur, even if they have tested negative in the past.

Another possibility to recognize is that “allergy-like” reactions can be indicative of other issues. For instance, rashes can occur for a number of reasons and do not necessarily signal an allergy to a product that was used in the area of the rash. At the same time, intolerance to certain substances can appear allergy-like while not posing the same risks as allergies. Glucose intolerant patients are not allergic to milk. Both food allergies and intolerance result in diarrhea and vomiting, but these symptoms are caused by different factors. Whereas allergies cause these symptoms because of an immune reaction, intolerance causes these symptoms because of deficiencies in enzymes that normally digest or absorb foods. Food allergies will often include key symptoms not conferred by intolerance that can help the child and parent identify the allergy. For example, swelling, hives, or difficulty breathing can occur with allergies but should not occur with intolerance.

How to Test Your Kids

There are a number of ways to test for allergies. Blood tests, skin tests, and diet tests are the most common. Blood tests are very quick, but because they involve a needle, kids often become upset at the prospect of this type of test. Similarly, intradermal skin tests involve injecting allergens into the skin with a needle.

Though in some circumstances, the allergist may determine that the blood test or intradermal skin test is most appropriate, percutaneous skin tests can provide highly accurate results and are less invasive. They are therefore often used for allergy diagnosis.

The percutaneous skin test exposes the top layer of skin to the allergens being tested. This exposure involves a quick scratch or prick that is minimally invasive. To prepare for this type of test, all antihistamines must be stopped a week before the test, so that the immune system goes back to its “natural” state, and its normal reaction to the allergens can be observed in testing. After the skin test is initiated, there is a waiting period of up to about 15 minutes, which gives the immune system time to react. At that point, the doctor can look at the skin and determine whether a reaction has occurred. Often, the doctor will test the reaction to a number of allergens at once, including a control, which is a substance that should cause no reaction in any patient.

Because the skin has been pricked or scratched, it may appear a bit redder or more inflamed than other parts of the body. The control therefore allows the doctor to see what “no reaction” should look like. The doctor can then compare the skin that received the control to the skin that received each allergen to determine which allergens the patient is allergic to, and also, to what extent the patient may be allergic to specific allergens. For instance, pollen may cause skin to become a bit more inflamed than the control, whereas mouse dander may result in highly inflamed skin. In this case, the doctor would know that the patient may be slightly allergic to pollen but that exposure to mice will cause much more severe symptoms for the patient.

Diet allergy tests, often called “elimination diets” test for allergies by individually removing certain foods from the diet and then monitoring allergy symptoms. These tests are often used when food allergies such as allergy to milk, nuts, eggs, wheat, or soy is suspected. If eliminating one of these foods also eliminates symptoms, the doctor may deem your child allergic to that food. However, a limitation of elimination diets is that they can also eliminate symptoms associated with other issues, such as a food intolerance and so may not necessarily pinpoint an allergy. Misdiagnosis of allergies, particularly of food allergies, is also on the rise lately and is of concern because the avoidance of certain food groups is implicated in malnutrition. It is generally agreed that unless there is a significant medical concern associated with ingestion of important food groups, these groups should not be avoided.

Managing Your Kids’ Allergies

If your child tests positive for an allergy, the specific treatment will depend on a number of factors, including the specific allergen, the symptoms associated with the allergy, and how severe the allergy appears to be. Often, allergies can be managed with regular allergy shots or oral medications. If the allergy is serious enough, you and your child may need to learn to use an Epi Pen and to create a plan that enables your child to always have access to one. An Epi Pen is used in the case of anaphylaxis that occurs outside a medical facility. By pushing the Epi Pen into the skin of the patient (often in the thigh), the Epi Pen injects the chemical epinephrine into the blood stream, which constricts blood vessels and opens up the airways in the lungs. By its actions, epinephrine reverses typical symptoms of allergic reactions, including wheezing, low blood pressure, hives, itchy skin, and most importantly, breathing difficulties. Its impact on the latter is a lifesaver in many scenarios.

