Dr. Summit Shah

Dr. Summit Shah

Friday, 25 August 2017 15:22

New Data on Penicillin Allergies

Though penicillin allergy is the most commonly diagnosed drug allergy, there has been mounting evidence in recent years that many people who believe they are allergic to penicillin are in fact not allergic to it. True penicillin allergy is actually quite rare.

A study that was just published in the journal Pediatrics investigated a potential penicillin allergy in 100 children between the ages of 4 and 18. The parents of all 100 children reported that their child had a penicillin allergy, but each child was deemed “low-risk” because the symptoms that led to a diagnosis were common symptoms seen in children, such as a rash.  The researchers tested all 100 children for a penicillin allergy, and all 100 children tested negative.

Why are so many children who are not allergic to penicillin diagnosed as such? The answer is that penicillin allergies are often diagnosed based on clinical symptoms rather than through allergy tests. In other words, physicians will often stop a course of penicillin if a rash, itching, or vomiting occurs because these symptoms could indicate an allergy.

Because subsequent exposures to penicillin in the case of allergy can be more dangerous, the physicians will often then avoid using these antibiotics. The children (and their parents) therefore continue assuming they have a penicillin allergy without being tested.  

The biggest problem with thinking that you’re allergic to penicillin when you’re not is that you will not be given penicillin or other widely used antibiotics like amoxicillin. If you get sick with an infection that would normally be treated with these antibiotics, you will instead be given something that is more likely to have adverse side effects and is also more likely to be much more expensive.

As it becomes clearer that penicillin allergy has been over-diagnosed, some physicians and researchers are recommending that penicillin allergy tests be conducted to confirm a penicillin allergy. Confirmation may be especially important in the low-risk cases, where the clinical symptoms that led to diagnosis are relatively harmless symptoms that are likely to arise from common viruses.

A study, recently published in European Respiratory Journal, investigated the potential link between pregnant women’s consumption of certain types of sugars and the development of allergy and asthma in their children.  Specifically, the scientists were interested in “free sugars,” which do not include sugars found in whole fruits and vegetables.

The researchers evaluated families with children born in 1991 and 1992 and did not find any correlation between sugar intake and eczema or hay fever. They also failed to find a significant relationship between sugar consumption and asthma generally.

The researchers did, however, find that higher sugar consumption was significantly associated with allergy and the allergic form of asthma. Specifically, the 20% of mothers who ate the most sugar during pregnancy were 38% more likely to have children who developed allergies or allergic asthma than the 20% of mothers who ate the least sugar. The highest sugar intake was 82-345 grams per day, which is equivalent to 16-69 teaspoons per day. In contrast, the lowest sugar intake was less than 34 grams (or 7 teaspoons) per day.

The identified correlation between sugar intake and allergy and allergic asthma does not mean that eating more sugar during pregnancy causes allergies or allergic asthma in children. Further research needs to be conducted to determine if these findings can be replicated.

If the findings appear robust, the next step will be to determine whether sugar can actually increase the risk for allergic conditions, or if some other factor may impact both sugar intake and allergy development. Interestingly, sugar intake in children has not been shown to impact the chance of developing allergies or allergic asthma.

Researchers hypothesizing any mechanisms that could explain a causal link have pointed to lung development and suggested that high levels of fructose could cause inflammation in the developing lungs. However, this idea has not yet been tested so there are no data to confirm or deny this concept.

Doctors and scientists have long suspected a connection between asthma and diabetes, as it has appeared that people with one of these conditions tend to be at higher risk for the other. What researchers have not been clear on is the strength of the relationship and whether asthma makes it more likely to develop diabetes or vice versa.

Scientists at the National Institute for Health and Welfare in Finland have now helped to clarify the relationship between type-1 diabetes and asthma. Rather than a simple link where the presence of one condition increases the likelihood of the other, the link between diabetes and asthma is apparently more complicated. Whereas having asthma increased the risk for type-1 diabetes by about 41% in the subjects studied, having type-1 diabetes actually decreased the risk of developing asthma. The magnitude of the reduced risk for asthma was about 18%.

The researchers investigated health records from 171,138 children who were born between 1981 and 2008. From this sample, which represented 10% of the Finnish population born in that time frame, the researchers identified 80,871 children who were diagnosed with asthma and 8,939 with type-1diabetes by the age of 16. Both conditions were present in 602 of these children.

The purchase of insulin and anti-asthmatic drugs helped researchers determine children’s diagnoses. To perform their analysis, the researchers divided children into groups based on their birth years and looked at 4 age groups: 0-3, 4-7 8-11, and 12-16. The relationships between diabetes and asthma were revealed in all age groups.

While the study provided novel insights into the link between diabetes and asthma, it also contained some limitations. For one, not all the diagnoses were confirmed. Second, there was limited information on any other conditions that the patients may have had. Similarly, the researchers did not have information on when the patients developed their conditions.

The lead author of the study, Dr. Johanna Metsala, recently presented these findings at the European Academy of Allergy and Clinical Immunology Congress. The discussion at the meeting provided more insights into how scientists can further clarify the link between diabetes and asthma in the future. Researchers are particularly interested in determining whether food allergies may also be linked to diabetes.

 

When most people think of food allergies, they think of things like nuts, eggs, or shellfish. However, red meat has been causing more allergic reactions in recent years, and the culprit is a sugar molecule found in red meat called galactose-alpha-1,3-galactose, or alpha-gal. The picture is complicated by the fact that people do not tend to be naturally allergic to the sugar molecule found in red meat but instead become allergic to it after experiencing a tick bite.