Friday, 03 April 2015 07:00

Issues in Latex Allergy

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iStock 000036825214 SmallA growing number of latex allergies are being recognized and diagnosed. It is believed that about 3 million people in the United States are allergic to latex. Those allergic to latex react to a milky fluid found in latex that is produced by rubber trees. As with other allergies, the immune system perceives the allergen (i.e. the milky fluid found in latex) as harmful. Many latex allergies are mild and may simply cause some slight irritation to the skin, termed irritant dermatitis. However, the allergy can also be much more serious, leading to hives, asthma, rhino-conjunctivitis, and of particularly concern, anaphylaxis. Because anaphylaxis is potentially fatal, increasing our understanding of latex allergy and how it may lead to this serious condition is important. Further, it is critical that people recognize risk factors for latex allergy so that they can minimize the likelihood of developing this allergy and manage the allergy safely when it does occur.

Risk Factor 1: Exposure to Latex

Like many other allergies, the risk for developing a latex allergy increases with exposure to latex. Between 7 and 10% of workers who where latex gloves regularly become allergic to latex. For instance, one study determined that over 12% of all anesthesiologists suffer from latex allergy, and many studies have reported the relatively high numbers of nurses with latex allergy. Though latex free gloves tend to be more expensive than latex gloves, several hospital programs have been developed to implement latex-free only gloves for use within the hospital. Supporters of these initiatives argue that the liability and spending that is saved by preventing employees from developing bothersome and potentially dangerous allergies is worth the added financial cost. A Japanese analysis, for example, concluded that using latex-free gloves could actually end up saving 3.5 million yen each year.

The FDA, however, says that latex free labels are misleading because there is no test that can accurately and definitively assure that no latex is present in products. However, they also acknowledge that complete elimination of latex is probably not required to prevent allergic reactions to latex. Accordingly, programs that switch to “latex free” gloves have

indeed significantly reduced latex allergies among healthcare workers.

Risk Factor 2: Family History of Allergy

Those with a family history of allergy seem to be more likely to suffer from latex allergies. About 33% of all people who receive positive skin test results for latex allergy do not demonstrate any allergy symptoms. For those who do suffer from allergic symptoms when exposed to latex, using powder free latex gloves can reduce symptoms, particularly if those symptoms are respiratory because reducing powder minimizes the airborne exposure to latex.

Risk Factor 3: Allergy to Fruits and Vegetables

Those allergic to fruits and vegetables may be more prone to latex allergies. Recently, some researchers have begun to focus on the potential cross-reactivity between latex allergies and food allergies. Indeed, a number of people who are allergic to latex turn out to also be allergic to specific foods Some of the most highly implicated foods for those allergic to latex are avocado, potato, and banana. Tomato, chestnut, bell peppers, papaya, and kiwi are also often problematic for those with allergies to latex. Some clinicians use the term “latex-fruit syndrome” because of the relatively high incidence of comorbid allergy to both latex and fruit. The reason this cross-reactivity occurs is that the protein in latex that leads to an allergic reaction is structurally similar to proteins found in many foods, particularly fruits and vegetables.

Other Groups Shown to be Vulnerable to Latex Allergy

The elderly population also appears to be vulnerable to latex allergy, though whether this vulnerability is simply due to an increased likelihood that elderly individuals have been exposed to latex more than younger individuals is not clear. Another group that often suffers from latex allergies is children with spina bifida. Between one quarter and two thirds of children with spina bifida test positive for latex allergy. Many studies conducted in Northern America, Europe, and Asia find about half of those with spina bifida also suffer from latex allergy.