The tick that leads to the red meat allergy has been linked to the lone star tick, which has a white spot in the shape of Texas on its back and is generally found in the southeastern United States. Dr. Thomas Platts-Mills, a lead allergy research from the University of Virginia helped to identify this critical link after he himself developed the meat allergy.

When Platts-Mills heard that an effective cancer drug, called cetuximab, was causing allergy-like side effects in 10x more people living in the southeastern United States than those living elsewhere, he decided to partner with Bristol-Myers Squibb, the drug’s distributor, to conduct blood tests. He found that all the cancer patients experiencing this reaction had pre-existing antibodies to the alpha-gal sugar. The sugar was indeed found in abundance in cetuximab.

What was causing people living in the southeastern United States to develop this sensitivity to alpha-gal sugar? The area where these cancer patients lived mapped on to the same geographical area where Rocky Mountain spotted fever, a disease carried by the lone star tick, occurs. With this clue, Platts-Mils screened more patients with meat allergies, and his studies revealed that 80% of these patients had reported tick bites. The tick bites resulted in 20x more antibodies to the alpha-gal sugar.

While Platts-Mills’ work helped to reveal the role of tick bites in red meat allergies and the allergic reaction to cetuximab, the mechanism by which the bite confers this sensitivity to the alpha-gal sugar is not yet understood. Some researchers have suggested that a virus or bacteria carried in the tick’s saliva may cause the change in the immune system of those who have been bitten.

A former member of Platts-Mills’ team at the University of Virginia is now conducted research on mice at the University of North Carolina to improve our understanding of how ticks cause these allergies. Now that more red meat allergies are being reported outside the southeastern United States – namely in Duluth, Minnesota, the eastern tip of Long Island, and Hanover, New Hampshire, one important question researchers are interested in is whether the lone star tick has traveled to new parts of the country, or if instead ticks of other species now cause the red meat allergies. Research that improves our understanding of how exactly ticks enable these allergies will hopefully enable us to develop effective interventions to reduce the suffering that accompanies these allergies.

Wednesday, 19 December 2012 00:00

‘Tis the Season For Allergy Testing

asthma-inhaler-300x199Runny noses and sniffles aren’t exactly rare this time of year; colds and the flu run rampant among adults and children alike. After the twentieth sneeze or so, chances are you’ll pop a sinus pill, load up on Kleenex, and plop yourself in front of the fire to watch another holiday-themed movie. Sometimes this works, but sometimes there’s something a bit more complicated going on that might require allergy testing. Ohio has an allergen-friendly climate, and often people go years without realizing they have seasonal allergies. If a cold and sinus medication hasn’t been doing the trick, and symptoms seem to drag on for days or weeks, you may be suffering from allergies.  

Cabot Rea: If you have allergies, the worst season could be on our doorstep.

Colleen Marshall: Central Ohio is a hotspot for seasonal allergies. In For Your Health tonight, Ellie Merritt is going to tell us what to expect. Ellie, I hear it’s going to be a bad one.

Ellie: Yes, allergy season comes on fast and furious and while it is chilly outside today, doctors are expecting seasonal allergies to be earlier this year. And you’re right, Colleen, much more intense. Blame the weather. Get ready for the sneezing.

Friday, 16 November 2012 00:00

Winter Allergies

Just because the seasons change, that doesn’t mean your symptoms will.

Most of us enjoy summer’s perks; it’s the season of long nights, bikinis, and pints of beer on the patio. But summer is also the season of pollen, and for the unlucky among us that means sneezing, runny noses, and dry, itchy eyes. If that sounds like you, you might happily trade warm weather and sunshine for early evenings and chill winds, if it comes with the promise of symptom relief.

If you’re an allergy sufferer you might eagerly anticipate the transition between summer and fall. So when temperatures drop to the low thirties and your nose is still as red as Rudolph’s, you probably feel a bit cheated. Isn’t summer supposed to be allergy season? Shouldn’t it all be over when the ground turns white?

Wednesday, 20 March 2013 00:00

Spring Allergies

spring-allergies-ohio-300x200The urge to spend time outdoors is never greater than in the early days of spring. The days start to get longer, the snow melts away, the sun comes out and gardens bloom. But when some of us pull off our winter boots and stop to smell the roses, we’re hit with the reality of our spring: runny noses, sneezing, coughing, and itchy, watery eyes.  

columbus-allergies-300x199A link between eating, exercising and a severe allergic reaction?

Dr. Shah seems to have found just that throughout his observations and findings that he presented at the World Allergy Conference. Throughout studies of exercising without eating beforehand and eating without exercise – Dr. Shah found that patients seem to have no unique allergic reaction. Yet when patients combine eating a particular food or meal, then partaking in some form of exercise right after, an anaphylactic or severe reaction of some sort has taken place. Sparking a clue into the reason behind this happening could be the increase in blood flow and absorption in the stomach while exercising, thus bringing to life an allergic reaction.

Dr. Shah presented his findings on Food Allergies and Exercise at the recent XXII World Allergy Congress, where he spoke on the importance of waiting 60 minutes after eating before exercise.  

Columbus, OH (PRWEB) June 26, 2012  

In December, Dr. Summit Shah, allergist at Nationwide Children’s Hospital, was asked to present his findings on food allergies and Exercise at the XXII World Allergy Congress. In his presentation, the Ohio allergist cautioned individuals to be mindful of reactions with food allergies and exercise.

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