Avoiding Latex

Much of the literature focuses on latex in gloves, which has been shown to significantly impact the healthcare community. However, latex has been identified in a number of products, ranging from balloons to yoga mats to eyelash glue. There have also been reports of vaccines and flu shots causing latex allergy reactions. Though many people misinterpreted these observations as indicating a problem with the medicine that was injected into patients, it is generally agreed that the most likely cause for these reactions is the latex found in syringes. Further support for this notion comes from the fact that the reactions tended to be local, causing irritation in the area of the skin where the injection was made. If, on the other hand, the medicine itself contained latex, a more widespread reaction would be expected with the injection of that medicine into a patient’s circulation.

Restaurants are another place where people report latex allergies. Because workers often wear latex gloves while handling food in restaurants, those who later consume that food can react to the latex that remains on the food. As a result, many restaurants have switched to vinyl gloves, though it has been reported that vinyl suffers its own dangers. In 1999, Rhode Island became the first restaurant to ban the use of latex gloves in restaurants. In the next few years, both Arizona and Oregon followed.

Diagnosis and Treatment of Latex Allergy

Latex allergies can be identified with both serum testing and skin prick testing. The American Latex Allergy Association says that the early symptoms of latex allergy include: hives, welts, a runny nose, swelling, headache, sneezing, itching, watery or reddening eyes, sore throat, chest tightness, wheezing, shortness of breath, or abdominal cramps.

There is not yet a universally adopted highly effective treatment for latex. The best option for preventing latex allergy is currently avoidance. However, other treatments have been shown to be useful in certain cases. For instance, last year, researchers successfully desensitized a nurse to latex using sublingual immunotherapy, which involves placing a small amount of latex under the tongue. This type of therapy works by getting the immune system used to the allergen in small doses so that it no longer reacts to the allergen as if it is a dangerous foreign invader.

Role of Omega-3 Fatty AcidsOmega-3 fatty acids are a specific type of fatty acid that are essential for a number of human functions and that can be found in plants and oils and many of the things we eat. Fatty acids provide us with energy and are essential for a number of human functions.

What are the health benefits of omega-3 fatty acids?

Asthma is the leading cause for death among children, and recent research suggests that susceptibility to asthma can be reduced with methods as simple as changes in diet. Specifically, eating more omega-3 fatty acids may improve resistance to asthma. Several studies now demonstrate that dietary omega-3 fatty acids improve asthma symptoms in children. However, some studies fail to show this beneficial effect of omega-3 fatty acids on children’s health. Genetic factors may underlie the inconsistencies found in studies analyzing the impact of omega-3 fatty acid consumption on asthma. Future research will likely help clarify when and in whom omega-3 fatty acids will improve health outcomes.

Though omega-3 fatty acids are implicated in a number of inflammatory diseases, including asthma and allergy, their benefits appear to extend to other types of diseases as well, including depression, heart disease, Alzheimer’s disease, diabetes, arthritis, gum disease, and hearing loss. These fatty acids are in fact critical for health and have been shown to be particularly important for growth in children. They are important for the development of the brain’s cell membranes and for blood clotting.

Where do we get our omega-3 fatty acids?

The body does not make omega-3 fatty acids, so our need for these fatty acids must be met by ingesting them. They are found in many foods including several oils, green vegetables, and fatty fish. Specifically, kale, spinach, and other salad greens, as well as brussel sprouts and salmon are all known sources for omega-3 fatty acids.

Though we know that these types of foods can provide the benefits associated with omega-3 fatty acids, we do not have good techniques for quantifying these benefits or comparing benefits across food types. However, it does appear clear that ingesting omega-3 fatty acids in food is more beneficial than taking supplements of omega-3 fatty acids. Further, some studies find an associated between the reduction in our intake of fish oil and our increased incidence of asthma and allergy. This finding is perhaps intuitive given the studies that show that children who consume oily fish tend to be less at risk for developing asthma than those who do not consume oily fish.

An important thing to recognize in terms of the benefits of omega-3 fatty acids is that the effects of omega-6 fatty acids can counter them. Unfortunately, omega-6 fatty acids are also abundant in foods we consume, including corn and soybean. Scientists and physicians therefore suggest that it is important to maintain a ratio of omega-3 fatty acids to omega-6 fatty acids that favors more omega-3 fatty acids in your system.

Why and how can omega-3 fatty acids minimize asthma or allergy?

Though many of the diseases that are affected by omega-3 fatty acid consumption are not categorized as inflammatory disease, the benefits imparted by omega-3 fatty acids may occur through the minimization of inflammation. For instance, it appears that for those who consume omega-3 fatty acids and enjoy benefits related to asthma and allergy, omega-3 fatty acids reduce immune responses associated with these disorders. Specifically, by reducing eosinophil activities, omega-3 fatty acids may help maintain lung function and prevent symptoms of asthma and allergy, including coughing, sneezing, and runny noses.

Not only can asthma and allergy be affect by the consumption of omega-3 fatty acids by patients themselves, but consumption by patients’ mothers may also have an influence. A study conducted in 2011 showed that if pregnant women took supplements of omega-3 polyunsaturated fatty acids, their children were less likely to develop asthma or to test positive on the egg skin prick test. However, once asthma or allergy have developed, it may take longer than 9 months of omega-3 fatty acid consumption to experience the health benefits. One study recently showed that 8-12 year olds who consumed omega-3 fatty acids over a 6 month period showed what should immune system changes that should theoretically reduce asthma and allergy symptoms, but they did not actually experience those clinical effects. Researchers therefore suggested that the severity of symptoms may not be reduced unless omega-3 fatty acids are consumed over a long period of time. It is also possible that there is a critical dose of omega-3 fatty acids, under which the clinical benefits are not realized.

Final thoughts

Research suggests that omega-3 fatty acids may help combat natural immune responses that lead to problematic health outcomes, such as asthma and allergy. The specific way omega-3 fatty acids achieve this effect on the immune system is not well understood, and there is a great degree of variability in the effects of omega-3 fatty acids between individuals. It is important to consume adequate amounts of omega-3 fatty acids in your diet to support several bodily functions and so that potential health benefits will be afforded. If you eat a lot of omega-6 fatty acids, it is particularly important to ingest omega-3 fatty acids as well.

Exercise-Induced AnaphylaxisWho experiences exercise-induced anaphylaxis?

In the late 1970s, the first incidence of exercise-induced anaphylaxis was described. The patient had consumed shellfish and had a late onset reaction that was catalyzed by exercise. Since that day, over 1000 more cases of exercise-induced anaphylaxis have been reported. Research on these cases indicates that young adults are more likely than those of other age groups to suffer from exercise-induced anaphylaxis and that females are about twice as likely as males to experience this type of anaphylaxis. The cases also suggest that atopic disorders commonly associated with the immune system, such as asthma, eczema, or rhinitis, are often found in those who suffer from exercise-induced anaphylaxis and that jogging is the most common exercise type to lead to this aversive outcome.

What happens to you during exercise-induced anaphylaxis?

The specific symptoms and sequel of events can differ from patient to patient, but there are often many similarities among exercise-induced anaphylaxis cases. Symptoms usually appear sometime between 5 and 50 minutes into exercise and often involve fatigue, a feeling of warmth throughout the body, and an accelerated heartbeat. Of course, these “symptoms” are often felt during exercise anyway so can easily be mistaken as normal reactions to a workout. Next, a reaction will often appear on the skin with what are known as urticarial lesions. These lesions tend to be raised from the skin, measure about 10-15 mm in diameter, be pink or red in color, and cause the patient to itch. Angiodema, which is swelling much like hives, is also likely to occur at this point, particular on the face, hands, and feet. Finally, widespread symptoms can occur, including gastrointestinal issues like nausea and vomiting, cardiovascular and pulmonary issues that can make it hard to breathe or cause chest pain, and neurological issues, which can lead to loss of consciousness. Even after intervention, when the specific reaction has resolved, headaches can persist for 1-3 days.

What are the risk factors for developing exercise-induced anaphylaxis?

Why exercise-induced anaphylaxis occurs is not precisely known, but there are a number of factors that may contribute. Taking certain medications like aspirin can increase ones chances of exercise-induced anaphylaxis, as can exhaustion, menstruation, infections of the airway, insect bites, and exposure to allergens. Exposure to extreme temperatures has also led to exercise-induced anaphylaxis, particularly cold temperatures. As cold temperatures are also often problematic for those suffering from asthma, it is generally recommended that those at risk for these issues refrain from outdoor winter exercise.

For a subset of those patients who have endured exercise-induced anaphylaxis, the anaphylaxis depends critically on the ingestion of a certain food before exercise. Interestingly, the foods that can lead to this type of anaphylaxis are not necessarily the same foods normally associated with allergy, or for which the patients have an active allergy. Some foods that have led to exercise-induced anaphylaxis are: fruits and vegetables, including peaches, tomatoes, corn, and celery, dairy products, such as milk, eggs, and cheese, alcohol, shellfish, soy, garlic, rice, and wheat.

Another less common variable that has become associated with exercise-induced anaphylaxis is inheritance. Familial exercise-induced anaphylaxis was described when two siblings and their father all suffered these incidents.

Why do seemingly innocuous variables lead to exercise-induced anaphylaxis?

How and why exercise-induced anaphylaxis occurs is not well understood. Exercise is known to have both pro-inflammatory and anti-inflammatory effects, which complicates the picture of how it leads to anaphylaxis, which occurs as an effect of an extreme or excessive inflammatory response. However, certain cells of the immune system, called mast cells, have been implicated in the condition. It has been suggested that the lowered pH that occurs with exercise allows for specific activity among mast cells that can lead to anaphylaxis.

Basophils are another type of immune system cell that may be involved in exercise-induced anaphylaxis. Physical exertion leads to hyperosmolarity in the blood, and it is thought that basophils may be particularly sensitive to this change, which leads to histamine release, an event that can lead to or exacerbate anaphylaxis.

A more complicated immune response involving macrophages and lymphocytes is also possible in exercise-induced anaphylaxis, and one hypothesis has been put forward for how these cells could contribute specifically to food-dependent exercise-induced anaphylaxis. According to this theory, macrophages and lymphocytes of the immune system are sensitive to food allergens and during exercise, are released into systemic circulation. Thus, during exercise, these cells can react with mast cells and basophils and drive anaphylaxis.

Aspirin may lead to exercise-induced anaphylaxis for a variety of reasons. It, along with alcohol, enhances the absorption of allergens from the gastrointestinal tract. However, aspirin also appears to have the capacity to activate mast cells and thus prime immune cells to become more sensitive to allergens and perhaps other stimuli. Studies have shown that giving a subject aspirin will enhance their reaction to skin prick tests. Additionally, some incidents of food-dependent exercise-induced anaphylaxis have also required the ingestion of aspirin for anaphylaxis to occur.

What can you do to avoid exercise-induced anaphylaxis?

Luckily for those who suffer from exercise-induced anaphylaxis, people usually build a tolerance to exercise over time and do not continue to endure the highly stressful experience of anaphylaxis. However, being education about the risks and signs of exercise-induced anaphylaxis can help prevent such an incident, as can avoiding foods and other factors that could act as triggers for you.

Why Its Important to Know the Difference

Allergy Symptoms vs Cold SymptomsColds and allergies have a number of overlapping symptoms, including runny nose, congestion, and cough. Given that these symptoms can indicate different issues that require different interventions, confusing one condition for another can prolong symptoms and reduce quality of life for an extended period of time. Understanding the different etiologies and other distinguishing features of colds and allergies can help increase the likelihood that the symptoms are accurately assessed and that optimal steps are taken to rid the patient of those symptoms.

The Cause of Colds Versus Allergies

Viruses cause colds. Once viruses invade the body, the immune system recognizes and attacks them. The process of immune response causes the symptoms that are associated with a cold. Like colds, allergy symptoms arise because of actions of the immune system. However, unlike with colds, the immune system’s role in allergies represents over-activity of the immune system. Specifically, the immune system mistakes an innocuous foreign substance as a harmful invader. In response, the immune system causes the body to release certain chemicals that it would also release upon an infection with a cold. For instance, histamine is released in both allergies and colds, which causes swelling in the nose, as well as coughing, and sneezing.

Because allergies represent the nature of one’s immune system, rather than the nature of what is coming into the body, allergies are not contagious. On the other hand, colds are easily transmitted from one person to another when a person with a cold transfers infected material – through things like a sneeze, cough, or handshake. Though this does not happen with allergies, having family members with allergies can increase one’s likelihood of developing them.

Distinguishing Between A Cold and An Allergy

Several overlapping symptoms of colds and allergies can make them difficult to distinguish. For example, a runny or stuffy nose is often associated with both colds and allergies, and each condition can lead to fatigue. Though fever is rare in both conditions, it does sometimes occur with colds but should never occur with allergies. A cough or a sore throat is more likely an indicator of a cold, though each can also occur with allergies. Better distinguishing characteristics are aches, which do not occur with allergies but can occur with a cold, and itchy, watery eyes, which often occur in allergies and rarely occur in colds.

In addition to the symptoms themselves, some other features of colds and allergies can be used to determine from which ailment one is suffering. The onset of symptoms can occur immediately in allergies once one is exposed to an allergen, whereas colds normally take a few days to occur after infection occurs. However, knowing when one was introduced to a virus can be difficult, so this difference in symptom onset is not always useful for identifying the cause of one’s symptoms. The time of year can provide a clue as to whether one is experiencing a cold or allergies, as colds are most frequent in the winter. Allergies can occur any time of year, but they are often specific to the time of year when specific allergens are in season.

One of the best indicators that one is suffering from allergies rather than a cold has to do with the duration of symptoms. Whereas cold symptoms last from a few days up to bout 2 weeks, allergies can last months and will likely persist as long as one is exposed to allergens. Thus, if symptoms exceed about 2 weeks, it is likely that those symptoms are associated with allergies rather than a cold. It is often at this point that patients realize that what they thought was a cold is actually a different type of immune reaction.

Preventing and Treating Colds and Allergies

Prevention in both colds and allergies involves avoiding the agent that causes the illness. For a cold, this means staying away from infected people and keeping your hands clean. Allergies are harder to avoid if one does not know what causes their allergies, but some allergens are common and cause more allergies in our population than others. For instance, pollen, dust mites, mold, animal dander, and cockroaches are among the substances most frequently associated with allergies.

Unfortunately, there is no cure for either colds or allergies, but there are specific medications that can help manage the symptoms. For colds, rest and consuming fluids can improve symptoms and help the body recover from the invading virus, whereas such healthy practices do not help one recover from allergies as long as allergens are present. Colds can also be treated with non-steroidal anti-inflammatories, which help reduce the most common symptoms of colds. Pain relievers can also be used to reduce aches that may be experienced during a cold.

Allergies are often treated with antihistamines, which prevent the histamine that the body releases in response to allergens from causing congestion. Decongestants help minimize swelling in the nasal passage, which can also be accomplished with nasal steroids. A doctor may decide to employ immunotherapy, which often involves allergy shots, to reduce one’s allergies over time. By injecting small amounts of the allergen, the body can get desensitized over time so that the immune system no longer overreacts to the presence of that allergen, and the symptoms of allergies are avoided.

By focusing on the specific experience one has during the presence of symptoms that resemble both colds and allergies, one may be able to determine which illness is occurring. Quicker recognition of the illness allows for better management of the underlying symptoms and quicker overall recovery from those symptoms.

Friday, 06 February 2015 08:00

Stanford Launches Center for Allergy Research

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Donation Facilitates Important Allergy Research

Food Allergy ResearchAlmost 40% of the global population currently suffers from allergies, and the percentage is expected to increase to 50% soon. There is no cure for allergies that is currently approved by the FDA. Stanford University School of Medicine is launching a new research center aimed at developing innovative solutions for allergies. The center received a $24 million donation, which is among the largest private gifts ever dedicated to allergy research in the United States. Of the $24 million $4 million will go toward a matching program for new gifts to the center.

The gift comes from from Sean Parker, a Silicon Valley entrepreneur who suffers from severe allergies to a number of foods. Parker was the co-founder of Napster and has also served as president of Facebook. He was prompted by Facebook COO Sheryl Sandberg to make this specific donation. Sean has landed in the emergency room over a dozen times due to accidental ingestion of allergens, which include avocados, shellfish, and nuts. Because allergies can be genetically passed on to children, Parker worries for the safety of his two children and wants to help in the global challenge to prevent, or at least safely control, allergic reactions. Reported allergic reactions to food allergens double each decade. It is estimated that about 1 in 4 people suffering from food allergies will have a potentially fatal anaphylactic reaction at some point in their lives.

Parker considers his gift more of a form of venture capital funding than a traditional endowment, as the investment is much like that of an investment in a startup. Specifically, Parker views the center as an opportunity to assemble an idea team to conduct important research and develop effective clinical applications.

The Allergy Center Will Be Innovative and Multidisciplinary

The new center for allergies will be inter-disciplinary, combining research initiatives with programs that ensure that care is compassionate and comprehensive. The center will also initiate clinical trials and organize community outreach. Several fields within Stanford’s medical school will also contribute to the center, including not only immunology, but also otolaryngology, pulmonology, pathology, genetics, gastroenterology, chemistry, and bioengineering.

Led by Kari Nadeau, MD, PhD, the center’s research will focus on both therapeutic interventions, as well as the uncovering of mechanisms by which allergies develop and the relevant causes for alterations within the immune system. Nadeau’s immunological research focusing on allergies – and in particular, the activity of regulatory T cells - is internationally recognized. She points to the need for a better understanding of how allergies emerge and evolve for the development of long-term therapies. Nadeau herself suffers from life-threatening allergies, which has inspired aspects of her career.

Nadeau developed the first combination therapy that involved multiple food allergies, demonstrating that it is safe to desensitize patients to multiple allergens at the same time. Using immunotherapy, Nadeau exposes patients to small doses of the substances to which they are allergic to help accustom their immune systems to these substances. Over time, as higher doses of these substances are introduced, the danger of natural exposure to these substances decreases, as the body no longer perceives these substances as harmful or dangerous. Nadeau has conducted these studies on how to build tolerance against multiple food allergies at once at Stanford’s Lucile Packard Children’s Hospital and Stanford Health Care. She was able to cure 680 of the 700 patients using methods from these clinical trials.

The experience of an eighth grade boy from Los Altos, CA in one of Nadeau’s clinical trial demonstrates the results of these studies. This youth had a severe peanut allergy and entered the study, hoping to become desensitized to peanuts. During a trial of oral immunotherapy, where he at small peanut doses, he became more able to tolerate nuts. He can now eat moderate doses of peanuts with no allergy symptoms. Future research should help determine if continued exposure is necessary for maintaining tolerance to allergens. For now, this patient eats about 8 peanuts a day, which helps ensure that he remains immune to peanuts. In the trial in which he was a part, Nadeau showed that this type of exposure to allergens could be particularly effective when used in combination with allergy an allergy drug, Xolair.

Specific Goals for the Center

The hope for the future is that better therapies will be developed. The combination therapies that Nadeau has shown can be effective can take a long time to become effective and can be both dangerous and scary for both patients and their loved ones. For some patients, the exposure to small amounts of an allergen can cause reactions without enabling the patient to build a tolerance against the allergen. Understanding the pathology associated with allergies could lead to cures that become active more quickly, are safer, and are more feasible as long-term solutions for allergies. Nadeau has said that the goal of the new Center for Allergy Research is to find a cure for allergies within 10 years.

Thursday, 27 November 2014 00:00

What Does It Mean To Be Allergic To Gluten?

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What Does It Mean To Be Allergic To Gluten? Premier Allergy

These days, we're hearing a lot about the benefits of a gluten-free diet. Gluten is a protein that makes dough elastic, and it's found in many of the staple food items we consume every day. While many people without sensitivity to the substance are opting for these diets, those with gluten allergies have a more urgent reason to cut this substance out of their daily routines.
Gluten sensitivity differs from many food allergies, as it can have chronic, malignant effects on the intestines, muscles, and joints. Over 250 symptoms have been observed in patients with an observed sensitivity. Patients most commonly complain of bloating, abdominal pain, constipation, and diarrhea. This condition has a genetic origin: there are several types of sensitivity, each traceable to the body's failure to handle these specific proteins properly.

It's important to distinguish gluten allergies from other similar conditions, such as celiac disease and wheat allergies. Celiac disease is, in fact, a specific kind of gluten sensitivity that is treated by cutting the protein from a patient's diet. However, the disease poses a host of risks to the immune system that an allergic condition does not. Wheat allergy is often confused with gluten intolerance, but it involves a reaction to a totally different set of substances.

How is gluten intolerance diagnosed? Well, the jury's still out on this. At present, researchers have not found any surefire biomarkers to indicate the disorder. Physicians will often ask patients to undergo a "gluten challenge," during which they are required to either regularly eat or cut out the substance for a specified time period. A diagnosis can then be made based on any symptoms patients experience. Those who seem prone to intolerance are advised to cut this protein from their diet, which means excluding foods that contain wheat, barley, rye, and cross-contaminated oats.

If you're experiencing some of the symptoms listed above, you should consider asking your doctor about getting tested for gluten allergies. The sooner you know, the sooner you'll be able to modify your habits for a healthier, happier lifestyle.

Thanksgiving is the time of year when cooks prepare magnificent feasts. Special dishes are often served that you just don't get the rest of the year. These yummy recipes are great, but you need to be careful if you have food allergies. The best way to enjoy a holiday meal is to identify allergies, make food substitutions, and communicate your needs to the cook.

How to Avoid Food Allergies in Your Thanksgiving Meal Premier Allergy

Identify Foods
Make a list of foods that you cannot eat. This will refresh your memory, and you can give the list to the cook if you will be sharing a meal at a friend or relative's home.

Side Dishes
When you are doing the cooking, you can create side dishes that do not contain the ingredients that you can't eat. That is one of the simplest solutions, or you can make ingredient substitutions and still enjoy a nice meal.
Most people with food allergies can eat fresh slices of vegetables like carrots, celery, or cucumbers. If you are allergic to milk products, however, you need to check the ingredients in the homemade dips that often accompany these veggies or avoid them all together.

The Main Course
The best turkeys are those that are tender and juicy. However, if you have an allergy to wheat, you need to be careful when choosing the turkey. Turkeys that are exceptionally juicy are often injected with wheat that many people cannot tolerate. Check the label on the packaging to determine if it contains wheat. Another alternative is to buy gluten-free birds. Also keep in mind that gravy purchased from the store contains wheat. Making your own gravy is safer and probably tastier.

Just Ask
Many different cooks often prepare Holiday meals, so it may be hard to convey what you cannot eat ahead of time. If some dishes look questionable, just politely ask what the ingredients are. The cooks will certainly rather answer a few questions that have you suffer through an allergy attack.

Individuals with food allergies must take great care to be selective about what they eat during the holidays. Just because you have to be careful doesn't mean you can't have any fun. As long as you make sure to check the ingredients of each dish you try, you're sure to be able to taste your way through the season!


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